Factors That Influence Suicide in People With Depression and Bipolar Disorder

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While there are mental disorders that carry an increased risk of suicidal ideation and suicide attempts, there has been little understanding of how to determine when a patient is most at risk. Understanding the risk factors for suicide and developing prevention strategies could be effective in reducing suicide attempts by those with bipolar and major depressive disorder.

A study illuminated the differences observed in the patterns of suicide attempts in bipolar and depression patients, finding that it’s the course of the illness, rather than a specific diagnosis, that determines the risk of suicide.

Patients with bipolar disorder have a higher prevalence of suicide attempts when compared with depression patients, but the difference was not significant when the disorders were measured at a comparable point in the illness progression.

The study by University of Helsinki researchers looked at 176 patients with bipolar disorder and 249 patients with major depressive disorder that were enrolled in the Jorvi Bipolar Study or the Vantaa Depression Study. The findings revealed that a higher prevalence of suicide for bipolar was attributed to a younger age at which symptoms appear, a longer duration of symptoms, more episodes of illness that represent a great proportion of time in a low, depressive mood and mixed illness phases. The researchers believe that the findings illustrate the importance of reducing the time which patients are in high-risk phase of the disorder.

Prior to the study 51 percent of the patients with a bipolar diagnosis had attempted suicide. Of those with major depressive disorder, 33 percent had attempted suicide. In the first 18 months following baseline, the suicide attempts were 20 percent and 10 percent, respectively.

The analysis showed that the median length of time past diagnosis was seven years more for bipolar disorder patients when compared with major depressive disorder patients. The age of onset for bipolar disorder was also ten years younger than for depression, with a median 21 versus 31 years.

Those patients that had bipolar disorder spent 33.5 percent of their time in a major depressive episode, compared to 22.5 percent for patients with major depressive disorder. However, major depressive disorder patients spent 30.3 percent of their time with sub threshold depression, compared with 16.6 percent of bipolar disorder patients.

The researchers found that suicide attempts did not vary widely between patients with bipolar I disorder, bipolar II disorder and major depressive disorder, but were more likely to vary by mood phase of the disorder.

The findings may provide critical information that helps clinicians reduce the incidence of high-risk phases of each disorder, or provide tools that help patients recognize warning signs. Patients that exhibit the phase associated with a high incidence of suicide attempts may receive additional treatments aimed at preventing suicide.

The researchers also determined that there were several factors that made a patient more likely to attempt suicide, such as being female, being below 40 years of age and having poor social support.

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