title: History of Lifetime suicide attempt in bipolar I disorder: its correlates and effect on illness course.
abstract: OBJECTIVE
  To identify the prevalence and correlates of bipolar I patients with a lifetime history of suicide attempt.
  
  
  METHODS
  Bipolar I disorder was diagnosed in 150 patients as per DSM-IV-TR criteria. Their lifetime suicide risk was assessed using the Columbia Suicide Severity Rating Scale. NIMH retrospective Life Chart Methodology was used to chart the illness course. Medication Adherence Rating Scale (MARS) and Pittsburgh Sleep Quality Index (PSQI) were used to assess the recent adherence and subjective sleep quality, respectively. The suicide attempters were compared with non-attempters on individual variables.
  
  
  RESULTS
  Around 23% had a positive lifetime history of suicide attempt. They were predominantly female, had an index (first ever) episode of depression, spent more proportion of time being ill, especially in depressive or mixed episode phase. Comorbid substance use disorder along with suicidal attempts was seen only in males. Suicide attempters displayed poor medication adherence attitudes for medications taken during the past week and reported impaired sleep quality for the previous month.
  
  
  CONCLUSIONS
  A positive history of lifetime suicide attempt was significantly associated with a worse course of bipolar I disorder. Effective treatment of depressive episodes, addressing non-adherence, substance use and sleep problems can reduce the suicide risk in such patients. Retrospective design of the study and recall bias are some of the limitations.
authors.affiliation: a Department of Psychiatry , Jawaharlal Institute of Post Graduate Medical Education and Research , Puducherry , India.
authors.forename: Shivanand
authors.initials: S
authors.lastname: Kattimani
authors.affiliation: a Department of Psychiatry , Jawaharlal Institute of Post Graduate Medical Education and Research , Puducherry , India.
authors.forename: Karthick
authors.initials: K
authors.lastname: Subramanian
authors.affiliation: b Department of Psychiatry , All India Institute of Medical Sciences , New Delhi , India.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Sarkar
authors.affiliation: a Department of Psychiatry , Jawaharlal Institute of Post Graduate Medical Education and Research , Puducherry , India.
authors.forename: Ravi Philip
authors.initials: RP
authors.lastname: Rajkumar
authors.affiliation: a Department of Psychiatry , Jawaharlal Institute of Post Graduate Medical Education and Research , Puducherry , India.
authors.forename: Shanmuganathan
authors.initials: S
authors.lastname: Balasubramanian
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology*; D016022:Case-Control Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D055815:Young Adult; D016903:Drug Monitoring
keywords: Bipolar I; India; adherence; course; sleep; suicide attempt