Bipolar disorder. IV: Early suicide attempts in a long-term follow-up of patients with bipolar disorder

Background

Bipolar disorder (BD) is a serious chronic disease with a high frequency of suicide attempts (SA) and suicides. There are few long-term studies concerning characteristics of SA in BD, especially what characterizes early from late SA.

Methods

A long-term study of 51 BD patients (DSM-IV) with SA were collected from lithium dispensaries in northern Sweden. Patients were divided into early SA (the first five years) after age of onset (AOO) or late SA.

Results

Patients with early SA were younger (p = 0.036), met BD earlier (p = 0.005), had less repeated depressions before SA (p = 0.002), often performed SA at first episode (p < 0.001) and before initiating of lithium (p = 0.002). Before first SA they had, fewer but more frequent episodes/year (p < 0.001), fewer depressive (p < 0.001) but more frequent depressive episodes/year (p < 0.001), lower frequency of hypomanic (p = 0.016) or manic episodes (p = 0.006). They had a higher frequency of episodes/year off (p = 0.047) and on (p = 0.042) lithium. Twenty percent of all patients performed SA at first episode, 47 % early SA and 65 % first ten years after AOO.

Early SA was associated with a family history of first- and/or second-degree relative of affective disorder (AD) (p = 0.005), first-degree relative of AD (p = 0.031) and first-degree relative of BD (p = 0.049). All patients with early SA had a family history of AD.

Conclusions

Patients with early SA have a more severe form of BD. Family history of AD among first- and/or second-degree relatives is significantly associated with especially early SA which implies a special psychiatric treatment and care for this BD group.