The authors of this paper do not have any commercial associations that might pose a conflict of interest in connection with this manuscript.
Clinical predictors of suicidal acts after major depression in bipolar disorder: a prospective study
Article first published online: 17 OCT 2006
Volume 8, Issue 5p2, pages 586–595, October 2006
How to Cite
Galfalvy, H., Oquendo, M. A., Carballo, J. J., Sher, L., Grunebaum, M. F., Burke, A. and John Mann, J. (2006), Clinical predictors of suicidal acts after major depression in bipolar disorder: a prospective study. Bipolar Disorders, 8: 586–595. doi: 10.1111/j.1399-5618.2006.00340.x
- Issue published online: 17 OCT 2006
- Article first published online: 17 OCT 2006
- Received 8 April 2005, revised and accepted for publication 17 February 2006
- bipolar disorder;
- suicide attempt
Objective: This study determined the clinical predictors of suicidal behavior during a 2-year follow-up of patients with bipolar disorder presenting with a major depressive episode (MDE).
Method: Sixty four patients with DSM-III-R bipolar disorder were assessed at presentation for treatment of an MDE. Correlates of past suicidal behavior were determined by comparing patients with and without a history of suicide attempts using a t-test, Wilcoxon test or chi-squared test of independence on individual explanatory variables. Putative predictors of attempts during the follow-up period were tested separately using Cox proportional hazards regression analysis.
Results: Twelve of 64 patients had at least one suicide attempt in the follow-up period, five of them attempted in the first 2 months and seven around or shortly after the 1-year follow-up visit. All attempters had a history of past suicide attempts. Most predictors of future suicidal behavior were correlates of past suicidal behavior. Family history of suicide acts and comorbid borderline personality disorder predicted early attempts, while younger age, high hostility scores, number of past attempts, subjective pessimism as reflected in depression and suicidal ideation, and few reported reasons for living predicted suicidal acts during the whole period.
Conclusion: In this data set of bipolar patients we noted an intriguing picture of two clusters of suicide attempts. Hostility was the strongest risk factor. These findings may have implications in both the identification of at-risk patients and the timing of clinical interventions including aggressive pharmacotherapeutic prophylaxis to prevent relapse or recurrence of depressive symptomatology.