Suicide attempts common in bipolar disorder inpatients

Results from a Norwegian study show that the prevalence of attempted suicide is high among inpatients with bipolar disorder (BD), with nearly half of patients having attempted to take their own lives at least once.

In a study of 206 BD patients (54% women), aged a mean of 42 years, who were admitted to hospital with mania, a mixed episode, or depression between 2002 and 2009, the team found that 45.1% had a lifetime history of suicide attempts.

The findings, published in Bipolar Disorders, provide further data on the prevalence of suicide attempts among acutely hospitalized BD patients and identify factors that may be useful for risk stratification among this severely ill patient group.

Of the 93 patients who had attempted suicide, 54 (58.1%) had made one attempt, 17 (18.3%) had made two, 12 (12.9%) had made three, and 10 (10.8%) had made four or more attempts. The mean age at first suicide attempt was 33 years.

There was no significant difference between BD I (n=140) and BD II (n=66) patients in the proportion of those who had attempted suicide, at 42.9% and 50.0%, respectively.

Patients who had attempted suicide had a higher median number of hospitalizations due to depression than those who had not, at 1 versus 2. They were also more likely to have antidepressant-induced hypomania/mania (15.6 vs 6.3%), antidepressant- and/or alcohol-induced affective episodes (31.2 vs 15.9%), alcohol and/or substance use disorder (37.6 vs 18.6%), and a family history of alcohol abuse and/or affective disorder (62.4 vs 44.2%).

Factors associated with reduced risk for suicide attempts among the patients included a higher positive symptom subscale score on the Positive and Negative Syndrome Scale for Schizophrenia, and more hospitalizations due to mania.

Per Finseth (Trondheim Norwegian University of Science and Technology) and team summarize: "In bipolar I disorder and bipolar II disorder inpatients suicide attempts are associated with patients with a predominant depressive course of illness, comorbid alcohol and substance use disorders, and a history of antidepressant- and/or alcohol-induced affective episodes."

They add: "These factors may be signs of a clinical subgroup at risk of suicidal behaviour, and seem to be important for suicide risk assessment in BD patients admitted to acute psychiatric departments."

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