title: Association between history of suicide attempts and family functioning in bipolar disorder.
abstract: OBJECTIVE
  To investigate the association between history of suicide attempts (SA) and family functioning in bipolar disorder (BD) patients.
  
  
  METHODS
  Thirty-one BD type I patients with lifetime history of SA, 31 BD type I with no lifetime history of SA, participating in the Outpatient Clinic of the Bipolar Disorder Program at the Institute of Psychiatry of the University of São Paulo Medical School were recruited for this study. We used the Family Assessment Device (FAD) to evaluate family functioning. We compared these two groups on demographic and clinical variables to identify which variables were associated with family functioning impairment. Fifty-one relatives of the same patients were also asked to complete a FAD.
  
  
  RESULTS
  BD patients with SA presented more psychiatric hospitalizations, higher frequency of psychotic symptoms, and higher scores on depressive, manic, and suicidal ideation than BD patients without SA. BD patients with SA presented significantly higher scores in several subscales of the FAD, including Problem Solving (p=0.042), Communication (p=0.009), Roles (p=0.006), and General Functioning (p=0.025), when compared with BD patients without SA. Relatives of BD patients with SA presented significantly higher scores in Communication, Roles, Affective Responsiveness, and General Functioning than relatives of BD patients without SA.
  
  
  CONCLUSIONS
  Cross-sectional study and long time elapsed since last SA.
  
  
  CONCLUSIONS
  History of SA in BD is associated with worse family functioning in several domains of FAD, including Problem Solving, Communication, Roles, and General Functioning. As suicide attempts are routinely assessed in clinical practice, these findings may help to identify patients with poorer family functioning and may suggest a role for environmental risk factors in suicidal behavior among BD patients.
authors.affiliation: Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: angie.berutti@gmail.com.
authors.forename: Mariangeles
authors.initials: M
authors.lastname: Berutti
authors.affiliation: Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Rodrigo Silva
authors.initials: RS
authors.lastname: Dias
authors.affiliation: Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Vivian Alves
authors.initials: VA
authors.lastname: Pereira
authors.affiliation: Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Beny
authors.initials: B
authors.lastname: Lafer
authors.affiliation: Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, USA.
authors.forename: Fabiano G
authors.initials: FG
authors.lastname: Nery
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000523:psychology*; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000523:psychology; D005190:Family / Q000523:psychology; D005195:Family Relations / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000523:psychology; D012307:Risk Factors; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology*
keywords: Bipolar disorder; Family functioning; Suicide attempt