Depressive Behaviors Linked To Suicide Risk in Bipolar Disorder Patients

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The results of a large Swedish study suggest that previous suicide attempts, recent affective episodes, and recent psychiatric inpatient care are the best indicators that a patient with bipolar disorder may attempt suicide.

This could potentially improve opportunities for intervention before suicide attempts occur, and implies that clinicians should “pay attention to the risk of suicidal behaviour in bipolar patients with depressive features and more severe or unstable forms of the disorder,” in the words of Dag Tidemalm, author of the study and researcher at the Karolinska Institutet, Stockholm.

The study, published in PLOS ONE, examined 18 risk factors believed to be associated with attempted suicide in 6,086 patients (60% women) registered in the Swedish National Quality Register for Bipolar Disorder between 2004 and 2011. The participants were assessed annually from 2005 to 2012, with a median follow up period of 2.4 years.

During the follow-up period, the researchers documented 13 fatal and 338 nonfatal suicide attempts, and noted the rate of attempted suicide was much significantly higher in women than men.

The researchers observed that having a previous suicide attempt at the time of baseline assessment was the strongest predictor of attempted suicide during the follow-up period. Among men, affective episodes in the year before baseline were also associated with a 3.63-fold increased risk of suicide attempt during the follow-up, compared to a 2.81-fold increase in women.

Another strong risk factor was having at least four depressive episodes prior to baseline, which doubled the chance of suicide attempts in both genders, while multiple mixed episodes were only associated with suicide attempts in women.

“These results point to the fundamental importance of observing signs of depressive symptomatology and supplying adequate treatment, in the follow-up of bipolar patients”, Tidemalm et al remark.

The researchers call the results a “novel finding”, but they could potentially improve intervention and prevention opportunities for those with bipolar disorder in the future.

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