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Incidence and Predictors of Suicide Attempts in Bipolar I and II Disorders: A Five-year Follow-up

Published online by Cambridge University Press:  23 March 2020

S. Pallaskorpi ,
K. Suominen ,
M. Ketokivi ,
H. Valtonen ,
P. Arvilommi ,
O. Mantere ,
S. Leppämäki  and
E. Isometsä
S. Pallaskorpi
Affiliation:
Finnish National Institute for Health and Welfare - THL, Psychiatric and Substance Abuse Services, Helsinki, Finland
K. Suominen
Affiliation:
Helsinki City Department of Social Services and Healthcare, Psychiatric and Substance Abuse Services, Helsinki, Finland
M. Ketokivi
Affiliation:
IE Business School, Operations and Technology Department, Madrid, Spain
H. Valtonen
Affiliation:
Helsinki City Department of Social Services and Healthcare, Psychiatric and Substance Abuse Services, Helsinki, Finland
P. Arvilommi
Affiliation:
Helsinki City Department of Social Services and Healthcare, Psychiatric and Substance Abuse Services, Helsinki, Finland
O. Mantere
Affiliation:
McGill University, Department of Psychiatry, Montreal, Canada
S. Leppämäki
Affiliation:
Helsinki University Central Hospital, Department of Psychiatry, Helsinki, Finland
E. Isometsä
Affiliation:
University of Helsinki, Department of Psychiatry, Helsinki, Finland

Abstract

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Introduction

Although suicidal behavior is very common in bipolar disorder (BD), few long-term studies have investigated incidence and risk factors of suicide attempts (SAs) specifically related to illness phases of BD.

Objectives

We examined incidence of SAs during different phases of BD in a long-term prospective cohort of bipolar I (BD-I) and II (BD-II) patients and risk factors specifically for SAs during major depressive episodes (MDEs).

Methods

In the Jorvi bipolar study (JoBS), 191 BD-I and BD-II patients were followed using life-chart methodology. Prospective information on SAs of 177 patients (92.7%) during different illness phases was available up to five years. Incidence of SAs and their predictors were investigated using logistic and Poisson regression models. Analyses of risk factors for SAs occurring during MDEs were conducted using two-level random-intercept logistic regression models.

Results

During the five-year follow-up, 90 SAs per 718 patient-years occurred. Compared with euthymia the incidence was highest, over 120-fold, during mixed states (765/1000 person-years [95% confidence interval (CI) 461–1269]) and also very high in MDEs, almost 60-fold (354/1000 [95%CI 277–451]). For risk of SAs during MDEs, the duration of MDEs, severity of depression and cluster C personality disorders were significant predictors.

Conclusions

In this long-term study, the highest incidences of SAs occurred in mixed phases and MDEs. The variations in incidence rates between euthymia and illness phases were remarkably large, suggesting that the question “when” rather than “who” may be more relevant for suicide risk in BD. However, risk during MDEs is likely also influenced by personality factors.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Type
Oral communications: E-mental health; bipolar disorders; child and adolescent psychiatry; eating disorders; intellectual disability and women, gender and mental health
Information
European Psychiatry , Volume 41 , Issue S1: Abstract of the 25th European Congress of Psychiatry , April 2017 , pp. S87
Copyright
Copyright © European Psychiatric Association 2017
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