A comparison of the medical lethality of suicide attempts in bipolar and major depressive disorder

Department of Psychiatry, Columbia University, New York, New York, United States
Bipolar Disorders (Impact Factor: 4.97). 11/2006; 8(5 Pt 2):558-65. DOI: 10.1111/j.1399-5618.2006.00381.x
Source: PubMed


Among mood disorders, bipolar disorder (BPD) is often noted to involve the highest rates of suicide attempts and possibly of completion. This study sought to determine whether suicide attempters with BPD exhibit suicide attempts with higher lethality than attempters with major depressive disorder (MDD) and to explore differences in clinical features associated with suicidal acts.
Mood disordered suicide attempters were interviewed about Axis I and II diagnoses, lifetime history of suicide attempts, suicidal intent, suicidal ideation, the medical lethality of their most severe suicide attempt, severity of depression, hopelessness, lifetime aggression, and impulsivity.
The maximum lethality of suicidal acts tended to be higher among BPD attempters compared with those with MDD. However, there were no differences in the number of suicide attempts, intent to die or suicidal ideation. Suicide attempters with BPD reported higher levels of aggression and impulsivity but less hopelessness compared with MDD attempters. These differences could not be explained by Cluster B personality disorder comorbidity. Of note, within the BPD group, but not the MDD group, males reported suicidal acts with higher lethality. Multivariate analyses suggested that risk for more lethal suicide attempts is associated with BPD and male sex and that bipolar males appear to be especially vulnerable to these behaviors.
Males with BPD make more lethal suicide attempts than females with BPD, an effect not observed among the MDD sample. Our findings suggest that higher rates of suicidal behavior in BPD may be due to a specific effect of BPD on males, leading to more dangerous suicidal behaviors. This effect, together with the larger proportion of males in the BPD group compared with the MDD group may lead to higher rates of reported attempted and completed suicide.

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    • "Lethality ratings were assigned by trained interviewers based on a thorough medical chart review and examination of participants' condition at the time of hospital admission. In accordance with the available literature (Beck et al., 1975; Oquendo et al., 2003; Zalsman et al., 2006), LS scores in the present study were used to categorize suicide attempts as low-lethality attempts (LS score G4) or high-lethality attempts (LS score Q4). An LS score of 4 or greater is indicative of physical injury requiring immediate medical treatment and, as a result, represents the threshold at which medical hospitalization is necessary (Beck et al., 1975). "
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    ABSTRACT: African-American women are at high risk for suicide ideation and suicide attempts and use emergency psychiatric services at disproportionately high rates relative to men and other ethnic groups. However, suicide death rates are low for this population. Cultural variables in the African-American community may promote resilience and prevent fatal suicidal behavior among African-American women. The present study evaluated self-reported reasons for living as a protective factor against suicidal intent and suicide attempt lethality in a sample of African-American female suicide attempters (n = 150). Regression analyses revealed that reasons for living were negatively associated with suicidal intent, even after controlling for spiritual well-being and symptoms of depression. These results indicate that the ability to generate and contemplate reasons for valuing life may serve as a protective characteristic against life-threatening suicidal behavior among African-American women. Implications for research and clinical practice are further discussed.
    Full-text · Article · Jul 2014 · Journal of Nervous & Mental Disease
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    • "This shows that, in general, bipolar disorders carry the highest risk for suicide, but bipolar II patients have an even higher risk than bipolar I (Akiskal, 2007; Tondo et al., 2003, 2007). Bipolar patients also use more violent and lethal suicidal methods than unipolars (Rihmer, 2007; Vieta et al., 1997; Zalsman et al., 2006). Cyclothymia and cyclothymic temperament, which can be considered an attenuated form of bipolar disorder (Rihmer, 2009), has been shown to predispose to suicidal behaviour and is associated with lifetime and current suicidality (Akiskal et al., 2003). "
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    ABSTRACT: Suicide is a complex and challenging human phenomenon, and, although knowledge is expanding concerning its risk factors, its background is still not fully understood. There is currently an increasing interest in genetic factors associated with suicide, since these may lead to the emergence of personality traits and temperaments that may be long-term predictors of suicidal behaviour. One of the most likely genetic candidates in the background of suicide is the 5-HTTLPR polymorphism of the serotonin transporter gene. This review focused on papers published on the association of the 5-HTTLPR polymorphism of the serotonin transporter gene and suicidal behaviour as well as research on possible endophenotypes related to suicide. Although there are contradictory results, several studies and meta-analyses support the idea that the S allele plays a role in the background of violent suicide. However, in order to be able to delineate the genetic background of suicide, different types of suicidal behaviour should be distinguished, since studies indicate that these may have different genetic factors. Also, personality traits and temperaments should be identified that may play a modulating role between genetic factors and suicidal behaviour. So far, neuroticism, affective temperaments, and impulsive aggression have been found to be associated with both the S allele and suicidal behaviour. This study aimed to integrate findings concerning possible endophenotypes modulating between genetic factors and manifested suicidal behaviour.
    Full-text · Article · Jul 2011 · Journal of Psychopharmacology
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    • "threshold for hospitalization for treatment of the medical consequences is considered to be 4. As suggested in the literature, suicide attempts scored 4 and higher were considered to be high lethality attempts and those with scores between 0 and 3 were considered low lethality attempts (Beck et al., 1975; Zalsman et al., 2006). d A score of 0–2 indicates little risk, of 3–4 to follow the patient closely, of 5–6 to strongly consider hospitalization, and of 7–10 very high risk of suicide indicating hospitalization. "
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    ABSTRACT: Prior studies on the association between sleep disturbances and suicidal behavior did not explore whether or not short sleep is a marker of suicide intent, lethality or risk. Design: Cross-sectional. Participants: Suicide attempters (SAs) (n=434). Controls included 83 psychiatric inpatients who have never been SAs, and 509 healthy controls. Measurements: Short sleep was defined by self-assessment as ≤ 5 h per day. The MINI and the DSM-IV version of the International Personality Disorder Examination Screening Questionnaire were used to diagnose Axis I and Axis II diagnoses, respectively. Suicide intent and lethality were evaluated through the Beck's Suicidal Intent Scale (SIS) and the Risk-Rescue Rating Scale (RRRS), respectively. Beck's Medical Lethality Scale (BMLS) was administered to assess the degree of medical injury, and the SAD PERSONS mnemonic scale was used to evaluate suicide risk. Statistical analyses: Chi-square tests and logistic regression analyses explored frequencies of short sleep in 3 samples. Chi-square tests explored whether or not suicide intent, lethality and risk were greater in SAs with short-sleep versus those without short-sleep. Short sleep was more prevalent in SAs than in psychiatric controls only in males. In female SAs, short sleep was significantly associated with several SIS items and high scores in the SAD PERSONS. Sleep duration was assessed only by self-report. The association between short sleep and suicidal behavior may be partly explained by confounders. Short sleep may be a marker of severity of suicidal behavior among female SAs.
    Full-text · Article · May 2011 · Journal of Affective Disorders
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