Depression severity marks suicide risk in bipolar patients

By Eleanor McDermid, Senior medwireNews Reporter

The likelihood for suicide ideation among patients with bipolar depression increases with the severity of the episode, shows a study in Indian patients.

In particular, hopelessness, assessed on the Beck Hopelessness Scale, was a strong independent predictor for suicide ideation among the 130 patients in the study.

This is in line with previous findings, say researchers Sandeep Grover (Postgraduate Institute of Medical Education and Research, Chandigarh, India) and co-workers, and shows that “the presence of hopelessness in patients with bipolar depression should be taken seriously.”

In addition, total score on the Buss–Durke Hostile Inventory and irritability directed inwards on the Irritability Depression Anxiety Scale were significantly associated with the likelihood for suicidality on multivariate analysis.

Depression was more severe in patients with suicide ideation by almost all other measures than in those without suicidality, and the current episode was longer, at 3.76 versus 2.22 months. Although these factors did not retain significance in the multivariate analysis, together they show that “every effort needs to be made to reduce the severity and chronicity of the depressive episodes to prevent suicidal behaviour in patients with bipolar disorder,” the team writes in Bipolar Disorders.

The study involved 65 patients with bipolar depression without suicide ideation who were matched for age, gender, socioeconomic status, and duration of illness to 65 patients with suicide ideation (≥1 on the suicide ideation item of the Beck Depression Inventory).

Several other factors suggesting generally more severe illness were significantly more common in patients with suicide ideation. These included a family history of bipolar disorder, at 44.6% versus 24.6% in those without suicide ideation; a family history of suicide, at 21.5% versus 1.5%; a past suicide attempt, at 36.9% versus 7.7%; past hospitalization, at 40.0% versus 20.0%; and a shorter average interval between mood episodes, at 11.8 versus 15.9 years.

“The findings of the present study do suggest that it is not only the severity of depression, but other illness-related factors (present during the current episode and during the longitudinal course of the illness) that influence the presence of suicidal ideations in patients with bipolar depression,” conclude the researchers.

They add that patients with these risk factors “should be monitored closely to prevent suicide attempts and completed suicide.”

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