Prospective predictors of suicide and suicide attempts in 1,556 patients with bipolar disorders followed for up to 2 years.
OBJECTIVE
Bipolar disorders are associated with high rates of suicide attempts (SAs) and completions. Several factors have been reported to be associated with suicide in persons with bipolar disorder, but most studies to date have been retrospective and have not utilized multivariate statistics to account for the redundant prediction among variables submitted for analysis.


METHODS
This study examined the association between baseline clinical and demographic variables and subsequent SAs and completions through 2 years of follow-up of participants in the Systematic Treatment Enhancement Program for Bipolar Disorder using a pattern-mixture model.


RESULTS
Of the sample with complete data (n = 1,556), 57 patients (3.66%) experienced an SA or completion (CS). Several variables predicted suicidality (SA + CS) in this data set when considered alone, but after controlling for redundant prediction from other baseline characteristics, only history of suicide [odds ratio (OR) = 4.52, p < 0.0001] and percent days depressed in the past year (OR = 1.16, p = 0.036) were significantly associated with SAs and completions. A secondary analysis included a greater number of variables but a smaller sample size (n = 1,014). In the secondary analyses, only prior SAs predicted prospective suicidality (OR = 3.87, p = 0.0029).


CONCLUSIONS
These results indicate that patients with bipolar disorder who present with a history of SAs are over four times as likely to have a subsequent SA or completion. Further studies are needed to evaluate and prevent future attempts in this high-risk cohort.
Marangell
Lauren B
LB
Mood Disorders Center, Menninger Department of Psychiatry, Baylor College of Medicine and the Department of Veterans Affairs, VISN 16 MIRECC, Houston, TX 77030, USA. laurenm@bcm.tmc.edu
Bauer
Mark S
MS
Dennehy
Ellen B
EB
Wisniewski
Stephen R
SR
Allen
Michael H
MH
Miklowitz
David J
DJ
Oquendo
Maria A
MA
Frank
Ellen
E
Perlis
Roy H
RH
Martinez
James M
JM
Fagiolini
Andrea
A
Otto
Michael W
MW
Chessick
Cheryl A
CA
Zboyan
Holly A
HA
Miyahara
Sachiko
S
Sachs
Gary
G
Thase
Michael E
ME
D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013997:Time Factors