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Suicide risk in bipolar patients: the role of co-morbid substance use disorders
Authors:Dalton E Jane  Cate-Carter Tasha D  Mundo Emanuela  Parikh Sagar V  Kennedy James L
Institution: Neurogenetics Section,; Bipolar Disorders Clinic, Center for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Ontario, Canada; Department of Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
Abstract:Objective:  Bipolar disorder is associated with a high frequency of both completed suicides and suicide attempts. The primary aim of this study was to identify clinical predictors of suicide attempts in subjects with bipolar disorder.
Methods:  We studied 336 subjects with a diagnosis of bipolar I, bipolar II, or schizoaffective disorder (bipolar type). The Structured Clinical Interview for DSM-IV (SCID-I) was administered and subsequently two expert psychiatrists established a diagnosis. Predictors of suicide attempts were examined in attempters and non-attempters.
Results:  The lifetime rate of suicide attempts for the entire sample was 25.6%. A lifetime co-morbid substance use disorder was a significant predictor of suicide attempts: bipolar subjects with co-morbid substance use disorders (SUD) had a 39.5% lifetime rate of attempted suicide, while those without had a 23.8% rate (odds ratio=2.09, 95% CI=1.03–4.21, χ2=4.33, df=1, p=0.037).
Conclusions:  Lifetime co-morbid SUD were associated with a higher rate of suicide attempts in patients with bipolar disorder. This relationship may have a genetic origin and/or be explained by severity of illness and trait impulsivity.
Keywords:alcohol use disorders  bipolar disorder  co-morbidity  impulsivity  substance use disorders  suicide risk
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