Bipolar Disorder VI: Long-Term Follow-Up of Suicide Attempts and Prophylactic Effect of Lithium Treatment in Bipolar...

Bipolar disorder (BD) is a common illness that is highly associated with suicide attempts (SAs) and suicide. There have been few long-term follow-up studies exploring characteristics of SAs among patients with bipolar disorder (BPs).

BPs (n = 192) diagnosed using DSM-IV criteria were recruited and followed up for approximately 25 years, comparing patients without and with SA on several relevant clinical variables. The effect of lithium treatment was also studied.

BPs with SAs were more commonly female (p = .047), had poorer treatment response to lithium (p = .018) and poorer compliance (p = .008), were younger (p = .010), and had earlier age of onset (p < .001). A family history of first- and/or second-degree relatives with affective disorders was more common in BPs with SAs (p = .028), who also more often had a first-degree relative with an affective disorder (p = .020). A family history of suicide was more common in BPs with SAs (p = .043). There were more total episodes of the disease (p < .001), episodes per year (p = .002), total depressive episodes (p = .001), and depressive episodes per year (p < .001) in BPs with SAs. While off lithium, there were more depressive episodes in BPs with SAs (p = .011). While on lithium, BPs with SAs had more episodes (p = .002), episodes per year (p = .001), depressive episodes (p = .001), depressive episodes per year (p = .004), hypomanic episodes (p = .034), and hypomanic episodes per year (p = .008). Multivariate logistic regression revealed significant risk factors in age of onset (p = .001) and total number of depressive episodes/year (p = .003).

BPs with SAs have a more severe form of BD and less protective effect of lithium treatment.