title: Personality disorders and suicide attempts in unipolar and bipolar mood disorders.
abstract: BACKGROUND
  Comorbid personality disorders may predispose patients with mood disorders to suicide attempts (SAs), but factors mediating this effect are not well known.
  
  
  METHODS
  Altogether 597 patients from three prospective cohort studies (Vantaa Depression Study, Jorvi Bipolar Study, and Vantaa Primary Care Depression Study) were interviewed at baseline, at 18 months, and in VDS and PC-VDS at 5 years. Personality disorders (PDs) at baseline, number of previous SAs, life-charted time spent in major depressive episodes (MDEs), and precise timing of SAs during follow-up were determined and investigated.
  
  
  RESULTS
  Overall, 219 (36.7%) patients had a total of 718 lifetime SAs; 88 (14.7%) patients had 242 SAs during the prospective follow-up. Having any PD diagnosis increased the SA rate, both lifetime and prospectively evaluated, by 90% and 102%, respectively. All PD clusters increased the rate of new SAs, although cluster C PDs more than the others. After adjusting for time spent in MDEs, only cluster C further increased the SA rate (by 52%). Mediation analyses of PD effects on prospectively ascertained SAs indicated significant mediated effects through time at risk in MDEs, but also some direct effects.
  
  
  CONCLUSIONS
  Findings generalizable only to patients with mood disorders.
  
  
  CONCLUSIONS
  Among mood disorder patients, comorbid PDs increase the risk of SAs to approximately two-fold. The excess risk is mostly due to patients with comorbid PDs spending more time in depressive episodes than those without. Consequently, risk appears highest for PDs that most predispose to chronicity and recurrences. However, also direct risk-modifying effects of PDs exist.
authors.affiliation: Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Jylhä
authors.affiliation: IBS, Unit of Personality, Work and Health Psychology,University of Helsinki, Helsinki, Finland.
authors.forename: Tom
authors.initials: T
authors.lastname: Rosenström
authors.affiliation: Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland.
authors.forename: Outi
authors.initials: O
authors.lastname: Mantere
authors.affiliation: Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; City of Helsinki, Social Services and Healthcare, Department of Mental Health and Substance Abuse, Helsinki, Finland.
authors.forename: Kirsi
authors.initials: K
authors.lastname: Suominen
authors.affiliation: Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland.
authors.forename: Tarja
authors.initials: T
authors.lastname: Melartin
authors.affiliation: Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland.
authors.forename: Maria
authors.initials: M
authors.lastname: Vuorilehto
authors.affiliation: Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland.
authors.forename: Mikael
authors.initials: M
authors.lastname: Holma
authors.affiliation: Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; Healthcare and Social Services, City of Järvenpää, Järvenpää, Finland.
authors.forename: Kirsi
authors.initials: K
authors.lastname: Riihimäki
authors.affiliation: Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY, USA.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Oquendo
authors.affiliation: IBS, Unit of Personality, Work and Health Psychology,University of Helsinki, Helsinki, Finland.
authors.forename: Liisa
authors.initials: L
authors.lastname: Keltikangas-Järvinen
authors.affiliation: Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland. Electronic address: erkki.isometsa@hus.fi.
authors.forename: Erkki T
authors.initials: ET
authors.lastname: Isometsä
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010552:Personality Assessment / Q000706:statistics & numerical data; D010554:Personality Disorders / Q000453:epidemiology* / Q000523:psychology; D011446:Prospective Studies; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*
keywords: Longitudinal studies; Mood disorders; Personality disorders; Suicidal behavior; Suicide attempt