title: Suicidal events and accidents in 216 first-episode bipolar I disorder patients: predictive factors.
abstract: BACKGROUND
  Risks of life-threatening behaviors are high among bipolar disorder (BPD) patients, but early rates and associated risk factors for suicides and accidents remain ill-defined.
  
  
  METHODS
  We assessed 216 DSM-IV BP-I patients prospectively for 4.2 years from first-lifetime hospitalization, using ordinal logistic-regression to estimate risks and associated demographic and clinical factors among risk-groups with: [1] no suicidal ideation, acts, or accidents, [2] suicidal ideation only, [3] suicides and attempts, [4] accidents, and [5] both suicidal acts and accidents.
  
  
  RESULTS
  Suicidal thoughts or acts were identified in 127/216 subjects/4.2 years (14%/year), including suicidal ideation in 88 (9.7%/year), and acts in 39 (4.3%/year: 38 attempts [17.6%/year], 1 suicide [0.11%/year]); 87% of acts occurred within a year of a first-episode. Life-threatening accidents occurred in 20 cases (2.2%/year) with a mean latency of 3.8 years, including 12 with suicidal ideation or attempts (60% co-occurrence of accidents and suicidality); alcohol was implicated in 25% of accidents. The 53 cases of violent behaviors (5.84%/year) included a fatal car-wreck and a suicide, for a mortality risk of 0.22%/year (2/216/4.2 years). Suicidality was associated with initial mixed-state, proportion of follow-up weeks in mixed-states or depression, and prior suicide attempts; accidents were associated selectively with initial mania or psychosis, later mania or hypomania, and alcohol abuse. Violent acts also were associated with use of more psychotropic medicines/person, and with use of antipsychotics or sedative-anxiolytics.
  
  
  CONCLUSIONS
  Treatment was clinical and uncontrolled, illness relatively severe, and statistical power limited.
  
  
  CONCLUSIONS
  Early in BP-I disorder, risks of suicidal acts and accidents were high, inter-related, and associated with particular types of initial and later morbidity, suggesting some predictability and potential for preventive intervention.
authors.affiliation: Department of Psychiatry, Harvard Medical School, Mailman Research Center, McLean Division of Massachusetts General Hospital, Belmont, MA 02478-9106, USA.
authors.forename: Hari Mandir Kaur
authors.initials: HM
authors.lastname: Khalsa
authors.forename: Paola
authors.initials: P
authors.lastname: Salvatore
authors.forename: John
authors.initials: J
authors.lastname: Hennen
authors.forename: Christopher
authors.initials: C
authors.lastname: Baethge
authors.forename: Mauricio
authors.initials: M
authors.lastname: Tohen
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Baldessarini
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data*; D000063:Accidents, Traffic / Q000401:mortality / Q000706:statistics & numerical data; D000328:Adult; D000435:Alcoholic Intoxication / Q000453:epidemiology / Q000523:psychology; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data