title: Differences and similarities of risk factors for suicidal ideation and attempts among patients with depressive or bipolar disorders.
abstract: BACKGROUND
  Substantial literature exists on risk factors for suicidal behaviour. However, their comparative strength, independence and specificity for either suicidal ideation or suicide attempt(s) remain unclear.
  
  
  METHODS
  The Helsinki University Psychiatric Consortium (HUPC) Study surveyed 287 psychiatric care patients with ICD-10-DCR depressive or bipolar disorders about lifetime suicidal behaviour, developmental history and attachment style, personality and psychological traits, current and lifetime symptom profiles, and life events. Psychiatric records were used to confirm diagnosis and complement information on suicide attempts. Multinomial regression models predicting lifetime suicidal ideation and single or repeated suicide attempts were generated.
  
  
  RESULTS
  Overall, 21.6% patients had no lifetime suicidal behaviour, 33.8% had lifetime suicide ideation without attempts, and 17.1% had a single and 27.5% repeated suicide attempts. In univariate analyses, lifetime suicidal behaviour was associated with numerous factors. In multivariate models, suicidal ideation was independently predicted by younger age, severe depressive disorder, bipolar disorder type II/nos, hopelessness, and childhood physical abuse. Repeated suicide attempts were independently predicted by younger age, female sex, severe depressive disorder with or without psychotic symptoms, bipolar disorder type II/nos, alcohol use disorder, borderline personality disorder traits, and childhood physical abuse.
  
  
  CONCLUSIONS
  Cross-sectional and retrospective study design, utilization of clinical diagnoses, and relatively low response rate.
  
  
  CONCLUSIONS
  Risk factors for suicidal ideation and attempts may diverge both qualitatively and in terms of dose response. When effects of risk factors from multiple domains are concurrently examined, proximal clinical characteristics remain the most robust. All risk factors cluster into the group of repeated attempters.
authors.affiliation: Department of Health, Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland; Department of Social Services and Health Care, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Aaltonen
authors.affiliation: Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Petri
authors.initials: P
authors.lastname: Näätänen
authors.affiliation: Department of Social Services and Health Care, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Martti
authors.initials: M
authors.lastname: Heikkinen
authors.affiliation: Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Maaria
authors.initials: M
authors.lastname: Koivisto
authors.affiliation: Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Ilya
authors.initials: I
authors.lastname: Baryshnikov
authors.affiliation: Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Boris
authors.initials: B
authors.lastname: Karpov
authors.affiliation: Department of Social Services and Health Care, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Jorma
authors.initials: J
authors.lastname: Oksanen
authors.affiliation: Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Tarja
authors.initials: T
authors.lastname: Melartin
authors.affiliation: Department of Health, Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland; Department of Social Services and Health Care, Helsinki, Finland.
authors.forename: Kirsi
authors.initials: K
authors.lastname: Suominen
authors.affiliation: Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Grigori
authors.initials: G
authors.lastname: Joffe
authors.affiliation: Department of Health, Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Tiina
authors.initials: T
authors.lastname: Paunio
authors.affiliation: Department of Health, Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: erkki.isometsa@hus.fi.
authors.forename: Erkki
authors.initials: E
authors.lastname: Isometsä
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology*; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D005387:Finland; D006306:Health Surveys; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Bipolar disorder; Depressive disorder; Risk factor; Suicidal behaviour; Suicide attempt