Comparison between clinical characteristics of suicide attempters and non-attempters in a sample of bipolar disorder patients with mania as first episode polarity

  • Lena Abreu, Bipolar Disorder Research Program, Institute of Psychiatry, University of São Paulo Medical School, Brazil
  • Fabiano Nery, University of São Paulo Medical School, Brazil
  • Elisa Brietzke, Bipolar Disorder Research Program, Institute of Psychiatry, University of São Paulo Medical School. Bipolar Disorder Program,, Brazil
  • Pedro Magalhaes, Federal University of Rio Grande do Sul, Brazil
  • Flavio Kapczinski, Federal University of Rio Grande do Sul, Brazil
  • Beny Lafer, University of São Paulo Medical School, Brazil

Objective: Little attention has been drawn to mania as first episode polarity and suicide attempts in bipolar disorder (BD). Our aim is to compare clinical characteristics between suicide attempters and non-attempters in a sample of BD patients with mania as first related episode.

Methods: We selected 247 outpatients with mania as first episode polarity from a sample of 552 patients with DSM-IV BD type I (DSM-IV) from the Brazilian Research Consortium for Bipolar Disorders. Participants were divided in two groups: suicide attempters (N=93, mean age: 43.0±12.9, males:30%) and non-attempters (N=154, mean age:39.8± 9.8, males:70%), according to the presence of lifetime suicide attempts. We compared these two groups regarding demographic and clinical variables.

Results: Attempters had more rapid cycling (p= 0.002), more SUD (substance use disorders, p=0.020), more anxiety disorders (p=0.002), eating disorders (p= 0.014), and early onset of mania (age of onset <=19) (p=0.001). Stepwise logistic regression revealed that the following variables are associated with suicide attempts: early onset of mania (Wald = 6.56; OR 2.2; 95% CI= 1.20-4.12, p=0.010), SUD (Wald= 4.48; OR 1.9; 95% CI= 1.04 -3.44; p=0.034) and anxiety disorders (Wald= 6.38; OR 2.0; 95% CI = 1.17 – 3.64; p=0.012). This model predicts 67% of suicide attempts status.

Conclusion: In our sample of BD patients with mania as first episode polarity, early age of onset of mania, SUD and anxiety disorders are associated with suicide attempts during lifetime. Our results suggest that these characteristics might be markers of suicidal behavior in this subgroup of patients.