title: Hopelessness and suicidal risk in bipolar disorder. A study in clinically nonsyndromal patients.
abstract: OBJECTIVE
  Attempted suicide and death due to suicide are not uncommon among patients with bipolar disorder. Although some risk factors for suicidality in bipolar patients have been identified, little is known about hopelessness and other possible trait or diathesis-related factors. Consequently, the objective of this study was to investigate variables associated with suicidal risk in clinically nonsyndromal bipolar patients.
  
  
  METHODS
  A sample of 102 outpatients with a diagnosis of bipolar disorder according to International Classification of Diseases, 10th Revision criteria during nonsyndromal stage were evaluated. On the basis of suicidal history, patients were divided into suicide attempt, suicidal ideation, and nonsuicidal groups. Sociodemographic, clinical, and psychopathological variables were assessed.
  
  
  RESULTS
  As compared with the nonsuicidal group, female sex, combined psychopharmacologic treatment, and hopelessness were independently associated with suicide attempt. Hopelessness and insight into having a mental disorder were independently associated with history of suicidal ideation.
  
  
  CONCLUSIONS
  Patients with bipolar disorder and suicidal history are characterized by the presence of hopelessness, which probably confers greater vulnerability for suicidal behavior in the presence of stress factors. This identification of the risk profile for suicidal behavior in nonsyndromal bipolar patients adds complementary information to risk factors established for suicidality during acute phases of the disease, allows for differentiated preventive and treatment approaches of patients at risk, and suggests psychotherapy as an advisable intervention in this group of patients.
authors.affiliation: Mental Health Research Program, Service of Mental Health, General Health Care Programs Direction, Canary Health Service, Gran Canaria, Spain. fjacostaartiles@hotmail.com
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Acosta
authors.forename: Dulcinea
authors.initials: D
authors.lastname: Vega
authors.forename: Luz
authors.initials: L
authors.lastname: Torralba
authors.forename: Santiago
authors.initials: S
authors.lastname: Navarro
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Ramallo-Fariña
authors.forename: Dolores
authors.initials: D
authors.lastname: Fiuza
authors.forename: José L
authors.initials: JL
authors.lastname: Hernández
authors.forename: Samuel G
authors.initials: SG
authors.lastname: Siris
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D015984:Causality; D002605:Character; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011599:Psychopathology; D011613:Psychotherapy; D013030:Spain; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data; D000092864:Suicide Prevention
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents