327
Clinical Neuropsychiatry (2006) 3, 5,
© 2006 Giovanni Fioriti Editore s.r.l.
327-331
RECEIVED NOVEMBER 2006, ACCEPTED JANUARY 2007
SUICIDE ATTEMPTS IN BIPOLAR DISORDER PATIENTS
Maurizio Pompili, Leonardo Tondo, Alessandro Grispini, Eleonora De Pisa, David Lester,
Gloria Angeletti, Letizia Buonocore, Paolo Girardi, and Roberto Tatarelli
Summary
Object: The risk of completed suicide is very high among bipolar disorder (BPD) patients. The risk of attempted
suicide is not as well-quantified, but attempting suicide is the most important factor for predicting the risk of subsequent
completed suicide.
Method: We retrospectively evaluated 88 patients diagnosed with bipolar I, bipolar II, or unipolar depression. Of
these, 44 had made at least one suicide attempt, and were matched for age, sex and diagnosis with 44 patients who had
never attempted suicide.
Results: In the univariate contrasts, suicidal patients were more likely to be men, single, ill for a long period of
time, bipolar, substance abusing, and unemployed. In a logistic regression analysis, only length of illness and
unemployment were statistically significant.
Conclusions: Our results support previous finding in the literature but suggest that length of illness and
unemployment are two important variables involved in the precipitation of suicide attempts in bipolar and unipolar
patients. Length of illness is a trait-dependent risk factor (unchangeable) while unemployment is a state-dependent
risk factor (which can potentially be modified).
Limitations: The study findings may not generalize to other samples, settings, and treatment programs.
Keywords: Suicide Attempts Bipolar Disorder Prevention
Declaration of interest: None
Maurizio Pompili, M.D.
a,b
, Leonardo Tondo M.D.
b,c
, Alessandro Grispini, M.D
a
., Eleonora De Pisa, M.D., David Lester,
Ph.D.
d
, Gloria Angeletti, M.D.
a
, Letizia Buonocore, M.D.
a
, Paolo Girardi, M.D.
a
and Roberto Tatarelli, M.D.
a
a. Department of Psychiatry, SantAndrea Hospital, University of Rome La Sapienza, Rome, Italy;
b. Department of Psychiatry, Harvard Medical School & International Consortium for Bipolar Disorder Research, McLean
Division of Massachusetts General Hospital, Belmont, MA 02478-1906 USA;
c. Department of Psychology, University of Cagliari, Centro Lucio Bini Mood Disorders Research Center, Cagliari, Sardinia
d. Center for the Study of Suicide, Blackwood, NJ, USA
Corresponding Author
Maurizio Pompili, M.D., Dept. of Psychiatry, SantAndrea Hospital, Via di Grottarossa,
1035 00189 Rome, Italy maurizio.pompili@uniroma1.it.
A call to action to prevent suicide has been
launched by WHO and by many governments
worldwide. A number of preventive strategies have been
proposed, but their effectivenss has rarely been tested
or verified. New strategies to identify persons at risk
for suicidal behavior have been proposed recently,
imitating programs for the early detection of
cardiovascular disorders (Knox et al. 2004). Persons
who attempt suicide, particularly those who make
violent or potentially lethal attempts, resemble closely
in clinical and psychological characteristics those who
commit suicide (Mann 2002).
Suicidal behavior in patients diagnosed with
bipolar (manic-depressive, BPD) or major depressive
disorders (MDD) has been investigated extensively
(Goodwin & Jamison 2006; Lester 1993; Baldessarini
et al. 2006a, b). The lifetime prevalence of DSM-IV
BPD type I (with mania and often psychotic features)
is at least 1%, and the total prevalence of bipolar
syndromes may by as high as 5% if type II BPD with
relatively liberal hypomania criteria and cyclothymia
are included (Kessler et al. 2005, Goodwin & Jamison
2006).
Guze and Robins (1970) analyzed 17 long-term
studies and found that the median proportion of deaths
ascribed to suicide among persons considered to have
a major affective disorder was approximately 15%
(mean 30.6% ± 18.3%; range, 12%60%) of all deaths.
BRIEF REPORT