Impact of first-episode polarity on clinical features associated to suicide attempts in bipolar disorder type I patients

Abstract

Background: Little attention has been drawn to the relationship between episode polarity at onset and its relationship with suicide attempts (SA) during the course of Bipolar Disorder (BD). Our aim was to compare clinical features between attempters and non-attempters with manic onset and depressive onset. Methods: We evaluated 376 outpatients with DSM-IV BD type I from the Brazilian Research Network. Participants were divided in two groups: manic onset (MO) (n = 146, 38.8%) and depressive onset (DO) (n = 230, 61.2%). Each subgroup was divided according the presence of lifetime suicide attempts (MO group: 52 attempters and 94 non-attempters; DO group: 95 attempters and 135 non-attempters). We compared the attempters and non-attempters of the two groups regarding demographic, clinical variables and outcome measures. Results: Stepwise logistic regression revealed that the following clinical features are associated with SA in MO patients: comorbid OCD (OR = 8.3 CI = 1.6–43.3 p = 0.01), alcohol dependence (OR = 4.7 CI = 1.4–15.8 p = 0.01), rapid cycling (OR = 4.2 CI = 1.3–13 p = 0.01) and agoraphobia (OR = 4.2 CI = 1.2–14.6 p = 0.02). For DO patients, the clinical features associated with SA were: presence of hospitalization (OR = 3.9 CI = 1.9–8 p £ 0.001), family history of completed suicide (OR = 2.9 CI = 1.3–6 p = 0.005), rapid cycling (OR = 2.7 CI = 1.2–5.7 p = 0.009) and female gender (OR = 2.2 CI = 1–5 p = 0.041). Conclusion: Risk factors for SA in MO patients are associated with rapid cycling and comorbidities with axis I disorders (OCD, alcohol dependence and agoraphobia) and in DO patients with features related to the course of illness (hospitalizations and rapid cycling), female gender and family history of completed suicide. Polarity of first episode may be important in determining different risk factors for suicide attempts in patients with Bipolar Disorder type I.