Research report Is the serotonin transporter polymorphism (5-HTTLPR) a potential marker for suicidal behavior in bipolar disorder patients? Fernando Silva Neves a, ⁎, Leandro Fernandes Malloy-Diniz c , Marco Aurélio Romano-Silva a , Gabriel Costa Aguiar b , Lorena Oliveira de Matos b , Humberto Correa a a Department of Mental Health, Universidade Federal de Minas Gerais, Brazil b Department of Pharmacology, Universidade Federal de Minas Gerais, Brazil c Department of Psychology, Universidade Federal de Minas Gerais, Brazil article info abstract Article history: Received 30 July 2009 Received in revised form 24 November 2009 Accepted 29 December 2009 Available online 21 January 2010 Background: Suicide prediction is a huge challenge for mental health workers. Structured interviews based on epidemiological and clinical factors don't show effectiveness for suicide prevention. Biological markers, such as 5-HTTLPR, could help for identification of potential suicide attempters. Methods: We evaluated 198 bipolar patients and 103 health controls, using a structured interview according to DSM-IV criteria. Genotyping, blind of clinical assessment for identification of S carriers and structured interviews were performed in order to describe clinical and epidemiological factors which could be associated with suicide behavior. Statistical analyses were calculated by the x 2 test and logistic regression model. Results: We found that 26.77% and 16.67% had a lifetime history of non violent suicide attempt and violent suicide attempt, respectively. The clinical factors associated with violent and non violent suicide attempt had several differences. Violent suicide attempters had an earlier illness onset and had a higher number of psychiatric comorbidities (borderline personality disorder, panic disorder and alcoholism). The frequency of S allele carriers was higher only in those patients who had made a violent suicide attempt in their lifetime (x 2 = 16.969; p = 0.0001). In a logistic regression model including these factors, S allele carrier (5-HTTLPR) was the only factor associated with violent suicide attempt. Limitations: Sample size and retrospective assessment of suicide behavior history are the limitations of this study. Conclusions: Our study showed that serotonin polymorphism (5-HTTLPR) is strongly associated with violent suicidal behavior in BD patients. If confirmed, our results could be an important step to create a genetic tool for long-term suicide prediction. © 2010 Elsevier B.V. All rights reserved. Keywords: Bipolar disorder 5-HTTLPR Suicide attempt Suicide prediction 1. Introduction Bipolar disorder (BD) is a severe, chronic and relatively common disorder that exhibits a considerable degree of morbidity as a consequence of its recurrent mood oscillations, cognitive impairment and a variable degree of disability (Goodwin and Jamison, 2007). Moreover, these patients have high rates of mortality from violent causes such as traffic accidents, homicide and suicide constituting a huge social burden (Osby et al., 2001). Suicidal behavior is a matter of major concern in the management of BD patients for many reasons. First, their suicide rates are about 60 times higher than that observed in Journal of Affective Disorders 125 (2010) 98–102 ⁎ Corresponding author. Departamento de Saúde Mental, Faculdade de Medicina, Universidade Federal de Minas Gerais, 30.130-100, Av. Alfredo Balena, 190, Belo Horizonte, Brazil. Tel.: + 55 31 34099785. E-mail address: fneves.bhz@terra.com.br (F.S. Neves). 0165-0327/$ – see front matter © 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2009.12.026 Contents lists available at ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad