Risk Factors for Completed Suicide in Bipolar Disorder

Department of Psychiatry, School of Medicine, Taipei Medical University, Taiwan.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 07/2002; 63(6):469-76. DOI: 10.4088/JCP.v63n0602
Source: PubMed


Because Chinese bipolar patients in Taiwan, unlike Western patients, exhibit low comorbidity of substance abuse disorders, this retrospective and controlled study of completed suicide in bipolar patients explored the risk period and other risk factors for such an outcome.
All acute inpatients with bipolar I disorder (DSM-IV) were followed from date of admission after January 1, 1985, until December 31, 1996, in regard to their death. The patients were followed by record linkage to the Death Certification System in Taiwan, which was issued throughout 1996. Nineteen female and 24 male patients died as a result of suicide within this period. Forty-one of 43 of the total number of patients were matched with 1 living bipolar individual (as a control subject) for age, sex, and date of admission. Demographic data, family history, and clinical characteristics were collected from the patients' medical records and were formally confirmed at every admission.
The lifetime prevalence of alcohol/drug use disorders was 14.6% in suicide completers. Thirty suicide completers (69.8%) revealed duration of illness of at least 7 years at the time of death. The latency period from the presumed time of onset to completing suicide averaged 12.2 years. The mean age at the first suicide attempt was 31.1 years among 43 completers and 10 living controls who had ever attempted suicide. Conditional logistic regression revealed a strong association of suicide (p < .001) with the following factors: onset with mood-congruent psychotic feature (adjusted odds ratio [OR] = 0.18, 95% confidence interval [CI] = 0.04 to 0.74), positive first-degree family history of completed suicide (adjusted OR = 15.08, 95% CI = 1.39 to 163.50), and making a suicide attempt at least once in 7 years of illness (adjusted OR = 4.96, 95% CI = 1.03 to 23.83). There appeared to be no significant difference in fasting levels of serum cholesterol or blood sugar between the suicide completers and the living controls.
The first 7 to 12 years subsequent to onset of affective illness and age less than 35 years may be the high-risk periods for suicide in bipolar disorder. Those bipolar disorder patients who have a first-degree family history of suicide and who have more suicide attempts (at least once in 7 years of illness) are likely to commit suicide. Symptomatology (e.g., mood congruence of psychotic features) at the time of presumed disease onset may potentially differentiate subgroups of bipolar patients with various levels of suicide risk.

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    • "It has been hypothesized that low peripheral and central cholesterol levels may reduce lipid viscosity of neuronal cell membranes lowering the availability of pre-synaptic serotonin transporters and post-synaptic serotonin receptors (Wallner and Machatschke, 2009; Lee and Kim, 2011). However, it should also be noted that some studies have failed to prove an association between lipid profile and suicidality in patients with schizophrenia (Steinert et al., 1999; Huang and Wu, 2000; Kuo et al., 2005; Park et al., 2013), major depressive disorder (Almeida- Montes et al., 2000; Deisenhammer et al., 2004; Roy and Roy, 2006; Pompili et al., 2010a; Persons et al., 2012; Park et al., 2013), bipolar disorder (Tsai et al., 2002; Pompili et al., 2010a; D'Ambrosio et al., 2012; Persons et al., 2012; Park et al., 2013), borderline personality disorder (Marcinko et al., 2011) and psychiatric inpatients (Fritze et al., 1992; Steinert et al., 1999). "
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    ABSTRACT: There are inconsistent reports showing that the relationship between total cholesterol (TC) level and suicidality might be gender-specific. We compared 30 first-episode schizophrenia (FES) patients reporting suicidal ideation based on the Operational Criteria for Psychotic Illness (OPCRIT) checklist with 70 FES patients, who have never experienced suicidal ideation. After controlling for potential confounders, higher TC was associated with suicidal ideation only in FES females. Future studies should disentangle biological underpinnings of this gender-specific association.
    Psychiatry Research 12/2014; 226(1). DOI:10.1016/j.psychres.2014.12.030 · 2.47 Impact Factor
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    • "All consecutive patients who were admitted to the TCPC were enrolled as the TCPC cohort. A series of long-term mortality studies of the TCPC cohort with different diagnoses, including methamphetamine dependence (Kuo et al., 2012b, 2011), schizophrenia (Kuo et al., 2005), and bipolar disorder (Tsai et al., 2002) were conducted. There were 24,386 patients admitted to the TCPC from January 1, 1990 to December 31, 2010 (Fig. 1). "
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    ABSTRACT: The mortality risk is high among individuals dependent on heroin, and suicide is a severe consequence of long-term heroin use. We estimated the incidence of suicide mortality and its risk factors in a large Asian cohort with heroin dependence. A consecutive series of 2750 inpatients dependent on heroin admitted to a psychiatric center in northern Taiwan between 1990 and 2010 were retrospectively enrolled as the study cohort. These patients were linked to the Taiwan National Mortality Database to obtain each mortality event. We determined the Standardized Mortality Ratio (SMR) for each cause of death. Among the deceased, 69 deaths were due to suicide (cases); 138 controls were randomly selected using risk-set density sampling based on a nested case-control design. We collected clinical information from subjects' medical records. Multivariate conditional logistic regression was employed to explore the correlates of suicide mortality. The findings showed a 7.9-fold SMR for all-cause mortality among heroin users compared to the general population while the SMR for suicide mortality was 16.2. Multivariate analysis showed that suicide attempt as the reason for the index admission (adjusted risk ratio [RR]=4.29, p=0.035) and depressive syndrome anytime during life (adjusted RR=2.61, p=0.019) were associated with the risk of suicide mortality. Individuals dependent on heroin are more likely to die of suicide compared to the general population. We recommend that clinical psychiatric staff carefully gather information related to the identified risk factors to prevent suicide among heroin users. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Drug and Alcohol Dependence 12/2014; 145:224-30. DOI:10.1016/j.drugalcdep.2014.10.021 · 3.42 Impact Factor
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    • "Alcohol addicts were associated with diagnoses of several types of personality disorder and bipolar disorder and presented a greater suicide risk than the subgroup of other SUDs. Tsai et al. (2002) "
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    ABSTRACT: Background Bipolar disorder confers the highest risk of suicide among major psychological disorders. The risk factors associated with bipolar disorder and suicide exist and are relevant to clinicians and researchers. Objective The aim of the present study was to conduct a systematic review of articles regarding the suicide risk factors in bipolar disorder. Methods A systematic review of articles on suicide risk factors in bipolar disorder, published from January 1, 2010 to April 05, 2014, on SCOPUS and PUBMED databases was carried out. Search terms were "Suicide" (medical subject headings [MeSH]), "Risk factors" (MeSH), and "Bipolar" (keyword). Of the 220 retrieved studies, 42 met the eligibility criteria. Results Bipolar disorder is associated with an increased rate death by suicide which contributes to overall mortality rates. Studies covered a wide range of aspects regarding suicide risk factors in bipolar disorder, such as risk factors associated to Sociodemographic conditions, Biological characteristics, Drugs Relationships, Psychological Factors, Genetic Compound, Religious and Spirituals conditions. Recent scientific literature regarding the suicide risk factors in bipolar disorder converge to, directly or indirectly, highlight the negative impacts of risk factors to the affected population quality of life. Conclusion This review demonstrated that Bipolar disorders commonly leads to other psychiatric disorders and co-morbidities involving risk of suicide. Thus the risk factors are relevant to have a better diagnosis and prognosis of BD cases involving risk of suicide.
    Journal of Affective Disorders 09/2014; 170C:237-254. DOI:10.1016/j.jad.2014.09.003 · 3.38 Impact Factor
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