title: Suicide risk in bipolar patients: the role of co-morbid substance use disorders.
abstract: OBJECTIVE
  Bipolar disorder is associated with a high frequency of both completed suicides and suicide attempts. The primary aim of this study was to identify clinical predictors of suicide attempts in subjects with bipolar disorder.
  
  
  METHODS
  We studied 336 subjects with a diagnosis of bipolar I, bipolar II, or schizoaffective disorder (bipolar type). The Structured Clinical Interview for DSM-IV (SCID-I) was administered and subsequently two expert psychiatrists established a diagnosis. Predictors of suicide attempts were examined in attempters and non-attempters.
  
  
  RESULTS
  The lifetime rate of suicide attempts for the entire sample was 25.6%. A lifetime co-morbid substance use disorder was a significant predictor of suicide attempts: bipolar subjects with co-morbid substance use disorders (SUD) had a 39.5% lifetime rate of attempted suicide, while those without had a 23.8% rate (odds ratio = 2.09, 95% CI = 1.03-4.21, chi2 = 4.33, df = 1, p = 0.037).
  
  
  CONCLUSIONS
  Lifetime co-morbid SUD were associated with a higher rate of suicide attempts in patients with bipolar disorder. This relationship may have a genetic origin and/or be explained by severity of illness and trait impulsivity.
authors.affiliation: Neurogenetics Section, Center for Addiction and Mental Health, University of Toronoto, Ontario, Canada.
authors.forename: E Jane
authors.initials: EJ
authors.lastname: Dalton
authors.forename: Tasha D
authors.initials: TD
authors.lastname: Cate-Carter
authors.forename: Emanuela
authors.initials: E
authors.lastname: Mundo
authors.forename: Sagar V
authors.initials: SV
authors.lastname: Parikh
authors.forename: James L
authors.initials: JL
authors.lastname: Kennedy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology*; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data