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Suicidal behavior in bipolar mood disorder: clinical characteristics of attempters and nonattempters.

Abstract

OBJECTIVE

Bipolar Disorder is associated with a higher frequency of attempted suicide than most other psychiatric disorders. The reasons are unknown. This study compared bipolar subjects with a history of a suicide attempt to those without such a history, assessing suicidal behavior qualitatively and quantitatively, and examining possible demographic, psychopathologic and familial risk factors.

METHODS

Patients (ages 18 to 75) with a DSM III-R Bipolar Disorder (n = 44) diagnosis determined by a structured interview for Axis I disorders were enrolled. Acute psychopathology, hopelessness, protective factors, and traits of aggression and impulsivity were measured. The number, method and degree of medical damage was assessed for suicide attempts, life-time.

RESULTS

Bipolar suicide attempters had more life-time episodes of major depression, and twice as many were in a current depressive or mixed episode, compared to bipolar nonattempters. Attempters reported more suicidal ideation immediately prior to admission, and fewer reasons for living even when the most recent suicide attempt preceded the index hospitalization by more than six months. Attempters had more lifetime aggression and were more likely to be male. However, attempters did not differ from nonattempters on lifetime impulsivity.

LIMITATIONS

The generalizability of the results is limited because this is a study of inpatients with a history of suicide attempts. Patients with Bipolar I and NOS Disorders were pooled and a larger sample is needed to look at differences. We could not assess psychopathology immediately prior to the suicide attempt because, only half of the suicide attempters had made attempts in the six months prior to admission. Patients with current comorbid substance abuse were excluded. No suicide completers were studied.

CONCLUSIONS

Bipolar subjects with a history of suicide attempt experience more episodes of depression, and react to them by having severe suicidal ideation. Their diathesis for acting on feelings of anger or suicidal ideation is suggested by a higher level of lifetime aggression and a pattern of repeated suicide attempts.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    MHCRC for the Study of Suicidal Behavior and the Stanley Foundation Center for Applied Neuroscience of Bipolar Disorders, Department of Neuroscience, New York State Psychiatric Institute, Columbia University, NY 10032, USA.

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    Source

    Journal of affective disorders 59:2 2000 Aug pg 107-17

    MeSH

    Adult
    Aged
    Aggression
    Bipolar Disorder
    Depressive Disorder
    Female
    Genetic Predisposition to Disease
    Humans
    Impulsive Behavior
    Inpatients
    Male
    Middle Aged
    Models, Psychological
    New York City
    Recurrence
    Risk Factors
    Suicide, Attempted

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    10837879