Bipolar Disorder. VI: Long-term follow-up of suicide attempts and prophylactic effect of lithium treatment in bipolar affective disorder

Bipolar disorder (BD) is a common illness highly associated with suicide attempts (SA) and suicide. There are few long-term follow-up studies exploring characteristics of SA among bipolar patients (BP). BP ( n =192) diagnosed by DSM-IV were recruited and followed-up for approximately 25 years comparing patients without and with SA for several relevant clinical variables. The effect of lithium treatment was also studied. BP with SA were more common in females (p=.047), had poorer treatment response with lithium (p=.018), poorer compliance (p=.008), were younger (p=.010) and had earlier age of onset (AOO) (p<.001). A family history (FH) of first- and/or second-degree relatives with affective disorders (AD) were more common in BP with SA (p=.028) and had more often a first-degree relative with AD (p=.020). A FH of suicide was more common in BP with SA (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 BP with SA. While off lithium, there were more depressive episodes in BP with SA (p=.011). While on lithium, BP with SA 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 found significant risk factors in AOO (p=.001) and total number of depressive episodes/year (p=.003). BP with SA have a more severe form of BD and less protective effect of lithium treatment. 192 bipolar patients (BP) with or without suicide attempts (SA) were followed-up for approximately 25 years assessing several clinical variables. The effect of lithium treatment was also studied. Multivariate logistic regression found significant risk factors in age of onset of BP (p=.001) and total number of depressive episodes/year (p=.003). BP with SA have a more severe form of BD and less protective effect of lithium treatment.