Suicidal behavior in the context of disrupted rhythmicity in bipolar disorder—Data from an association study of suicide attempts with clock genes

OBJECTIVE: The objective of this study was to test the hypothesis that the polarity of the first mood episode may be a marker for suicidal behavior, particularly the violent subtype. METHOD: One hundred and sixty-eight patients diagnosed with bipolar disorder (DSM-IV) were grouped according to type of first episode: depression or manic/hypomanic. Groups were compared for demographic and clinical variables. We performed logistic regression in order to test the association between first episode polarity and suicidal behavior. RESULTS: We found that depressed patients have a lifetime history of more suicide attempts. However, univariate analysis of number of suicide attempts showed that the best model fits the bipolar II subtype (mean square = 15.022; p = 0.010) and lifetime history of psychotic episodes (mean square = 17.359; p = 0.021). Subgrouping the suicide attempts by subtype (violent or non-violent) revealed that manic/hypomanic patients had a greater tendency toward attempting violent suicide (21.2 vs. 14.7%, X² = 7.028, p = 0.03). Multiple logistic regression analysis confirmed this result. CONCLUSION: Depressed patients had more suicide attempts over time, which could be explained by the higher prevalence of bipolar II subtype in this group, whereas manic/hypomanic patients had a lifelong history of more frequent violent suicide attempts, not explained by any of the variables studied. Our results support the evidence that non-violent suicide attempters and violent suicide attempters tend to belong to different phenotypic groups.

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Individual level prediction of emerging suicide events in the pharmacologic treatment of bipolar disorder

10.1101/2021.01.13.20246603 ◽

2021 ◽

Author(s):

Sean X. Luo ◽

Adam Ciarleglio ◽

Hanga Galfalvy ◽

Michael Grunebaum ◽

Leo Sher ◽

...

Keyword(s):

Bipolar Disorder ◽

Variable Selection ◽

Suicidal Behavior ◽

Predictive Models ◽

Suicide Attempts ◽

Bipolar Depression ◽

Depression Scale ◽

Hamilton Depression Scale ◽

Pharmacologic Treatment ◽

Survival Trees

AbstractBackgroundPatients with bipolar disorder have a high lifetime risk of suicide. Predicting, preventing and managing suicidal behavior are major goals in clinical practice. Changes in suicidal thoughts and behavior are common in the course of treatment of bipolar disorder.MethodsUsing a dataset from a randomized clinical trial of bipolar disorder treatment (N=98), we tested predictors of future suicidal behavior identified through a review of literature and applied marginal variable selection and machine learning methods. The performance of the models was assessed using the optimism-adjusted C statistic.ResultsNumber of prior hospitalizations, number of prior suicide attempts, current employment status and Hamilton Depression Scale were identified as predictors and a simple logistic regression model was constructed. This model was compared with a model incorporating interactions with treatment group assignment, and more complex variable selection methods (LASSO and Survival Trees). The best performing models had average optimism-adjusted C-statistics of 0.67 (main effects only) and 0.69 (Survival Trees). Incorporating medication group did not improve prediction performance of the models.ConclusionsThese results suggest that models with a few predictors may yield a clinically meaningful way to stratify risk of emerging suicide events in patients who are undergoing pharmacologic treatment for bipolar disorder.Significance StatementThis study aims to find out whether suicide events that occur during the pharmacological treatment of bipolar disorder, a severe psychiatric disorder that is highly associated with suicide behavior, can be predicted. Using existing methods, we developed and compared several predictive models. We showed that these models performed similarly to predictive models of other outcomes, such as treatment efficacy, in unipolar and bipolar depression. This suggests that suicide events during bipolar disorder may be a feasible target for individualized interventions in the future.

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Suicidal ideation and suicide attempts in bipolar disorder type I: an update for the clinician

Brazilian Journal of Psychiatry ◽

10.1590/s1516-44462009005000003 ◽

2009 ◽

Vol 31 (3) ◽

pp. 271-280 ◽

Cited By ~ 54

Author(s):

Lena Nabuco de Abreu ◽

Beny Lafer ◽

Enrique Baca-Garcia ◽

Maria A. Oquendo

Keyword(s):

Risk Factors ◽

Bipolar Disorder ◽

Suicidal Ideation ◽

Suicidal Behavior ◽

Suicide Ideation ◽

Suicide Attempts ◽

Clinical Samples ◽

Type I ◽

History Of ◽

Axis I

OBJECTIVE: This article reviews the evidence for the major risk factors associated with suicidal behavior in bipolar disorder. METHOD: Review of the literature studies on bipolar disorder, suicidal behavior and suicidal ideation. RESULTS: Bipolar disorder is strongly associated with suicide ideation and suicide attempts. In clinical samples between 14-59% of the patients have suicide ideation and 25-56% present at least one suicide attempt during lifetime. Approximately 15% to 19% of patients with bipolar disorder die from suicide. The causes of suicidal behavior are multiple and complex. Some strong predictors of suicidal behavior have emerged in the literature such as current mood state, severity of depression, anxiety, aggressiveness, hostility, hopelessness, comorbidity with others Axis I and Axis II disorders, lifetime history of mixed states, and history of physical or sexual abuse. CONCLUSION: Bipolar disorder is the psychiatric condition associated with highest lifetime risk for suicide attempts and suicide completion. Thus it is important to clinicians to understand the major risk factors for suicidal behavior in order to choose better strategies to deal with this complex behavior.

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Variations in seasonal solar insolation are associated with a history of suicide attempts in bipolar I disorder

International Journal of Bipolar Disorders ◽

10.1186/s40345-021-00231-7 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Michael Bauer ◽

Tasha Glenn ◽

Eric D. Achtyes ◽

Martin Alda ◽

Esen Agaoglu ◽

...

Keyword(s):

Bipolar Disorder ◽

Suicidal Behavior ◽

Exploratory Study ◽

Suicide Attempts ◽

Solar Insolation ◽

Bipolar I Disorder ◽

Summer Insolation ◽

History Of ◽

Winter Insolation ◽

Collection Sites

Abstract Background Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries. Methods Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun’s electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries). Results This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p < 0.01. Conclusion A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed.

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Suicidal behavior is four times more frequent in university students with bipolar disorder assessed by an online version of Mood Disorder Questionnaire

GSC Advanced Research and Reviews ◽

10.30574/gscarr.2020.5.1.0086 ◽

2020 ◽

Vol 5 (1) ◽

pp. 030-042

Author(s):

Luiz Henrique Costa Neto ◽

Kévia Maria Rodrigues de Sousa ◽

Aliny Hellen Lima Pinheiro ◽

Dhynne Kelley Lima de Menezes ◽

Samara Fonseca Frota ◽

...

Keyword(s):

Bipolar Disorder ◽

Young People ◽

University Students ◽

Mood Disorder ◽

Suicidal Behavior ◽

Suicide Attempts ◽

Private Universities ◽

Online Version ◽

Worth Living ◽

Mood Disorder Questionnaire

Introduction: Bipolar disorder (BD) in young people is frequently associated with suicidal behavior. The main objective of this research is to evaluate if university students who have BD show more suicidal behavior than those who do not have BD. Materials and Methods: 583 university students from Fortaleza, Brazil, participated in this study. Volunteers over 18 years of age who were attending public or private universities from March to December 2019 were able to participate. A sociodemographic and clinical questionnaire and the Mood Disorder Questionnaire (MDQ) were filled out. According to MDQ, participants were classified into three groups: 1) individuals without BD (n=318); 2) individuals with subthreshold BD symptoms (n=160); 3) individuals with BD (n=105). Results: Compared to those who do not have BD, individuals with BD had four times less plans for the future (x2=16.00; p=0.000), considered four times life less worth living (x2=13.44; p=0.001), assumed two times more frequently death as welcome if it comes (x2=19.10; p=0.000), thought two times more about getting hurt (x2=75.32; p=0.000), had seven times more specific plans to die (x2=39.93; p=0.000) and had four times more suicide attempts (x2=33.50; p=0.000). Conclusions: Suicidal behavior was four times more prominent in university students with BD than in those who did not have BD.

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Suicidal Behavior in German Adolescents

Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie ◽

10.1024/1422-4917/a000331 ◽

2015 ◽

Vol 43 (1) ◽

pp. 39-45 ◽

Cited By ~ 4

Author(s):

Joana Straub ◽

Ferdinand Keller ◽

Nina Sproeber ◽

Michael G. Koelch ◽

Paul L. Plener

Keyword(s):

Suicidal Behavior ◽

Suicide Attempts ◽

Depression Scale ◽

Epidemiological Studies ◽

Present Sample ◽

Manic Symptoms ◽

Symptoms Of Depression ◽

Adolescent Sample ◽

History Of ◽

Sum Scores

Objective: Research in adults has identified an association between bipolar disorder and suicidal behavior. This relationship, however, has been insufficiently investigated in adolescents to date. Methods: 1,117 adolescents from 13 German schools (mean age = 14.83, SD = .63; 52.7% females) completed an extended German version of the Center for Epidemiological Studies Depression Scale (CES-D), which assesses depressive and manic symptoms during the last week, as well as the Self-Harm Behavior Questionnaire (SHBQ) for the assessment of lifetime suicidal behavior. Results: In the present sample 39.4% of the girls and 23.1% of the boys reported lifetime suicidal thoughts and 7.1% of the girls as well as 3.9% of the boys a lifetime history of suicide attempts. 18.7% of the adolescent sample revealed elevated symptoms of depression and 9% elevated levels of mania symptoms. Elevated sum scores of depression and mania were associated with a higher number of suicidal ideations and suicide attempts. A block-wise regression analysis revealed that sum scores of depression and mania predicted suicidal ideations best. Concerning suicide attempts, the best predictors were age as well as depression and mania sum scores. Conclusions: Suicidal behavior was reported more often when adolescents demonstrate symptoms of mania as well as symptoms of depression than when they demonstrate only depressive symptoms. The presence of bipolar symptoms in adolescents should alert clinicians to the heightened possibility of suicidal behavior.

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Suicidal Behavior in Patients with Adjustment Disorders

Crisis ◽

10.1027//0227-5910.22.3.125 ◽

2001 ◽

Vol 22 (3) ◽

pp. 125-131 ◽

Cited By ~ 34

Author(s):

Ludmila Kryzhanovskaya ◽

Randolph Canterbury

Keyword(s):

Personality Disorder ◽

Suicidal Behavior ◽

Suicide Attempts ◽

Adjustment Disorder ◽

Adjustment Disorders ◽

Involuntary Hospitalization ◽

Axis Ii ◽

The Past ◽

Substance Abuse Disorders ◽

Axis I

Summary: This retrospective study characterizes the suicidal behavior in 119 patients with Axis I adjustment disorders as assessed by psychiatrists at the University of Virginia Hospital. Results indicated that 72 patients (60.5%) had documented suicide attempts in the past, 96% had been suicidal during their admission to the hospital, and 50% had attempted suicide before their hospitalization. The most commonly used method of suicide attempts was overdosing. Of the sample group with suicide attempts in the past, 67% had Axis II diagnoses of borderline personality disorder and antisocial personality disorder. Adjustment disorder diagnosis in patients with the suicide attempts was associated with a high level of suicidality at admission, involuntary hospitalization and substance-abuse disorders. Axis II diagnoses in patients with adjustment disorders constituted risk factors for further suicidal behavior. Additional future prospective studies with reliability checks on diagnosis of adjustment disorders and suicidal behavior are needed.

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Interactive Effects of Acute Suicidal Affective Disturbance and Pain Persistence on Suicide Attempt Frequency and Lethality

Crisis ◽

10.1027/0227-5910/a000588 ◽

2019 ◽

Vol 40 (6) ◽

pp. 413-421 ◽

Cited By ~ 2

Author(s):

Megan L. Rogers ◽

Thomas E. Joiner

Keyword(s):

Suicide Attempt ◽

Suicidal Behavior ◽

Pain Perception ◽

Suicide Attempts ◽

Pain Tolerance ◽

Self Report ◽

Interactive Effects ◽

Physical Pain ◽

Affective Disturbance ◽

The Relationship

Abstract. Background: Acute suicidal affective disturbance (ASAD) has been proposed as a suicide-specific entity that confers risk for imminent suicidal behavior. Preliminary evidence suggests that ASAD is associated with suicidal behavior beyond a number of factors; however, no study to date has examined potential moderating variables. Aims: The present study tested the hypotheses that physical pain persistence would moderate the relationship between ASAD and (1) lifetime suicide attempts and (2) attempt lethality. Method: Students ( N = 167) with a history of suicidality completed self-report measures assessing the lifetime worst-point ASAD episode and the presence of a lifetime suicide attempt, a clinical interview about attempt lethality, and a physical pain tolerance task. Results: Physical pain persistence was a significant moderator of the association between ASAD and lifetime suicide attempts ( B = 0.00001, SE = 0.000004, p = .032), such that the relationship between ASAD and suicide attempts strengthened at increasing levels of pain persistence. The interaction between ASAD and pain persistence in relation to attempt lethality was nonsignificant ( B = 0.000004, SE = 0.00001, p = .765). Limitations: This study included a cross-sectional/retrospective analysis of worst-point ASAD symptoms, current physical pain perception, and lifetime suicide attempts. Conclusion: ASAD may confer risk for suicidal behavior most strongly at higher levels of pain persistence, whereas ASAD and pain perception do not influence attempt lethality.

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Relationship Between Antiepileptic Drugs and Suicide Attempts in Patients With Bipolar Disorder

Yearbook of Neurology and Neurosurgery ◽

10.1016/s0513-5117(10)79186-9 ◽

2010 ◽

Vol 2010 ◽

pp. 50-51

Author(s):

M.J. Brodie

Keyword(s):

Bipolar Disorder ◽

Antiepileptic Drugs ◽

Suicide Attempts

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