title: Suicidal attempts in bipolar disorder: results from an observational study (EMBLEM).
abstract: OBJECTIVE
  To compare patients with and without a history of suicidal attempts in a large cohort of patients with bipolar disorder and to identify variables that are associated with suicidal behavior.
  
  
  METHODS
  European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) is a two-year, prospective, observational study that enrolled 3,684 adult patients with bipolar disorder and initiated or changed oral treatment for an acute manic/mixed episode. Of those, 2,416 patients were eligible for the two-year follow-up. Only baseline characteristics were studied in the present study, included sociodemographic data, psychiatric history and comorbidities, history of suicide attempts, history of substance use problems, compliance with treatment, inpatient admissions, and functional status. Symptom severity was assessed using the Clinical Global Impression-Bipolar Disorder (CGI-BP) scale, the Young Mania Rating Scale (YMRS), and the 5-item Hamilton Depression Rating Scale (HAMD-5). A logistic regression model identified baseline variables independently associated with a history of suicidal behavior.
  
  
  RESULTS
  Of the 2,219 patients who provided data on their lifetime history of suicide attempts, 663 (29.9%) had a history of suicidal behavior (at least one attempt). Baseline factors associated with a history of suicidal behavior included female gender, a history of alcohol abuse, a history of substance abuse, young age at first treatment for a mood episode, longer disease duration, greater depressive symptom severity (HAMD-5 total score), current benzodiazepine use, higher overall symptom severity (CGI-BP: mania and overall score), and poor compliance.
  
  
  CONCLUSIONS
  These factors may be considered as potential characteristics to identify subjects at risk for suicidal behavior throughout the course of bipolar disorder.
authors.affiliation: INSERM, Unité 955, IMRB, Equipe de Psychiatrie Génétique, Créteil, France. frank.bellivier@inserm.fr
authors.forename: Frank
authors.initials: F
authors.lastname: Bellivier
authors.forename: Liova
authors.initials: L
authors.lastname: Yon
authors.forename: Amandine
authors.initials: A
authors.lastname: Luquiens
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Azorin
authors.forename: Jordan
authors.initials: J
authors.lastname: Bertsch
authors.forename: Stephanie
authors.initials: S
authors.lastname: Gerard
authors.forename: Catherine
authors.initials: C
authors.lastname: Reed
authors.forename: Michael
authors.initials: M
authors.lastname: Lukasiewicz
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000523:psychology*; D016009:Chi-Square Distribution; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009770:Obsessive Behavior; D011569:Psychiatric Status Rating Scales; D013406:Suicide, Attempted / Q000706:statistics & numerical data