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P.556 Risk Factors for Suicide in Bipolar Disorder: a Cohort Study of 12,850 Patients

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P.556 Risk Factors for Suicide in Bipolar Disorder: a Cohort Study of 12,850 Patients P.556 Risk factors for suicide in bipolar disorder: a cohort study of 12,850 patients Caroline Hansson1, Erik Joas1, Erik Pålsson1, Keith Hawton2, Bo Runeson3, Mikael Landén1,4. 1 Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 2 Centre for Suicide Research, University Department of Psychiatry, Oxford, UK. 3 Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden. 4 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Background Results Suicide is the 15th leading cause of death worldwide, with around Of 12,850 persons (4,844 men and 8,006 women) with 800 000 annual suicides worldwide 1. It has been estimated that bipolar disorder, 90 (55 men and 35 women) died by suicide 90% of all suicide victims suffer from a psychiatric disorder 2. during the follow-up period (between one and 10 years). Individuals with bipolar affective disorder constitute a high-risk The statistically significant risk factors for suicide were: male group with an estimated risk of suicide that is 20-30 times higher sex; living alone; previous suicide attempts; any comorbid than in the general population 3. A number of risk factors psychiatric disorder; comorbid substance use disorder, generally associated with suicide have been identified. But it is anxiety disorder and personality disorder; recent affective also important to determine risk factors for specific populations, episode(s); recent depressive episode(s); criminal conviction; e.g., in specific psychiatric disorders, as these might differ - or psychiatric inpatient care; and involuntary commitment. When have different weight - across diagnoses 3. analyzing the data for men and women separately, we found that living alone, comorbid substance use, involuntary commitment, and having had at least one affective episode in Aim the previous year were significant predictors of suicide in To study risk factors for suicide in a large cohort of men and men, but not in women. Criminal conviction, comorbid women with bipolar disorder. personality disorder, and having had at least one depressive episode in the previous year were significant predictors of Method suicide in women, but not in men. A prospective cohort study using clinical data from the Swedish National Quality Register for Bipolar Affective Disorder (BipoläR). Conclusion The outcome variable was suicide captured in the Cause of Risk factors for suicide in bipolar disorder include factors Death Register between 2004 and 2014. Hazard ratios (HR) were associated with suicide in general, but also diagnosis-specific calculated using Cox proportional hazards models and adjusted factors. Several of the statistically significant risk factors for for age and sex. suicide in bipolar disorder differ between men and women. Potential risk factors for suicide in bipolar disorder patients Potential risk factors for suicide in male bipolar disorder patients N Nsuicides HR (95% CI) p N Nsuicides HR (95% CI) p Male sex 12850 90 2.56 (1.68-3.92) <0.01 Living alone 2694 31 2.71 (1.25-5.89) 0.01 Age 12850 90 0.99 (0.98-1.01) 0.45 Criminal conviction 2676 31 3.30 (0.77-14.07) 0.11 Body Mass Index (BMI) 12287 86 1.00 (0.96-1.05) 0.90 Any affective episode in the previous year 4670 55 3.19 (1.66-6.14) <0.01 Education (completed higher education) 11791 87 0.98 (0.63-1.52) 0.93 Any depressive episode in the previous year 2577 29 1.97 (0.94-4.11) 0.07 Living alone 7138 51 2.45 (1.36-4.43) <0.01 Any comorbid psychiatric disorder 4447 52 2.57 (1.46-4.52) <0.01 Complicating social factors 11825 85 1.27 (0.81-2.01) 0.30 Comorbid substance use disorder 4447 52 4.20 (2.28-7.75) <0.01 Violent behavior 6921 51 1.55 (0.81-2.97) 0.18 Comorbid anxiety disorder 4447 52 1.97 (0.92-4.20) 0.08 Criminal conviction 7083 51 4.43 (1.35-14.53) 0.01 Comorbid personality disorder 4447 52 0.80 (0.11-5.83) 0.83 Bipolar disorder type 12849 90 Previous suicide attempt 4419 53 4.12 (2.08-8.15) <0.01 type 1 (ref) 1 Psychiatric inpatient care 3838 38 2.95 (1.47-5.90) <0.01 type 2 0.78 (0.49-1.25) 0.31 Involuntary commitment 3537 37 4.30 (1.87-9.86) <0.01 not otherwise specified 0.75 (0.41-1.36) 0.34 schizoaffective order, bipolar (manic) type 0.55 (0.13-2.27) 0.41 Any affective episode in the previous year 12436 90 2.39 (1.47-3.88) <0.01 Potential risk factors for suicide in female bipolar disorder patients Any depressive episode in the previous year 6631 48 2.24 (1.25-4.01) 0.01 Any (hypo-)manic episode in the previous year 6632 48 0.88 (0.44-1.73) 0.71 N Nsuicides HR (95% CI) p Any mixed episode in the previous year 6628 48 1.33 (0.52-3.40) 0.55 Living alone 4444 20 2.08 (0.83-5.22) 0.12 Family history of affective disorder 7902 62 0.74 (0.44-1.24) 0.26 Criminal conviction 4407 20 9.85 (1.30-74.75) 0.03 Early onset of psychiatric problems (<18 years) 6692 54 0.92 (0.50-1.68) 0.78 Any affective episode in the previous year 7766 35 1.56 (0.75-3.24) 0.24 Any comorbid psychiatric disorder 11802 83 2.64 (1.69-4.13) <0.01 Any depressive episode in the previous year 4054 19 2.81 (1.06-7.47) 0.04 Comorbid substance use disorder 11802 83 3.79 (2.21-6.50) <0.01 Any comorbid psychiatric disorder 7355 31 2.80 (1.34-5.88) 0.01 Comorbid anxiety disorder 11802 83 1.91 (1.07-3.42) 0.03 Comorbid substance use disorder 7355 31 2.72 (0.83-8.97) 0.10 Comorbid eating disorder 11802 83 1.60 (0.39-6.67) 0.52 Comorbid anxiety disorder 7355 31 1.89 (0.77-4.66) 0.17 Comorbid personality disorder 11802 83 2.49 (1.07-5.77) 0.03 Comorbid personality disorder 7355 31 4.78 (1.77-12.89) <0.01 Previous suicide attempt 11747 84 4.10 (2.43-6.92) <0.01 Previous suicide attempt 7328 31 4.31 (1.91-9.71) <0.01 Psychiatric inpatient care 10106 63 2.79 (1.62-4.80) <0.01 Psychiatric inpatient care 6268 25 2.50 (1.04-6.01) 0.04 Involuntary commitment 9309 60 3.50 (1.71-7.15) <0.01 Involuntary commitment 5772 23 2.08 (0.49-8.94) 0.32 References For additional information, please contact: 1. World Health Organization, Preventing suicide: a global imperative. 2014. Name: Caroline Hansson 2. Cavanagh, J.T., et al., Psychological autopsy studies of suicide: a systematic review. Psychol Med, 2003. 33(3): p. 395-405. E-mail: [email protected] 3. Pompili, M., et al., Epidemiology of suicide in bipolar disorders: a systematic review of the literature. Bipolar Disord, 2013. 15(5): p. 457-90. Website: https://psykiatricentrum.gu.se .
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