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Do risk factors for suicidal behavior differ by affective disorder polarity?

Published online by Cambridge University Press:  30 July 2008

J. G. Fiedorowicz ,
A. C. Leon ,
M. B. Keller ,
D. A. Solomon ,
J. P. Rice  and
W. H. Coryell
J. G. Fiedorowicz*
Affiliation:
Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
A. C. Leon
Affiliation:
Department of Psychiatry, Weill Medical College of Cornell University, New York, NY, USA
M. B. Keller
Affiliation:
Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI, USA
D. A. Solomon
Affiliation:
Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI, USA
J. P. Rice
Affiliation:
Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
W. H. Coryell
Affiliation:
Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
*
*Address for correspondence: J. G. Fiedorowicz, M.D., M.S., 200 Hawkins Drive W278 GH, Iowa City, IA 52242, USA. (Email: [email protected])
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Abstract

Background

Suicide is a leading cause of death and has been strongly associated with affective disorders. The influence of affective disorder polarity on subsequent suicide attempts or completions and any differential effect of suicide risk factors by polarity were assessed in a prospective cohort.

Method

Participants with major affective disorders in the National Institute of Mental Health (NIMH) Collaborative Depression Study (CDS) were followed prospectively for up to 25 years. A total of 909 participants meeting prospective diagnostic criteria for major depressive and bipolar disorders were followed through 4204 mood cycles. Suicidal behavior was defined as suicide attempts or completions. Mixed-effects, grouped-time survival analysis assessed risk of suicidal behavior and differential effects of risk factors for suicidal behavior by polarity. In addition to polarity, the main effects of age, gender, hopelessness, married status, prior suicide attempts and active substance abuse were modeled, with mood cycle as the unit of analysis.

Results

After controlling for age of onset, there were no differences in prior suicide attempts by polarity although bipolar participants had more prior severe attempts. During follow-up, 40 cycles ended in suicide and 384 cycles contained at least one suicide attempt. Age, hopelessness and active substance abuse but not polarity predicted suicidal behavior. The effects of risk factors did not differ by polarity.

Conclusions

Bipolarity does not independently influence risk of suicidal behavior or alter the influence of well-established suicide risk factors within affective disorders. Suicide risk assessment strategies may continue to appraise these common risk factors without regard to mood polarity.

Keywords

Adultbipolar disordercompleted suicidemajor depressionprospective cohort studyrisk factors
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 5 , May 2009 , pp. 763 - 771
Copyright
Copyright © Cambridge University Press 2008

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References

Akiskal, HS, Maser, JD, Zeller, PJ, Endicott, J, Coryell, W, Keller, M, Warshaw, M, Clayton, P, Goodwin, F (1995). Switching from ‘unipolar’ to bipolar II. An 11-year prospective study of clinical and temperamental predictors in 559 patients. Archives of General Psychiatry 52, 114–123.CrossRefGoogle Scholar
Akiskal, HS, Walker, P, Puzantian, VR, King, D, Rosenthal, TL, Dranon, M (1983). Bipolar outcome in the course of depressive illness. Phenomenologic, familial, and pharmacologic predictors. Journal of Affective Disorders 5, 115–128.CrossRefGoogle ScholarPubMed
Angst, F, Stassen, HH, Clayton, PJ, Angst, J (2002). Mortality of patients with mood disorders: follow-up over 34–38 years. Journal of Affective Disorders 68, 167–181.CrossRefGoogle ScholarPubMed
Angst, J, Angst, F, Gerber-Werder, R, Gamma, A (2005 a). Suicide in 406 mood-disorder patients with and without long-term medication: a 40 to 44 years' follow-up. Archives of Suicide Research 9, 279–300.CrossRefGoogle ScholarPubMed
Angst, J, Sellaro, R, Stassen, HH, Gamma, A (2005 b). Diagnostic conversion from depression to bipolar disorders: results of a long-term prospective study of hospital admissions. Journal of Affective Disorders 84, 149–157.CrossRefGoogle ScholarPubMed
Beautrais, AL (2001). Suicides and serious suicide attempts: two populations or one? Psychological Medicine 31, 837–845.CrossRefGoogle ScholarPubMed
Black, DW, Winokur, G, Nasrallah, A (1988). Effect of psychosis on suicide risk in 1593 patients with unipolar and bipolar affective disorders. American Journal of Psychiatry 145, 849–852.Google Scholar
Cassano, GB, Akiskal, HS, Savino, M, Musetti, L, Perugi, G (1992). Proposed subtypes of bipolar II and related disorders: with hypomanic episodes (or cyclothymia) and with hyperthymic temperament. Journal of Affective Disorders 26, 127–140.CrossRefGoogle ScholarPubMed
CDC (2005). Years of Potential Life Lost (YPLL) before age 65, 1999–2002 United States. In WISQARS Years of Potential Life Lost (YPLL) Reports, 1999–2002. Centers for Disease Control and Prevention (http://webapp.cdc.gov/sasweb/ncipc/ypll10.html). Accessed 21 October 2005.Google Scholar
Chen, YW, Dilsaver, SC (1996). Lifetime rates of suicide attempts among subjects with bipolar and unipolar disorders relative to subjects with other Axis I disorders. Biological Psychiatry 39, 896–899.CrossRefGoogle ScholarPubMed
Coryell, W, Andreasen, NC, Endicott, J, Keller, M (1987). The significance of past mania or hypomania in the course and outcome of major depression. American Journal of Psychiatry 144, 309–315.Google ScholarPubMed
Coryell, W, Arndt, S, Turvey, C, Endicott, J, Solomon, D, Mueller, T, Leon, AC, Keller, M (2001). Lithium and suicidal behavior in major affective disorder: a case-control study. Acta Psychiatrica Scandinavica 104, 193–197.CrossRefGoogle ScholarPubMed
Coryell, W, Endicott, J, Reich, T, Andreasen, N, Keller, M (1984). A family study of bipolar II disorder. British Journal of Psychiatry 145, 49–54.CrossRefGoogle ScholarPubMed
Coryell, W, Haley, J, Endicott, J, Solomon, D, Leon, AC, Keller, M, Turvey, C, Maser, JD, Mueller, T (2002). The prospectively observed course of illness among depressed patients who commit suicide. Acta Psychiatrica Scandinavica 105, 218–223.CrossRefGoogle ScholarPubMed
Coryell, W, Keller, M, Endicott, J, Andreasen, N, Clayton, P, Hirschfeld, R (1989). Bipolar II illness: course and outcome over a five-year period. Psychological Medicine 19, 129–141.CrossRefGoogle ScholarPubMed
Dalton, EJ, Cate-Carter, TD, Mundo, E, Parikh, SV, Kennedy, JL (2003). Suicide risk in bipolar patients: the role of co-morbid substance use disorders. Bipolar Disorders 5, 58–61.CrossRefGoogle Scholar
Dunner, DL, Gershon, ES, Goodwin, FK (1976). Heritable factors in the severity of affective illness. Biological Psychiatry 11, 31–42.Google ScholarPubMed
Endicott, J, Nee, J, Andreasen, N, Clayton, P, Keller, M, Coryell, W (1985). Bipolar II. Combine or keep separate? Journal of Affective Disorders 8, 17–28.CrossRefGoogle ScholarPubMed
Endicott, J, Spitzer, RL (1978). A diagnostic interview: the Schedule for Affective Disorders and Schizophrenia. Archives of General Psychiatry 35, 837–844.CrossRefGoogle ScholarPubMed
Endicott, J, Spitzer, RL (1979). Use of the Research Diagnostic Criteria and the Schedule for Affective Disorders and Schizophrenia to study affective disorders. American Journal of Psychiatry 136, 52–56.Google ScholarPubMed
Fawcett, J, Scheftner, W, Clark, D, Hedeker, D, Gibbons, R, Coryell, W (1987). Clinical predictors of suicide in patients with major affective disorders: a controlled prospective study. American Journal of Psychiatry 144, 35–40.Google ScholarPubMed
Fawcett, J, Scheftner, WA, Fogg, L, Clark, DC, Young, MA, Hedeker, D, Gibbons, R (1990). Time-related predictors of suicide in major affective disorder. American Journal of Psychiatry 147, 1189–1194.Google ScholarPubMed
Fiedorowicz, JG, Coryell, WH (2007). Cholesterol and suicide attempts: a prospective study of depressed inpatients. Psychiatry Research 152, 11–20.CrossRefGoogle ScholarPubMed
Goldberg, JF, Harrow, M (2004). Consistency of remission and outcome in bipolar and unipolar mood disorders: a 10-year prospective follow-up. Journal of Affective Disorders 81, 123–131.CrossRefGoogle ScholarPubMed
Goldberg, JF, Harrow, M, Whiteside, JE (2001). Risk for bipolar illness in patients initially hospitalized for unipolar depression. American Journal of Psychiatry 158, 1265–1270.CrossRefGoogle ScholarPubMed
Goldstein, RB, Black, DW, Nasrallah, A, Winokur, G (1991). The prediction of suicide. Sensitivity, specificity, and predictive value of a multivariate model applied to suicide among 1906 patients with affective disorders. Archives of General Psychiatry 48, 418–422.CrossRefGoogle ScholarPubMed
Hedeker, D, Siddiqui, O, Hu, FB (2000). Random-effects regression analysis of correlated grouped-time survival data. Statistical Methods in Medical Research 9, 161–179.CrossRefGoogle ScholarPubMed
Hoyer, EH, Olesen, AV, Mortensen, PB (2004). Suicide risk in patients hospitalised because of an affective disorder: a follow-up study, 1973–1993. Journal of Affective Disorders 78, 209–217.CrossRefGoogle ScholarPubMed
Judd, LL, Akiskal, HS, Schettler, PJ, Coryell, W, Maser, J, Rice, JA, Solomon, DA, Keller, MB (2003). The comparative clinical phenotype and long term longitudinal episode course of bipolar I and II: a clinical spectrum or distinct disorders? Journal of Affective Disorders 73, 19–32.CrossRefGoogle ScholarPubMed
Judd, LL, Akiskal, HS, Schettler, PJ, Endicott, J, Maser, J, Solomon, DA, Leon, AC, Rice, JA, Keller, MB (2002). The long-term natural history of the weekly symptomatic status of bipolar I disorder. Archives of General Psychiatry 59, 530–537.CrossRefGoogle ScholarPubMed
Kallner, G, Lindelius, R, Petterson, U, Stockman, O, Tham, A (2000). Mortality in 497 patients with affective disorders attending a lithium clinic or after having left it. Pharmacopsychiatry 33, 8–13.CrossRefGoogle ScholarPubMed
Keller, MB, Lavori, PW, Friedman, B, Nielsen, E, Endicott, J, McDonald-Scott, P, Andreasen, NC (1987). The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry 44, 540–548.CrossRefGoogle ScholarPubMed
Krupinski, M, Fischer, A, Grohmann, R, Engel, R, Hollweg, M, Moller, HJ (1998). Risk factors for suicides of inpatients with depressive psychoses. European Archives of Psychiatry and Clinical Neuroscience 248, 141–147.CrossRefGoogle ScholarPubMed
Kupfer, DJ, Carpenter, LL, Frank, E (1988). Is bipolar II a unique disorder? Comprehensive Psychiatry 29, 228–236.CrossRefGoogle Scholar
Leon, AC, Friedman, RA, Sweeney, JA, Brown, RP, Mann, JJ (1990). Statistical issues in the identification of risk factors for suicidal behavior: the application of survival analysis. Psychiatry Research 31, 99–108.CrossRefGoogle ScholarPubMed
Mann, JJ, Apter, A, Bertolote, J, Beautrais, A, Currier, D, Haas, A, Hegerl, U, Lonnqvist, J, Malone, K, Marusic, A, Mehlum, L, Patton, G, Phillips, M, Rutz, W, Rihmer, Z, Schmidtke, A, Shaffer, D, Silverman, M, Takahashi, Y, Varnik, A, Wasserman, D, Yip, P, Hendin, H (2005). Suicide prevention strategies: a systematic review. Journal of the American Medical Association 294, 2064–2074.CrossRefGoogle ScholarPubMed
Maser, JD, Akiskal, HS, Schettler, P, Scheftner, W, Mueller, T, Endicott, J, Solomon, D, Clayton, P (2002). Can temperament identify affectively ill patients who engage in lethal or near-lethal suicidal behavior? A 14-year prospective study. Suicide and Life-Threatening Behavior 32, 10–32.CrossRefGoogle ScholarPubMed
McMahon, FJ, Stine, OC, Chase, GA, Meyers, DA, Simpson, SG, DePaulo, Jr. JR (1994). Influence of clinical subtype, sex, and lineality on age at onset of major affective disorder in a family sample. American Journal of Psychiatry 151, 210–215.Google Scholar
Murphy, GE, Wetzel, RD, Robins, E, McEvoy, L (1992). Multiple risk factors predict suicide in alcoholism. Archives of General Psychiatry 49, 459–463.CrossRefGoogle ScholarPubMed
Oquendo, MA, Bongiovi-Garcia, ME, Galfalvy, H, Goldberg, PH, Grunebaum, MF, Burke, AK, Mann, JJ (2007). Sex differences in clinical predictors of suicidal acts after major depression: a prospective study. American Journal of Psychiatry 164, 134–141.CrossRefGoogle ScholarPubMed
Oquendo, MA, Waternaux, C, Brodsky, B, Parsons, B, Haas, GL, Malone, KM, Mann, JJ (2000). Suicidal behavior in bipolar mood disorder: clinical characteristics of attempters and nonattempters. Journal of Affective Disorders 59, 107–117.CrossRefGoogle ScholarPubMed
Rice, J, Reich, T, Andreasen, NC, Endicott, J, Van Eerdewegh, M, Fishman, R, Hirschfeld, RM, Klerman, GL (1987). The familial transmission of bipolar illness. Archives of General Psychiatry 44, 441–447.CrossRefGoogle ScholarPubMed
Rice, JP, McDonald-Scott, P, Endicott, J, Coryell, W, Grove, WM, Keller, MB, Altis, D (1986). The stability of diagnosis with an application to bipolar II disorder. Psychiatry Research 19, 285–296.CrossRefGoogle ScholarPubMed
Rice, JP, Rochberg, N, Endicott, J, Lavori, PW, Miller, C (1992). Stability of psychiatric diagnoses. An application to the affective disorders. Archives of General Psychiatry 49, 824–830.CrossRefGoogle Scholar
Rihmer, Z (1996). Strategies of suicide prevention: focus on health care. Journal of Affective Disorders 39, 83–91.CrossRefGoogle ScholarPubMed
Scheftner, WA, Young, MA, Endicott, J, Coryell, W, Fogg, L, Clark, DC, Fawcett, J (1988). Family history and five-year suicide risk. British Journal of Psychiatry 153, 805–809.CrossRefGoogle ScholarPubMed
Schneider, B, Muller, MJ, Philipp, M (2001). Mortality in affective disorders. Journal of Affective Disorders 65, 263–274.CrossRefGoogle ScholarPubMed
Serretti, A, Mandelli, L, Lattuada, E, Cusin, C, Smeraldi, E (2002). Clinical and demographic features of mood disorder subtypes. Psychiatry Research 112, 195–210.CrossRefGoogle ScholarPubMed
Spitzer, RL, Endicott, J, Robins, E (1978). Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry 35, 773–782.CrossRefGoogle ScholarPubMed
Tondo, L, Baldessarini, RJ, Hennen, J, Minnai, GP, Salis, P, Scamonatti, L, Masia, M, Ghiani, C, Mannu, P (1999). Suicide attempts in major affective disorder patients with comorbid substance use disorders. Journal of Clinical Psychiatry 60 (Suppl. 2), 63–69; discussion 75–66, 113–116.Google ScholarPubMed
Tondo, L, Lepri, B, Baldessarini, RJ (2007). Suicidal risks among 2826 Sardinian major affective disorder patients. Acta Psychiatrica Scandinavica 116, 419–428.CrossRefGoogle ScholarPubMed
Valtonen, H, Suominen, K, Mantere, O, Leppamaki, S, Arvilommi, P, Isometsa, ET (2005). Suicidal ideation and attempts in bipolar I and II disorders. Journal of Clinical Psychiatry 66, 1456–1462.CrossRefGoogle ScholarPubMed
Young, MA, Fogg, LF, Scheftner, WA, Fawcett, JA (1994). Interactions of risk factors in predicting suicide. American Journal of Psychiatry 151, 434–435.Google ScholarPubMed