Suicidal behavior during different phases of bipolar disorder

Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland.
Journal of Affective Disorders (Impact Factor: 3.38). 02/2007; 97(1-3):101-7. DOI: 10.1016/j.jad.2006.05.033
Source: PubMed


There are no previous studies comparing the prevalence and risk factors for suicidal behaviour during different phases of bipolar disorder.
In the Jorvi Bipolar Study (JoBS), 1630 psychiatric in- and outpatients were screened for bipolar disorders with the Mood Disorder Questionnaire. Using SCID I and II interviews, 191 patients were diagnosed with bipolar disorders (90 bipolar I, 101 bipolar II). Suicidal ideation was measured using the Scale for Suicidal Ideation (SSI). Prevalence and risk factors for ideation and attempts during different phases (depressive, mixed, depressive mixed and hypomanic/manic phases) were investigated.
There were marked differences between phases regarding suicide attempts and level of suicidal ideation. Hopelessness predicted suicidal behaviour during the depressive phase, whereas a subjective rating of severity of depression and younger age predicted suicide attempts during mixed phases.
The relatively small sample size in some phases.
Suicidal behaviour varied markedly between different phases of BD. Suicide attempts and suicidal ideation were related to phases which are associated with depressive aspects of the illness. Hopelessness and severity of depression were key indicators of risk in all phases.

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    • "Th e combination of these factors seems to lead to adverse behavior such as impulsive, aggressive, and hyperactive behavior and anxiety (Simon et al. 2007), panic attacks (Kilbane et al. 2009), further mood disorders, insomnia, and rapid cycling. Moreover, Beghi et al. (2013) summarized that the following factors do further confer to adverse suicidal behavior: A history of physical and sexual childhood abuse (Abreu et al. 2009), occurrence of psychiatric disorders in family members, and psychosocial and psychological issues (negative life events, lack of social skills, and loss of job or job constraints), a general decrease in quality of life (see also Abreu et al. 2009), and hopelessness (Valtonen et al. 2007). In this regard, two recent publications make important contributions to the literature, showing that people attempting to commit suicide repeatedly (i.e., multiple suicide attempters) are characterized by young age, not being married, reporting more severe and multiple psychiatric disorders, lower psychological and social resources (Choi et al. 2013), and a history of previous SAs (Rudd et al. 2013). "
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    ABSTRACT: Objectives: To assess the relationship between lifetime suicide attempts (SAs), serum lipid values, and metabolic syndrome (MetS) in patients with bipolar disorders (BPD). Methods: Eighty patients with BPD took part in the study (M = 40.60 years). After psychiatric diagnosis, demographic data, SAs, and serum lipids were measured and MetS was calculated. Results: 70% reported at least one suicide attempt. 52.5% suffered from MetS. Suicide attempters had higher cholesterol values. SAs were associated with a family history of suicide, current mood state, and lower educational level. SAs were unrelated to MetS. Conclusions: In patients with BPD, against expectations, the occurrence of SAs was associated with higher cholesterol values. Serum lipid values are not suitable as a biological trait marker to predict SAs.
    Full-text · Article · Nov 2014 · International Journal of Psychiatry in Clinical Practice
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    • "Moreover, we identified two additional major residual symptoms: guilt/low selfesteem and physical pain. Suicidal ideation was not reported as a residual symptom, confirming that suicidal behavior occurs almost exclusively in the context of severe major depressive or mixed affective episodes and very rarely during euthymia (Valtonen et al., 2007). Of the persistent treatment-related symptoms, some were ascribed to the molecular bases of the treatments themselves (sedation, slowing, weight gain, decreased libido, etc.), whereas others were subjective symptoms (affective anesthesia), and yet others were felt to reduce the quality of life (compliance constraints). "
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    ABSTRACT: Euthymic bipolar patients are often impacted by residual symptoms (RSs) that increase the risk of relapse or low functioning. We aimed to identify the perceptions of RSs, barriers to management, and service needs in euthymic bipolar patients. A qualitative methodology (focus group) was used. The interviews were investigated using a semistructured guide, tape-recorded, transcribed verbatim, and analyzed thematically. Twenty-three bipolar patients expressed concern about several RSs, such as emotional dysregulation, circadian rhythm disruption, cognitive impairment, low self-esteem, and physical symptoms. They reported concern about the impact of RSs on their functioning and about the need for more systematic assessment of RSs during interepisode visits. Selection bias may have occurred because the recruitment was limited to France and there may be cultural differences in the perceptions of RSs. Bipolar patients experienced bipolar disorder as a chronic disorder because they frequently continued to suffer from RSs associated with a functional impact.
    Full-text · Article · Jun 2014 · The Journal of nervous and mental disease
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    • "Suicidal behavior varied markedly between different phases of bipolar disorder and it is predominantly associated with depressive and mixed phases of the illness, rarely with pure manic phase. (Goldberg et al., 1999; Oquendo et al., 2000 ; Valtonen et al., 2007). "
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    ABSTRACT: Patient with mental illnesses such as schizophrenia and bipolar disorder have an increased prevalence of metabolic syndrome (MetS) and its components compared to general population. Among psychiatric disorders, bipolar disorder ranks highest in suicidality with a relative risk ratio of completed suicide of about 25 compared to the general population. Regarding the biological hypotheses of suicidality, low blood cholesterol level has been extensively explored, although results are still conflicting. The aim of this study was to investigate whether there were differences in the serum cholesterol levels in hospitalized bipolar disorder men patients with history of suicide attempts (N=20) and without suicide attempts (N=20). Additionally, we investigated if there were differences in the prevalence of MetS according to NCEP ATP-III criteria in these two groups of patients. Results of the study indicated significantly lower serum cholesterol levels (p=0.013) and triglyceride levels (p=0.047), in the bipolar disorder men with suicide attempts in comparison to bipolar disorder men without suicide attempts. The overall prevalence of MetS was 11/40 (27.5%). On this particular sample it was higher in the non-attempters 8/20 (40.0%) than in attempters 3/20 (15.0%) bipolar men group, but without statistical significance. Lower concentrations of serum cholesterol might be useful biological markers of suicidality in men with bipolar disorder.
    Full-text · Article · Dec 2008 · Progress in Neuro-Psychopharmacology and Biological Psychiatry
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