© 2014 John Wiley & Sons A/S Published by John Wiley & Sons Ltd.
Bipolar Disorders 2014: 16: 642–651
BIPOLAR DISORDERS
Original Article
Risk factors for suicidal ideations in patients with bipolar disorder Umamaheswari V, Avasthi A, Grover S. Risk factors for suicidal ideations in patients with bipolar disorder. Bipolar Disord 2014: 16: 642–651. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Objective: To identify the risk factors for suicidal ideation in subjects with bipolar depression.
Vanamoorthy Umamaheswari, Ajit Avasthi and Sandeep Grover Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Methods: One-hundred and thirty subjects diagnosed with bipolar depression were evaluated on the following scales: Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), Patient Health Questionnaire-15 (PHQ-15), Barrat’s Impulsivity Scale (BIS), Irritability, Anxiety, and Depression (IDA) Scale, Young Mania Rating Scale (YMRS), Buss–Durke Hostile Inventory (BDHI), and Brief Psychiatric Rating Scale (BPRS). Results: Based on the BDI suicidal thoughts and wishes item (score of ≥1), the study sample was divided into those with and those without suicidal ideation. On binary logistic regression analysis, the odds ratio (OR) for the presence of suicidal ideations was highest for grade of severity of current episode [OR = 22.601, 95% confidence interval (CI): 6.39–79.92], followed by the presence of a family history of suicide attempt (OR = 18.06, 95% CI: 1.36–238.39), any preceding life event (OR = 3.797, 95% CI: 1.195–12.067), and past history of suicide attempt (OR = 3.11, 95% CI: 0.649–14.96). Other risk factors for the presence of suicidal ideations were severity of subsyndromal manic symptoms, family history of bipolar disorder, past history of hospitalization, severity of subsyndromal anxiety, hopelessness, hostility, presence of psychotic symptoms, and duration of current episode. Conclusion: Among the various predictors of suicidal ideations, the severity of the current episode, the presence of a family history of suicide attempt, preceding life event, and past history of suicide attempt are the most important risk factors for suicidal ideations in patients with bipolar disorder. Hence, patients with these risk factors should be closely monitored to prevent suicide attempts and completed suicides.
Bipolar disorder is a debilitating, chronic mental illness associated with considerable health care costs and high rates of premature mortality (1–3). It is estimated that 25–50% of patients with bipolar disorder attempt suicide at least once (4–6), and 33–80% of patients with bipolar disorder report suicidal ideation and/or suicide attempts during their lifetime (7, 8). About one-fifth (19%) of all deaths in subjects with bipolar disorder are due to suicide (4). In bipolar disorder, the ratio of suicide attempt to completed suicide is approximately 3:1
642
doi: 10.1111/bdi.12179 Key words: bipolar depression – risk factors – suicidal ideations Received 26 January 2013, revised and accepted for publication 29 August 2013 Corresponding author: Dr. Sandeep Grover Department of Psychiatry Postgraduate Institute of Medical Education & Research Chandigarh 160012 India Fax: +91-172-2744401 E-mail: [email protected]
in contrast to the ratio of 30:1 in the general population (9). This suggests high lethality of suicidal acts in patients with bipolar disorder. Therefore, it is very important to detect risk factors for suicide as early as possible and to intervene prior to the person making the first suicide attempt. Studies suggest that suicidal ideations are an important marker for identifying patients at risk for suicide (10, 11) and suicide attempts (12). The lifetime prevalence of suicidal ideations in patients with bipolar disorder varies from 30 to
Risk factors for suicidal ideations 75% (13, 14) in contrast to 2.0–25.4% in the general population (10, 11). Although some studies have evaluated the risk factors for suicide attempt in subjects with bipolar disorder, only a handful of studies have investigated the risk factors for suicidal ideations in subjects with bipolar disorder, especially in the depressive phase of the disorder. The various risk factors for suicide ideations in patients with bipolar disorder include early age of onset (1 on Item 9), the study subjects were divided into those with and those without suicidal ideation. By design, each group had 65 subjects. These two groups were matched on the sociodemographic variables of age, gender, socioeconomic status, and duration of illness. All of the subjects in both groups were assessed on the above-described instruments over one to two sessions, not separated by more than 24 hours. Statistical analyses
Data were analysed using SPSS-14 (SPSS Inc., Chicago, IL, USA). Means and standard deviations (SDs) with ranges were computed for continuous variables. Frequencies and percentages were computed for discontinuous sociodemographic and clinical variables. Continuous variables for the two groups (those with and those without suicidal ideation) were compared using the t-test or the Mann–Whitney U-test. Ordinal and nominal variables for the two groups were compared using the chi-square test. Yate’s correction and Fisher’s exact values were computed, wherever required. Binary regression analysis was used to study the relationship between various risk factors and suicidal ideation in bipolar depression.
643
Umamaheswari et al. The NIMH Life Chart was used to study the clinical course. As shown in Table 2, the two groups did not differ in terms of number of episodes (depressive, manic, mixed, and total) in their lifetime and affective morbidity (i.e., total number of episodes prior to assessment multiplied by duration of each episode). However, they differed significantly in terms of mean duration spent in depression, with longer duration of depressive episodes in the bipolar depression with suicidal ideation group and shorter duration of inter-episodic period. A significantly higher percentage of patients in the bipolar depression with suicidal ideation group had a past history of suicide attempt (36.92%) and hospitalization for their affective disorder (40%). Few patients in either group had a rapid cycling course and seasonality as a specifier, and there was no significant difference between the two groups on these variables. Also, as shown in Table 2, the duration of the current episode was significantly longer for the bipolar depression with suicidal ideation group. Ten patients in the bipolar depression with suicidal ideation group attempted suicide in the current episode, and this was statistically significant when compared to the group without suicidal ideation, in which only one patient attempted suicide in the current episode. There was no significant difference between the two groups with respect to abuse of/ dependence on any substance at the time of assess-
Results Sociodemographic profile
The mean age of the study sample was 43.04 (SD = 11.96) years and the mean duration of education was 10.37 (SD = 3.95) years. Two-thirds of the subject group were male (n = 86; 66.2%). As shown in Table 1, the groups differed significantly in terms of religious affiliation, with non-Hindus being overrepresented in the group of patients with bipolar depression with suicidal ideation as compared to the group of patients with bipolar depression without suicidal ideation. Clinical profile
A comparison of the clinical characteristics of patients with and without suicidal ideation is shown in Table 2. As per the study design, the two groups were matched for total duration of illness in years. There was no significant difference in the age of onset of illness between groups. Very few patients in either group had a comorbid physical illness or a psychiatric disorder. One-third to onefourth of patients in both groups had comorbid substance abuse/dependence. A family history of bipolar disorder and suicide was significantly more frequently present in patients with suicidal ideation as compared to the group of patients without suicidal ideation.
Table 1. Sociodemographic profiles of patients with bipolar depression with and without suicidal ideation Variables Marital status, n (%) Currently single Married Religion, n (%) Hindu Non-Hindu Occupation, n (%) Employed Unemployed Income, rupees, mean (SD) SES class, n (%)a Upper Middle Lower Family type (%) Nuclear Non-nuclear Locality, n (%) Urban Rural
BD with suicidal ideation (n = 65)
BD without suicidal ideation (n = 65)
9 (13.84) 56 (86.15)
14 (21.53) 51 (78.46)
31 (47.69) 34 (52.30)
43 (66.15) 22 (33.84)
40 (61.53) 25 (38.46) 15,031 (22,039.00)
39 (60.00) 26 (40.00) 17,184 (43,253.38)
3 60 2
2 62 1
34 (52.30) 31 (47.69)
23 (35.38) 42 (64.61)
30 (46.15) 35 (53.84)
36 (55.38) 29 (44.61)
BD = bipolar depression; SD = standard deviation; SES = socioeconomic status. a SES status as assessed by the Kuppuswamy Socioeconomic Status Scale (42, 43). b The chi-square value was calculated by using the weighted cases statistic for the SES class.
644
Chi-square/t-test
p-value
1.321
0.25
4.517
0.034
0.032
0.857
0.357 1.595b
0.722 0.450
3.780
0.052
1.108
0.293
Risk factors for suicidal ideations Table 2. Clinical profile of the study groups
Variables Age of illness onset, years, mean (SD) Duration of illness, years, mean (SD) Comorbid physical diagnosis, n (%) Comorbid psychiatric illness, n (%) Family history of BPAD, n (%) Family history of suicide, n (%)a Family history of psychiatric disorder other than BPAD, n (%)b Substance abuse/dependence, n (%) No. of lifetime episodes, mean (SD)c Depression Mania Hypomania Mixed Duration of each lifetime episode, months, mean (SD)c Depression Mania Hypomania Mixed Affective morbidity, mean (SD) Duration of inter-episodic period, years, mean (SD) Past suicide attempt, n (%) Past hospitalization, n (%) Rapid cycling affective disorder, n (%) Seasonality, n (%) Current substance abuse/dependence, n (%) Any preceding life event, n (%)d Any preceding poor compliance, n (%) Suicide attempt in current episode, n (%) Duration of current episode, mean (SD)e
BD with suicidal ideation (n = 65)
BD without suicidal ideation (n = 65)
Chi-square/ t-test
p-value
29.13 (10.42) 13.10 (9.70) 17 (26.15) 7 (10.76) 29 (44.61) 14 (21.53) 6 (9.23) 22 (33.84)
26.46 (10.21) 16.80 (11.90) 13 (20.00) 4 (6.15) 16 (24.61) 1 (1.53) 8 (12.30) 17 (26.15)
1.47 1.96 0.69 0.40f 5.74 10.85f 0.32 0.91
0.14 0.052 0.40 0.52 0.016 0.001 0.57 0.33
2.98 (2.20) 1.80 (1.70) 0.26 (0.59) 0.01 (0.12)
2.98 (2.60) 2.18 (2.90) 0.33 (0.66) 0.04 (0.27)
0.00 0.87 0.69 0.82
1.00 0.38 0.48 0.41
3.52 (1.99) 2.24 (2.77) 0.14 (0.31) 0.01 (0.12) 15.31 (18.34) 11.81 (9.39) 24 (36.92) 26 (40.00) 2 (3.07) 6 (9.23) 18 (27.69) 27 (41.53) 13 (20.00) 10 (15.38) 3.76 (5.76)
2.77 (1.87) 1.51 (1.60) 0.48 (1.93) 0.02 (0.13) 13.51 (17.26) 15.95 (11.92) 5 (7.69) 13 (20.00) 1 (1.53) 1 (1.53) 11 (16.92) 15 (23.07) 8 (12.30) 1 (1.53) 2.22 (2.34)
2.19 1.84 1.42 0.33 0.57 2.20 14.38f 6.19 1.00g 2.41f 2.17 5.06 1.42 6.35f 13.62
0.03 0.06 0.15 0.73 0.56 0.029 0.000 0.01 – 0.12 0.14 0.02 0.23 0.01 0.001
BD = bipolar depression; BPAD = bipolar affective disorder; SD = standard deviation. a Family history of mental illness and suicide was obtained from the Family Intervention of Genetics Study scale. b Other psychiatric disorders: (i) patients with bipolar disorder with suicidal ideation: schizophrenia (n = 4), anxiety disorders (n = 1), unipolar depression (n = 1); (ii) patients with bipolar disorder without suicidal ideation: schizophrenia (n = 4), anxiety disorders (n = 1), unipolar depression (n = 3). c Including the current episode prior to assessment. d Life events included stressors such as the death of a family member, financial loss, loss of job, and divorce. e Mann–Whitney value. f Chi-square test with Yate’s correction. g Fisher’s exact test.
ment for the current episode and for any preceding poor compliance with medications. However, significantly more patients in the suicidal ideation group had a prior life event when compared to those without suicidal ideation. Severity of current episode and various dimensions of psychopathology. As shown in Table 3, patients with bipolar depression with suicidal ideation had significantly higher scores on the BDI when compared to patients with bipolar depression without suicidal ideation. Similarly, patients with bipolar depression with suicidal ideation had significantly higher YMRS score, BPRS total score, and IDA scale total score as well as significantly higher scores on all four domains of the IDA scale and PHQ-15 items. The BHS total score for true items,
total score for false items, and overall total BHS score were significantly higher for patients with bipolar depression with suicidal ideation. There was no significant difference between the two groups with respect to any of the six first-order factors (attention, motor, self-control, cognitive complexity, perseverance, and cognitive instability) and three second-order factors (attentional impulsiveness, motor impulsiveness, and non-planning impulsiveness) of the BIS or BIS total score. Patients with bipolar depression with suicidal ideation had significantly higher scores on four of the five assault subscales (i.e., assault, verbal aggression, indirect hostility, and irritability), both the hostility subscales (i.e., resentment and suspicion), and the guilt subscale of the BDHI. The total hostility score (sum of the first seven subscales) was
645
Umamaheswari et al. Table 3. Comparison of severity of current episode and various psychopathology and psychological dimensions Variables
BD with suicidal ideation
BD without suicidal ideation
t-test/chi-square
p-value
BDI total score YMRS total scorea BPRS total score IDA total score PHQ-15 total score BHS–total positive score BHS–total false score BHS total score BIS total score Buss–Durke Hostile Inventory Assault Verbal aggression Indirect hostility Irritability Negativism Resentment Suspicion Guilt Total hostility score
33.50 (8.09) 1.29 (1.47) 25.89 (4.47) 29.32 (8.48) 7.10 (3.70) 9.30 (2.04) 7.60 (1.81) 16.90 (3.49) 68.42 (12.94)
22.63 (5.60) 0.30 (0.78) 23.60 (4.56) 19.92 (7.04) 4.89 (3.26) 5.69 (2.06) 5.06 (1.95) 10.75 (3.13) 68.87 (11.77)
8.90 1,342.50 2.80 6.80 3.61 10.01 7.65 10.56 0.20
Bipolar Disorders 2014: 16: 642–651
BIPOLAR DISORDERS
Original Article
Risk factors for suicidal ideations in patients with bipolar disorder Umamaheswari V, Avasthi A, Grover S. Risk factors for suicidal ideations in patients with bipolar disorder. Bipolar Disord 2014: 16: 642–651. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Objective: To identify the risk factors for suicidal ideation in subjects with bipolar depression.
Vanamoorthy Umamaheswari, Ajit Avasthi and Sandeep Grover Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Methods: One-hundred and thirty subjects diagnosed with bipolar depression were evaluated on the following scales: Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), Patient Health Questionnaire-15 (PHQ-15), Barrat’s Impulsivity Scale (BIS), Irritability, Anxiety, and Depression (IDA) Scale, Young Mania Rating Scale (YMRS), Buss–Durke Hostile Inventory (BDHI), and Brief Psychiatric Rating Scale (BPRS). Results: Based on the BDI suicidal thoughts and wishes item (score of ≥1), the study sample was divided into those with and those without suicidal ideation. On binary logistic regression analysis, the odds ratio (OR) for the presence of suicidal ideations was highest for grade of severity of current episode [OR = 22.601, 95% confidence interval (CI): 6.39–79.92], followed by the presence of a family history of suicide attempt (OR = 18.06, 95% CI: 1.36–238.39), any preceding life event (OR = 3.797, 95% CI: 1.195–12.067), and past history of suicide attempt (OR = 3.11, 95% CI: 0.649–14.96). Other risk factors for the presence of suicidal ideations were severity of subsyndromal manic symptoms, family history of bipolar disorder, past history of hospitalization, severity of subsyndromal anxiety, hopelessness, hostility, presence of psychotic symptoms, and duration of current episode. Conclusion: Among the various predictors of suicidal ideations, the severity of the current episode, the presence of a family history of suicide attempt, preceding life event, and past history of suicide attempt are the most important risk factors for suicidal ideations in patients with bipolar disorder. Hence, patients with these risk factors should be closely monitored to prevent suicide attempts and completed suicides.
Bipolar disorder is a debilitating, chronic mental illness associated with considerable health care costs and high rates of premature mortality (1–3). It is estimated that 25–50% of patients with bipolar disorder attempt suicide at least once (4–6), and 33–80% of patients with bipolar disorder report suicidal ideation and/or suicide attempts during their lifetime (7, 8). About one-fifth (19%) of all deaths in subjects with bipolar disorder are due to suicide (4). In bipolar disorder, the ratio of suicide attempt to completed suicide is approximately 3:1
642
doi: 10.1111/bdi.12179 Key words: bipolar depression – risk factors – suicidal ideations Received 26 January 2013, revised and accepted for publication 29 August 2013 Corresponding author: Dr. Sandeep Grover Department of Psychiatry Postgraduate Institute of Medical Education & Research Chandigarh 160012 India Fax: +91-172-2744401 E-mail: [email protected]
in contrast to the ratio of 30:1 in the general population (9). This suggests high lethality of suicidal acts in patients with bipolar disorder. Therefore, it is very important to detect risk factors for suicide as early as possible and to intervene prior to the person making the first suicide attempt. Studies suggest that suicidal ideations are an important marker for identifying patients at risk for suicide (10, 11) and suicide attempts (12). The lifetime prevalence of suicidal ideations in patients with bipolar disorder varies from 30 to
Risk factors for suicidal ideations 75% (13, 14) in contrast to 2.0–25.4% in the general population (10, 11). Although some studies have evaluated the risk factors for suicide attempt in subjects with bipolar disorder, only a handful of studies have investigated the risk factors for suicidal ideations in subjects with bipolar disorder, especially in the depressive phase of the disorder. The various risk factors for suicide ideations in patients with bipolar disorder include early age of onset (1 on Item 9), the study subjects were divided into those with and those without suicidal ideation. By design, each group had 65 subjects. These two groups were matched on the sociodemographic variables of age, gender, socioeconomic status, and duration of illness. All of the subjects in both groups were assessed on the above-described instruments over one to two sessions, not separated by more than 24 hours. Statistical analyses
Data were analysed using SPSS-14 (SPSS Inc., Chicago, IL, USA). Means and standard deviations (SDs) with ranges were computed for continuous variables. Frequencies and percentages were computed for discontinuous sociodemographic and clinical variables. Continuous variables for the two groups (those with and those without suicidal ideation) were compared using the t-test or the Mann–Whitney U-test. Ordinal and nominal variables for the two groups were compared using the chi-square test. Yate’s correction and Fisher’s exact values were computed, wherever required. Binary regression analysis was used to study the relationship between various risk factors and suicidal ideation in bipolar depression.
643
Umamaheswari et al. The NIMH Life Chart was used to study the clinical course. As shown in Table 2, the two groups did not differ in terms of number of episodes (depressive, manic, mixed, and total) in their lifetime and affective morbidity (i.e., total number of episodes prior to assessment multiplied by duration of each episode). However, they differed significantly in terms of mean duration spent in depression, with longer duration of depressive episodes in the bipolar depression with suicidal ideation group and shorter duration of inter-episodic period. A significantly higher percentage of patients in the bipolar depression with suicidal ideation group had a past history of suicide attempt (36.92%) and hospitalization for their affective disorder (40%). Few patients in either group had a rapid cycling course and seasonality as a specifier, and there was no significant difference between the two groups on these variables. Also, as shown in Table 2, the duration of the current episode was significantly longer for the bipolar depression with suicidal ideation group. Ten patients in the bipolar depression with suicidal ideation group attempted suicide in the current episode, and this was statistically significant when compared to the group without suicidal ideation, in which only one patient attempted suicide in the current episode. There was no significant difference between the two groups with respect to abuse of/ dependence on any substance at the time of assess-
Results Sociodemographic profile
The mean age of the study sample was 43.04 (SD = 11.96) years and the mean duration of education was 10.37 (SD = 3.95) years. Two-thirds of the subject group were male (n = 86; 66.2%). As shown in Table 1, the groups differed significantly in terms of religious affiliation, with non-Hindus being overrepresented in the group of patients with bipolar depression with suicidal ideation as compared to the group of patients with bipolar depression without suicidal ideation. Clinical profile
A comparison of the clinical characteristics of patients with and without suicidal ideation is shown in Table 2. As per the study design, the two groups were matched for total duration of illness in years. There was no significant difference in the age of onset of illness between groups. Very few patients in either group had a comorbid physical illness or a psychiatric disorder. One-third to onefourth of patients in both groups had comorbid substance abuse/dependence. A family history of bipolar disorder and suicide was significantly more frequently present in patients with suicidal ideation as compared to the group of patients without suicidal ideation.
Table 1. Sociodemographic profiles of patients with bipolar depression with and without suicidal ideation Variables Marital status, n (%) Currently single Married Religion, n (%) Hindu Non-Hindu Occupation, n (%) Employed Unemployed Income, rupees, mean (SD) SES class, n (%)a Upper Middle Lower Family type (%) Nuclear Non-nuclear Locality, n (%) Urban Rural
BD with suicidal ideation (n = 65)
BD without suicidal ideation (n = 65)
9 (13.84) 56 (86.15)
14 (21.53) 51 (78.46)
31 (47.69) 34 (52.30)
43 (66.15) 22 (33.84)
40 (61.53) 25 (38.46) 15,031 (22,039.00)
39 (60.00) 26 (40.00) 17,184 (43,253.38)
3 60 2
2 62 1
34 (52.30) 31 (47.69)
23 (35.38) 42 (64.61)
30 (46.15) 35 (53.84)
36 (55.38) 29 (44.61)
BD = bipolar depression; SD = standard deviation; SES = socioeconomic status. a SES status as assessed by the Kuppuswamy Socioeconomic Status Scale (42, 43). b The chi-square value was calculated by using the weighted cases statistic for the SES class.
644
Chi-square/t-test
p-value
1.321
0.25
4.517
0.034
0.032
0.857
0.357 1.595b
0.722 0.450
3.780
0.052
1.108
0.293
Risk factors for suicidal ideations Table 2. Clinical profile of the study groups
Variables Age of illness onset, years, mean (SD) Duration of illness, years, mean (SD) Comorbid physical diagnosis, n (%) Comorbid psychiatric illness, n (%) Family history of BPAD, n (%) Family history of suicide, n (%)a Family history of psychiatric disorder other than BPAD, n (%)b Substance abuse/dependence, n (%) No. of lifetime episodes, mean (SD)c Depression Mania Hypomania Mixed Duration of each lifetime episode, months, mean (SD)c Depression Mania Hypomania Mixed Affective morbidity, mean (SD) Duration of inter-episodic period, years, mean (SD) Past suicide attempt, n (%) Past hospitalization, n (%) Rapid cycling affective disorder, n (%) Seasonality, n (%) Current substance abuse/dependence, n (%) Any preceding life event, n (%)d Any preceding poor compliance, n (%) Suicide attempt in current episode, n (%) Duration of current episode, mean (SD)e
BD with suicidal ideation (n = 65)
BD without suicidal ideation (n = 65)
Chi-square/ t-test
p-value
29.13 (10.42) 13.10 (9.70) 17 (26.15) 7 (10.76) 29 (44.61) 14 (21.53) 6 (9.23) 22 (33.84)
26.46 (10.21) 16.80 (11.90) 13 (20.00) 4 (6.15) 16 (24.61) 1 (1.53) 8 (12.30) 17 (26.15)
1.47 1.96 0.69 0.40f 5.74 10.85f 0.32 0.91
0.14 0.052 0.40 0.52 0.016 0.001 0.57 0.33
2.98 (2.20) 1.80 (1.70) 0.26 (0.59) 0.01 (0.12)
2.98 (2.60) 2.18 (2.90) 0.33 (0.66) 0.04 (0.27)
0.00 0.87 0.69 0.82
1.00 0.38 0.48 0.41
3.52 (1.99) 2.24 (2.77) 0.14 (0.31) 0.01 (0.12) 15.31 (18.34) 11.81 (9.39) 24 (36.92) 26 (40.00) 2 (3.07) 6 (9.23) 18 (27.69) 27 (41.53) 13 (20.00) 10 (15.38) 3.76 (5.76)
2.77 (1.87) 1.51 (1.60) 0.48 (1.93) 0.02 (0.13) 13.51 (17.26) 15.95 (11.92) 5 (7.69) 13 (20.00) 1 (1.53) 1 (1.53) 11 (16.92) 15 (23.07) 8 (12.30) 1 (1.53) 2.22 (2.34)
2.19 1.84 1.42 0.33 0.57 2.20 14.38f 6.19 1.00g 2.41f 2.17 5.06 1.42 6.35f 13.62
0.03 0.06 0.15 0.73 0.56 0.029 0.000 0.01 – 0.12 0.14 0.02 0.23 0.01 0.001
BD = bipolar depression; BPAD = bipolar affective disorder; SD = standard deviation. a Family history of mental illness and suicide was obtained from the Family Intervention of Genetics Study scale. b Other psychiatric disorders: (i) patients with bipolar disorder with suicidal ideation: schizophrenia (n = 4), anxiety disorders (n = 1), unipolar depression (n = 1); (ii) patients with bipolar disorder without suicidal ideation: schizophrenia (n = 4), anxiety disorders (n = 1), unipolar depression (n = 3). c Including the current episode prior to assessment. d Life events included stressors such as the death of a family member, financial loss, loss of job, and divorce. e Mann–Whitney value. f Chi-square test with Yate’s correction. g Fisher’s exact test.
ment for the current episode and for any preceding poor compliance with medications. However, significantly more patients in the suicidal ideation group had a prior life event when compared to those without suicidal ideation. Severity of current episode and various dimensions of psychopathology. As shown in Table 3, patients with bipolar depression with suicidal ideation had significantly higher scores on the BDI when compared to patients with bipolar depression without suicidal ideation. Similarly, patients with bipolar depression with suicidal ideation had significantly higher YMRS score, BPRS total score, and IDA scale total score as well as significantly higher scores on all four domains of the IDA scale and PHQ-15 items. The BHS total score for true items,
total score for false items, and overall total BHS score were significantly higher for patients with bipolar depression with suicidal ideation. There was no significant difference between the two groups with respect to any of the six first-order factors (attention, motor, self-control, cognitive complexity, perseverance, and cognitive instability) and three second-order factors (attentional impulsiveness, motor impulsiveness, and non-planning impulsiveness) of the BIS or BIS total score. Patients with bipolar depression with suicidal ideation had significantly higher scores on four of the five assault subscales (i.e., assault, verbal aggression, indirect hostility, and irritability), both the hostility subscales (i.e., resentment and suspicion), and the guilt subscale of the BDHI. The total hostility score (sum of the first seven subscales) was
645
Umamaheswari et al. Table 3. Comparison of severity of current episode and various psychopathology and psychological dimensions Variables
BD with suicidal ideation
BD without suicidal ideation
t-test/chi-square
p-value
BDI total score YMRS total scorea BPRS total score IDA total score PHQ-15 total score BHS–total positive score BHS–total false score BHS total score BIS total score Buss–Durke Hostile Inventory Assault Verbal aggression Indirect hostility Irritability Negativism Resentment Suspicion Guilt Total hostility score
33.50 (8.09) 1.29 (1.47) 25.89 (4.47) 29.32 (8.48) 7.10 (3.70) 9.30 (2.04) 7.60 (1.81) 16.90 (3.49) 68.42 (12.94)
22.63 (5.60) 0.30 (0.78) 23.60 (4.56) 19.92 (7.04) 4.89 (3.26) 5.69 (2.06) 5.06 (1.95) 10.75 (3.13) 68.87 (11.77)
8.90 1,342.50 2.80 6.80 3.61 10.01 7.65 10.56 0.20
