title: Bipolar disorder first episode and suicidal behavior: are there differences according to type of suicide attempt?
abstract: 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.
  
  
  METHODS
  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%, X(2) = 7.028, p = 0.03). Multiple logistic regression analysis confirmed this result.
  
  
  CONCLUSIONS
  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.
authors: Department of Mental Health, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors: Fernando Silva
authors: FS
authors: Neves
authors: Leandro Fernandes
authors: LF
authors: Malloy-Diniz
authors: Izabela Guimarães
authors: IG
authors: Barbosa
authors: Paulo Marcos
authors: PM
authors: Brasil
authors: Humberto
authors: H
authors: Corrêa
mesh_terms: D000328:Adult; D017668:Age of Onset; D000704:Analysis of Variance; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D001938:Brazil / Q000453:epidemiology; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data*; D014754:Violence