Characteristics and psychosocial problems of patients with bipolar disorder at high risk for suicide attempt

Background: Bipolar disorder with a history of substance abuse or suicide attempt is a strong predictor of suicide. A high comorbidity of substance use disorders may obscure the specificity of findings about suicide behaviors in Western patients with bipolar disorder. Methods: The clinical data of Chinese bipolar patients (DSM-III-R) in Taiwan who had been naturalistically followed up for at least 15 years were obtained by a combination of chart reviews and interviews with patients and family members. The national identity numbers were used to search for deceased subjects. Results: There were 158 patients originally included for chart review; 4 of them died from suicide. A 9.9% lifetime prevalence of alcohol use disorders was found in 101 final subjects who accepting interview. Multiple logistic regression showed that subjects with a history of suicide attempt (n = 53, 52.5%) were more likely to have interpersonal problems with spouse or romantic partner (adjusted odds ratio = 2.85, 95% C.I. = 0.69-11.51), occupational problems mainly maladjustment and frequently changing job (adjusted odds ratio = 3.08, 95% C.I. = 1.12-10.49), and an earlier age (less than or equal to 22 years) of onset (adjusted odds ratio = 0.96, 95% C.I. = 0.90-1.02). Limitation: To use an interview schedule for assessing the psychosocial problems of clinical population limits the interpretation and generalisability of the data. Conclusion: Despite low comorbidity of alcohol/drug use disorders in Chinese bipolar patients, a consistently high rate of suicide attempts reinforces that bipolar disorder is a high-risk group of suicide. An earlier age of onset, interpersonal problems with spouse or romantic partner, and occupational maladjustment rather than demographic characteristics may collectively identify those at high risk of suicide attempt in bipolar disorder. (C) 1999 Elsevier Science B.V. All rights reserved.