Does first episode polarity predict risk for suicide attempt in bipolar disorder?
BACKGROUND
Defining bipolar disorder (BD) subtypes with increased risk of suicidal behavior may help clinical management. We tested the hypothesis that the polarity of a patient's first mood episode would be a marker for BD subtypes with differential risk for suicidality.


METHODS
One hundred thirteen subjects with DSM-IV defined BD were classified based on whether their first reported episode was manic/hypomanic (FM) or depressed (FD). They were compared on demographic and clinical variables. Logistic regression adjusting for potential confounds tested the association between first episode polarity and history of suicide attempt.


RESULTS
Multiple logistic regression analysis showed that FD group membership was associated with eightfold odds of a past suicide attempt, adjusting for years ill and total number of lifetime major depressive episodes.


CONCLUSIONS
Sample size, retrospective design, recall bias, assessment during a mood episode, and imprecise recall of hypomania.


CONCLUSIONS
Polarity of patients' first reported mood episode suggested a depression-prone subtype with a greater probability of past suicide attempt. The FM group had more alcoholism and psychosis, but less likelihood of past suicide attempt. Validation of these putative subtypes requires prospective study.
Chaudhury
Sadia R
SR
Department of Neuroscience, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Box 42, New York, NY 10032, United States.
Grunebaum
Michael F
MF
Galfalvy
Hanga C
HC
Burke
Ainsley K
AK
Sher
Leo
L
Parsey
Ramin V
RV
Everett
Benjamin
B
Mann
J John
JJ
Oquendo
Maria A
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D003710:Demography; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires