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Risk factors related to lifetime suicide attempts in acutely admitted bipolar disorder inpatients

Authors

  • Per I Finseth,

    1. Department of Neuroscience, Faculty of Medicine, Trondheim Norwegian University of Science and Technology (NTNU)
    2. Østmarka Psychiatric Department, St. Olavs Hospital, Trondheim University Hospital, Trondheim
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  • Gunnar Morken,

    1. Department of Neuroscience, Faculty of Medicine, Trondheim Norwegian University of Science and Technology (NTNU)
    2. Østmarka Psychiatric Department, St. Olavs Hospital, Trondheim University Hospital, Trondheim
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  • Ole A Andreassen,

    1. Institute of Clinical Medicine, University of Oslo
    2. Division of Mental Health and Addiction, Department of Psychosis Research, Oslo University Hospital–Ullevål
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  • Ulrik F Malt,

    1. Institute of Clinical Medicine, University of Oslo
    2. Department of Neuropsychiatry and Psychosomatic Medicine, Division of Surgery and Neuroscience, Oslo University Hospital–Rikshospitalet, Oslo, Norway
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  • Arne E Vaaler

    1. Department of Neuroscience, Faculty of Medicine, Trondheim Norwegian University of Science and Technology (NTNU)
    2. Østmarka Psychiatric Department, St. Olavs Hospital, Trondheim University Hospital, Trondheim
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Corresponding author:
Per Ivar Finseth, M.D.
Østmarka Psychiatric Department
St. Olavs Hospital
Pb 3008 Lade
7441 Trondheim
Norway
Fax: +47 72822813
E-mail: per.i.finseth@ntnu.no

Abstract

Finseth PI, Morken G, Andreassen OA, Malt UF, Vaaler AE. Risk factors related to lifetime suicide attempts in acutely admitted bipolar disorder inpatients.
Bipolar Disord 2012: 14: 727–734. © 2012 The Authors.
Journal compilation © 2012 John Wiley & Sons A/S.

Objective:  The main aim of this study was to assess possible clinical characteristics of acutely admitted bipolar I disorder (BD-I) and bipolar II disorder (BD-II) inpatients at high risk of suicide by comparing patients who had made one or several serious suicide attempts with patients who had not.

Methods:  A total of 206 consecutive patients (mean age 42 ± 15 years; 54.9% women) with DSM–IV diagnosed BD-I (n = 140) and BD-II (n = 66) acutely admitted to a single psychiatric hospital department from November 2002 through June 2009 were included. Using a detailed retrospective questionnaire, patients with a history of a serious suicide attempt were compared to those with no history of a suicide attempt.

Results:  Ninety-three patients (45.1%) had a history of one or more serious suicide attempts. These constituted 60 (42.9%) of the BD-I patients and 33 (50%) of the BD-II patients (no significant difference). Lifetime suicide attempt was associated with a higher number of hospitalizations due to depression (p < 0.0001), antidepressant (AD)-induced hypomania/mania (p = 0.033), AD- and/or alcohol-induced affective episodes (p = 0.009), alcohol and/or substance use (p = 0.002), and a family history of alcohol abuse and/or affective disorder (p = 0.01). Suicide attempt was negatively associated with a higher Positive and Negative Syndrome Scale for Schizophrenia (PANSS) Positive Subscale score (p = 0.022) and more hospitalizations due to mania (p = 0.006).

Conclusions:  The lifetime suicide attempt rate in BD inpatients is high. Risk factors of suicide attempts were: (i) a predominant depressive course of illness, (ii) comorbid alcohol and substance use disorders, and (iii) a history of AD- and/or alcohol-induced affective episodes. Risk-reducing factors were a preponderant manic or psychotic course of the illness. These risk factors may be signs of a clinical subgroup at risk of suicidal behaviour, and seem to be important for suicide risk assessment in acutely admitted BD patients.

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