title: Suicide attempts are associated with worse quality of life in patients with bipolar disorder type I.
abstract: BACKGROUND
  The association between suicidal behavior and quality of life (QoL) in bipolar disorder (BD) is poorly understood. Worse QoL has been associated with suicide attempts and suicidal ideation in schizophrenic patients, but this relationship has not been investigated in BD. This study tested whether a history of suicide attempts was associated with poor QoL in a well-characterized sample of patients with BD, as has been observed in other psychiatric disorders and in the general population.
  
  
  METHODS
  One hundred eight patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition BD type I (44 with previous suicide attempts, 64 without previous suicide attempts) were studied. Quality of life was assessed using the World Health Organization's Quality of Life Instrument-Short Version. Depressive and manic symptoms were assessed using the Hamilton Depression Rating Scale-17 items and the Young Mania Rating Scale.
  
  
  RESULTS
  Patients with BD and previous suicide attempts had significantly lower scores in all the 4 domains of the World Health Organization's Quality of Life Instrument-Short Version scale than did patients with BD but no previous suicide attempts (physical domain P = .001; psychological domain P < .0001; social domain P = .001, and environmental domain P = .039). In the euthymic subgroup (n = 70), patients with previous suicide attempts had significantly lower scores only in the psychological and social domains (P = .020 and P = .004).
  
  
  CONCLUSIONS
  This was a cross-sectional study, and no causal associations can be assumed.
  
  
  CONCLUSIONS
  Patients with BD and a history of previous suicide attempts seem to have a worse QoL than did patients who never attempted suicide. Poorer QoL might be a marker of poor copying skills and inadequate social support and be a risk factor for suicidal behavior in BD. Alternatively, poorer QoL and suicidal behavior might be different expressions of more severe BD.
authors.affiliation: Bipolar Disorder Research Program, Department of Psychiatry, University Sao Paulo, Medical School, Sao Paulo, Brazil. lenabuco@hotmail.com
authors.forename: Lena Nabuco
authors.initials: LN
authors.lastname: de Abreu
authors.forename: Fabiano G
authors.initials: FG
authors.lastname: Nery
authors.forename: Jill M
authors.initials: JM
authors.lastname: Harkavy-Friedman
authors.forename: Karla Matias
authors.initials: KM
authors.lastname: de Almeida
authors.forename: Bernardo Carramao
authors.initials: BC
authors.lastname: Gomes
authors.forename: Maria A
authors.initials: MA
authors.lastname: Oquendo
authors.forename: Beny
authors.initials: B
authors.lastname: Lafer
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology*; D011795:Surveys and Questionnaires