title: Is religiosity a protective factor against suicidal behavior in bipolar I outpatients?
abstract: BACKGROUND
  Several risk factors have been associated with suicidal behavior (SB) in bipolar disorder (BD), but little is known regarding possible protective factors. Religiosity has been related to favorable outcomes in mental health and to a reduction in the risk of SB, although the relation between BD, religiosity and SB remains under-investigated. The objective of this study was to evaluate the association between religiosity and SB in euthymic bipolar I outpatients.
  
  
  METHODS
  In this study, 164 outpatients with BD type I with and without a history of suicide attempts were assessed and compared using a questionnaire to collect clinical and sociodemographic characteristics, the Structured Clinical Interview for DSM-IV, the Hamilton Depression Rating Scale, the Young Mania Rating Scale, the Duke Religious Index, and the Barratt Impulsivity Scale.
  
  
  RESULTS
  The suicide attempters (SA) group had more psychiatric comorbidity (p=0.007), more rapid cycling (p=0.004), higher levels of impulsivity in all domains (p=0.000), and less religious affiliation (p=0.006) compared with the non-SA group. In the multivariate analysis, after controlling for covariates, non-organizational religious activities (OR, 0.66; 95% CI, 0.50-0.86) and intrinsic religiosity (OR, 0.70; 95% CI, 0.60-0.81) were associated with less SB.
  
  
  CONCLUSIONS
  A small sample size, the cross-sectional design that precluded the possibility of assessing cause and effect relationships, and the infeasibility of determining the time lapse between the last suicide attempt and the period when the patients were evaluated.
  
  
  CONCLUSIONS
  Non-organizational religious activities and intrinsic religiosity dimensions exert a protective effect against SB in bipolar I outpatients, even when controlling for variables that may affect the outcome in question.
authors.affiliation: Program of Mood and Anxiety Disorders (CETHA), University Hospital, Federal University of Bahia, Salvador, Brazil; Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil. Electronic address: andrecaribe@terra.com.br.
authors.forename: André C
authors.initials: AC
authors.lastname: Caribé
authors.affiliation: Program of Mood and Anxiety Disorders (CETHA), University Hospital, Federal University of Bahia, Salvador, Brazil; Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil.
authors.forename: Paula
authors.initials: P
authors.lastname: Studart
authors.affiliation: Program of Mood and Anxiety Disorders (CETHA), University Hospital, Federal University of Bahia, Salvador, Brazil; Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil.
authors.forename: Severino
authors.initials: S
authors.lastname: Bezerra-Filho
authors.affiliation: Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Elisa
authors.initials: E
authors.lastname: Brietzke
authors.affiliation: Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Mariane
authors.initials: M
authors.lastname: Nunes Noto
authors.affiliation: Laboratory of Molecular Psychiatry, INCT for Translational Medicine, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Mireia
authors.initials: M
authors.lastname: Vianna-Sulzbach
authors.affiliation: Laboratory of Molecular Psychiatry, INCT for Translational Medicine, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Flavio
authors.initials: F
authors.lastname: Kapczinski
authors.affiliation: Department of Mental Health, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Silva Neves
authors.affiliation: Department of Mental Health, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Humberto
authors.initials: H
authors.lastname: Correa
authors.affiliation: Program of Mood and Anxiety Disorders (CETHA), University Hospital, Federal University of Bahia, Salvador, Brazil; Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil.
authors.forename: Ângela
authors.initials: Â
authors.lastname: Miranda-Scippa
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000523:psychology*; D001938:Brazil; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology*; D065840:Protective Factors; D012069:Religion and Psychology; D029181:Spirituality; D013406:Suicide, Attempted / Q000517:prevention & control / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Bipolar disorder; Religiosity; Suicidal behavior; Suicidality; Suicide; Suicide attempt