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Suicidal attempts in bipolar disorder: results from an observational study (EMBLEM)


  • The EMBLEM Study is supported by Eli Lilly & Co. FB has received honoraria or research or educational conference grants in the past two years from Bristol-Myers Squibb, Otsuka, Eli Lilly & Co., Servier, Sanofi-aventis, Lundbeck, AstraZeneca; and has received peer-review research funding from the French Ministry of Research, Assistance Publique–Hôpitaux de Paris, the National Institute for Research (INSERM), and NARSAD. LY has received honoraria or educational conference grants in the past two years from Bristol-Myers Squibb and Sanofi-aventis. AL and ML were Eli Lilly & Co. employees when the manuscript was drafted. J-MA has accepted reimbursement for advice or participation in industry-supported symposia from pharmaceutical companies with an interest in bipolar disorder in the last three years; and holds grants from Eli Lilly & Co. and Sanofi-aventis. SG and CR are Eli Lilly & Co. employees. JB has no conflicts of interest to report.

Corresponding author:
Frank Bellivier, M.D., Ph.D.
Pôle de Psychiatrie
INSERM Unité 955, EQ 15
Hôpital Henri Mondor
94010 Créteil, France
Fax: +33 1 49 81 43 10


Bellivier F, Yon L, Luquiens A, Azorin J-M, Bertsch J, Gerard S, Reed C, Lukasiewicz M. Suicidal attempts in bipolar disorder: results from an observational study (EMBLEM).
Bipolar Disord 2011: 13: 377–386. © 2011 The Authors.
Journal compilation © 2011 John Wiley & Sons A/S.

Objectives:  To compare patients with and without a history of suicidal attempts in a large cohort of patients with bipolar disorder and to identify variables that are associated with suicidal behavior.

Methods:  European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) is a two-year, prospective, observational study that enrolled 3,684 adult patients with bipolar disorder and initiated or changed oral treatment for an acute manic/mixed episode. Of those, 2,416 patients were eligible for the two-year follow-up. Only baseline characteristics were studied in the present study, included sociodemographic data, psychiatric history and comorbidities, history of suicide attempts, history of substance use problems, compliance with treatment, inpatient admissions, and functional status. Symptom severity was assessed using the Clinical Global Impression–Bipolar Disorder (CGI-BP) scale, the Young Mania Rating Scale (YMRS), and the 5-item Hamilton Depression Rating Scale (HAMD-5). A logistic regression model identified baseline variables independently associated with a history of suicidal behavior.

Results:  Of the 2,219 patients who provided data on their lifetime history of suicide attempts, 663 (29.9%) had a history of suicidal behavior (at least one attempt). Baseline factors associated with a history of suicidal behavior included female gender, a history of alcohol abuse, a history of substance abuse, young age at first treatment for a mood episode, longer disease duration, greater depressive symptom severity (HAMD-5 total score), current benzodiazepine use, higher overall symptom severity (CGI-BP: mania and overall score), and poor compliance.

Conclusions:  These factors may be considered as potential characteristics to identify subjects at risk for suicidal behavior throughout the course of bipolar disorder.