Differences in incidence of suicide attempts between bipolar I and II disorders and major depressive disorder
Objectives Whether risk of suicide attempts (SAs) differs between patients with bipolar disorder (BD) and patients with major depressive disorder (MDD) is unclear. We investigated whether cumulative risk differences are due to dissimilarities in time spent in high‐risk states, incidence per unit tim...
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| Veröffentlicht in: | Bipolar disorders 2014-09, Vol.16 (6), p.652-661 |
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| creator | Holma, K Mikael Haukka, Jari Suominen, Kirsi Valtonen, Hanna M Mantere, Outi Melartin, Tarja K Sokero, T Petteri Oquendo, Maria A Isometsä, Erkki T |
| description | Objectives
Whether risk of suicide attempts (SAs) differs between patients with bipolar disorder (BD) and patients with major depressive disorder (MDD) is unclear. We investigated whether cumulative risk differences are due to dissimilarities in time spent in high‐risk states, incidence per unit time in high‐risk states, or both.
Methods
Incidence rates for SAs during various illness phases, based on prospective life charts, were compared between patients from the Jorvi Bipolar Study (n = 176; 18 months) and the Vantaa Depression Study (n = 249; five years). Risk factors and their interactions with diagnosis were investigated with Cox proportional hazards models.
Results
By 18 months, 19.9% of patients with BD versus 9.5% of patients with MDD had attempted suicide. However, patients with BD spent 4.6% of the time in mixed episodes, and more time in major depressive episodes (MDEs) (35% versus 21%, respectively) and in subthreshold depression (39% versus 31%, respectively) than those with MDD. Compared with full remission, the combined incidence rates of SAs were 5‐, 25‐, and 65‐fold in subthreshold depression, MDEs, and BD mixed states, respectively. Between cohorts, incidence of attempts was not different during comparable symptom states. In Cox models, hazard was elevated during MDEs and subthreshold depression, and among patients with preceding SAs, female patients, those with poor social support, and those aged |
| doi_str_mv | 10.1111/bdi.12195 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1566830370</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1558528458</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5715-fa4153588d6a0eb78c463da78cab6aec8ce341b00f12eaf4390a0950ed14fb883</originalsourceid><addsrcrecordid>eNqNkclOwzAQhi0EomwHXgD5CIdQO44d5whli6hAQqAeLSceSy7ZsFOWtydtoTckLEuz-Jtf1vwIHVNyToczLow7pzHN-BbaoyzLIi6o3F7lcsiTdIT2Q5gTQkVM-C4axYlgIuFsD9VXzlrw0JQQsGuGWzqzrHBrcVi4ZYV130Pd9QEX0H8ANLhwXVtpj3OsG4PzHBsXWm_Ah1Wj1vPWYwOdhxDcO2yeD9GO1VWAo594gF5urp8nd9H08TafXEyjkqeUR1YnlDMupRGaQJHKcviv0UPUhdBQyhJYQgtCLI1B24RlRJOMEzA0sYWU7ACdrnU7374tIPSqdqGEqtINtIugKBdCMsJS8g-USx7LhC9Vz9Zo6dsQPFjVeVdr_6UoUUsj1GCEWhkxsCc_souiBrMhfzc_AOM18OEq-PpbSV1e5b-S0XrChR4-NxPavyqRspSr2cOtmtzfPEwFm6kn9g1Vd6Gr</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1558528458</pqid></control><display><type>article</type><title>Differences in incidence of suicide attempts between bipolar I and II disorders and major depressive disorder</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Holma, K Mikael ; Haukka, Jari ; Suominen, Kirsi ; Valtonen, Hanna M ; Mantere, Outi ; Melartin, Tarja K ; Sokero, T Petteri ; Oquendo, Maria A ; Isometsä, Erkki T</creator><creatorcontrib>Holma, K Mikael ; Haukka, Jari ; Suominen, Kirsi ; Valtonen, Hanna M ; Mantere, Outi ; Melartin, Tarja K ; Sokero, T Petteri ; Oquendo, Maria A ; Isometsä, Erkki T</creatorcontrib><description>Objectives
Whether risk of suicide attempts (SAs) differs between patients with bipolar disorder (BD) and patients with major depressive disorder (MDD) is unclear. We investigated whether cumulative risk differences are due to dissimilarities in time spent in high‐risk states, incidence per unit time in high‐risk states, or both.
Methods
Incidence rates for SAs during various illness phases, based on prospective life charts, were compared between patients from the Jorvi Bipolar Study (n = 176; 18 months) and the Vantaa Depression Study (n = 249; five years). Risk factors and their interactions with diagnosis were investigated with Cox proportional hazards models.
Results
By 18 months, 19.9% of patients with BD versus 9.5% of patients with MDD had attempted suicide. However, patients with BD spent 4.6% of the time in mixed episodes, and more time in major depressive episodes (MDEs) (35% versus 21%, respectively) and in subthreshold depression (39% versus 31%, respectively) than those with MDD. Compared with full remission, the combined incidence rates of SAs were 5‐, 25‐, and 65‐fold in subthreshold depression, MDEs, and BD mixed states, respectively. Between cohorts, incidence of attempts was not different during comparable symptom states. In Cox models, hazard was elevated during MDEs and subthreshold depression, and among patients with preceding SAs, female patients, those with poor social support, and those aged < 40 years, but was unrelated to BD diagnosis.
Conclusions
The observed higher cumulative incidence of SAs among patients with BD than among those with MDD is mostly due to patients with BD spending more time in high‐risk illness phases, not to differences in incidence during these phases, or to bipolarity itself. BD mixed phases contribute to differences involving very high incidence, but short duration. Diminishing the time spent in high‐risk phases is crucial for prevention.</description><identifier>ISSN: 1398-5647</identifier><identifier>EISSN: 1399-5618</identifier><identifier>DOI: 10.1111/bdi.12195</identifier><identifier>PMID: 24636453</identifier><language>eng</language><publisher>Denmark: Blackwell Publishing Ltd</publisher><subject>Adult ; Age Factors ; Age of Onset ; bipolar disorder ; Bipolar Disorder - classification ; Bipolar Disorder - epidemiology ; Bipolar Disorder - psychology ; Cohort Studies ; Depressive Disorder, Major - epidemiology ; Depressive Disorder, Major - psychology ; Female ; Finland - epidemiology ; Humans ; Incidence ; major depressive disorder ; Male ; Middle Aged ; Risk Factors ; Statistics, Nonparametric ; suicide ; suicide attempts ; Suicide, Attempted - psychology ; Suicide, Attempted - statistics & numerical data ; Survival Analysis ; Young Adult</subject><ispartof>Bipolar disorders, 2014-09, Vol.16 (6), p.652-661</ispartof><rights>2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd</rights><rights>2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5715-fa4153588d6a0eb78c463da78cab6aec8ce341b00f12eaf4390a0950ed14fb883</citedby><cites>FETCH-LOGICAL-c5715-fa4153588d6a0eb78c463da78cab6aec8ce341b00f12eaf4390a0950ed14fb883</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fbdi.12195$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fbdi.12195$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24636453$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Holma, K Mikael</creatorcontrib><creatorcontrib>Haukka, Jari</creatorcontrib><creatorcontrib>Suominen, Kirsi</creatorcontrib><creatorcontrib>Valtonen, Hanna M</creatorcontrib><creatorcontrib>Mantere, Outi</creatorcontrib><creatorcontrib>Melartin, Tarja K</creatorcontrib><creatorcontrib>Sokero, T Petteri</creatorcontrib><creatorcontrib>Oquendo, Maria A</creatorcontrib><creatorcontrib>Isometsä, Erkki T</creatorcontrib><title>Differences in incidence of suicide attempts between bipolar I and II disorders and major depressive disorder</title><title>Bipolar disorders</title><addtitle>Bipolar Disord</addtitle><description>Objectives
Whether risk of suicide attempts (SAs) differs between patients with bipolar disorder (BD) and patients with major depressive disorder (MDD) is unclear. We investigated whether cumulative risk differences are due to dissimilarities in time spent in high‐risk states, incidence per unit time in high‐risk states, or both.
Methods
Incidence rates for SAs during various illness phases, based on prospective life charts, were compared between patients from the Jorvi Bipolar Study (n = 176; 18 months) and the Vantaa Depression Study (n = 249; five years). Risk factors and their interactions with diagnosis were investigated with Cox proportional hazards models.
Results
By 18 months, 19.9% of patients with BD versus 9.5% of patients with MDD had attempted suicide. However, patients with BD spent 4.6% of the time in mixed episodes, and more time in major depressive episodes (MDEs) (35% versus 21%, respectively) and in subthreshold depression (39% versus 31%, respectively) than those with MDD. Compared with full remission, the combined incidence rates of SAs were 5‐, 25‐, and 65‐fold in subthreshold depression, MDEs, and BD mixed states, respectively. Between cohorts, incidence of attempts was not different during comparable symptom states. In Cox models, hazard was elevated during MDEs and subthreshold depression, and among patients with preceding SAs, female patients, those with poor social support, and those aged < 40 years, but was unrelated to BD diagnosis.
Conclusions
The observed higher cumulative incidence of SAs among patients with BD than among those with MDD is mostly due to patients with BD spending more time in high‐risk illness phases, not to differences in incidence during these phases, or to bipolarity itself. BD mixed phases contribute to differences involving very high incidence, but short duration. Diminishing the time spent in high‐risk phases is crucial for prevention.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Age of Onset</subject><subject>bipolar disorder</subject><subject>Bipolar Disorder - classification</subject><subject>Bipolar Disorder - epidemiology</subject><subject>Bipolar Disorder - psychology</subject><subject>Cohort Studies</subject><subject>Depressive Disorder, Major - epidemiology</subject><subject>Depressive Disorder, Major - psychology</subject><subject>Female</subject><subject>Finland - epidemiology</subject><subject>Humans</subject><subject>Incidence</subject><subject>major depressive disorder</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Risk Factors</subject><subject>Statistics, Nonparametric</subject><subject>suicide</subject><subject>suicide attempts</subject><subject>Suicide, Attempted - psychology</subject><subject>Suicide, Attempted - statistics & numerical data</subject><subject>Survival Analysis</subject><subject>Young Adult</subject><issn>1398-5647</issn><issn>1399-5618</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkclOwzAQhi0EomwHXgD5CIdQO44d5whli6hAQqAeLSceSy7ZsFOWtydtoTckLEuz-Jtf1vwIHVNyToczLow7pzHN-BbaoyzLIi6o3F7lcsiTdIT2Q5gTQkVM-C4axYlgIuFsD9VXzlrw0JQQsGuGWzqzrHBrcVi4ZYV130Pd9QEX0H8ANLhwXVtpj3OsG4PzHBsXWm_Ah1Wj1vPWYwOdhxDcO2yeD9GO1VWAo594gF5urp8nd9H08TafXEyjkqeUR1YnlDMupRGaQJHKcviv0UPUhdBQyhJYQgtCLI1B24RlRJOMEzA0sYWU7ACdrnU7374tIPSqdqGEqtINtIugKBdCMsJS8g-USx7LhC9Vz9Zo6dsQPFjVeVdr_6UoUUsj1GCEWhkxsCc_souiBrMhfzc_AOM18OEq-PpbSV1e5b-S0XrChR4-NxPavyqRspSr2cOtmtzfPEwFm6kn9g1Vd6Gr</recordid><startdate>201409</startdate><enddate>201409</enddate><creator>Holma, K Mikael</creator><creator>Haukka, Jari</creator><creator>Suominen, Kirsi</creator><creator>Valtonen, Hanna M</creator><creator>Mantere, Outi</creator><creator>Melartin, Tarja K</creator><creator>Sokero, T Petteri</creator><creator>Oquendo, Maria A</creator><creator>Isometsä, Erkki T</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7TK</scope></search><sort><creationdate>201409</creationdate><title>Differences in incidence of suicide attempts between bipolar I and II disorders and major depressive disorder</title><author>Holma, K Mikael ; Haukka, Jari ; Suominen, Kirsi ; Valtonen, Hanna M ; Mantere, Outi ; Melartin, Tarja K ; Sokero, T Petteri ; Oquendo, Maria A ; Isometsä, Erkki T</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5715-fa4153588d6a0eb78c463da78cab6aec8ce341b00f12eaf4390a0950ed14fb883</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Age of Onset</topic><topic>bipolar disorder</topic><topic>Bipolar Disorder - classification</topic><topic>Bipolar Disorder - epidemiology</topic><topic>Bipolar Disorder - psychology</topic><topic>Cohort Studies</topic><topic>Depressive Disorder, Major - epidemiology</topic><topic>Depressive Disorder, Major - psychology</topic><topic>Female</topic><topic>Finland - epidemiology</topic><topic>Humans</topic><topic>Incidence</topic><topic>major depressive disorder</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Risk Factors</topic><topic>Statistics, Nonparametric</topic><topic>suicide</topic><topic>suicide attempts</topic><topic>Suicide, Attempted - psychology</topic><topic>Suicide, Attempted - statistics & numerical data</topic><topic>Survival Analysis</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Holma, K Mikael</creatorcontrib><creatorcontrib>Haukka, Jari</creatorcontrib><creatorcontrib>Suominen, Kirsi</creatorcontrib><creatorcontrib>Valtonen, Hanna M</creatorcontrib><creatorcontrib>Mantere, Outi</creatorcontrib><creatorcontrib>Melartin, Tarja K</creatorcontrib><creatorcontrib>Sokero, T Petteri</creatorcontrib><creatorcontrib>Oquendo, Maria A</creatorcontrib><creatorcontrib>Isometsä, Erkki T</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Neurosciences Abstracts</collection><jtitle>Bipolar disorders</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Holma, K Mikael</au><au>Haukka, Jari</au><au>Suominen, Kirsi</au><au>Valtonen, Hanna M</au><au>Mantere, Outi</au><au>Melartin, Tarja K</au><au>Sokero, T Petteri</au><au>Oquendo, Maria A</au><au>Isometsä, Erkki T</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Differences in incidence of suicide attempts between bipolar I and II disorders and major depressive disorder</atitle><jtitle>Bipolar disorders</jtitle><addtitle>Bipolar Disord</addtitle><date>2014-09</date><risdate>2014</risdate><volume>16</volume><issue>6</issue><spage>652</spage><epage>661</epage><pages>652-661</pages><issn>1398-5647</issn><eissn>1399-5618</eissn><abstract>Objectives
Whether risk of suicide attempts (SAs) differs between patients with bipolar disorder (BD) and patients with major depressive disorder (MDD) is unclear. We investigated whether cumulative risk differences are due to dissimilarities in time spent in high‐risk states, incidence per unit time in high‐risk states, or both.
Methods
Incidence rates for SAs during various illness phases, based on prospective life charts, were compared between patients from the Jorvi Bipolar Study (n = 176; 18 months) and the Vantaa Depression Study (n = 249; five years). Risk factors and their interactions with diagnosis were investigated with Cox proportional hazards models.
Results
By 18 months, 19.9% of patients with BD versus 9.5% of patients with MDD had attempted suicide. However, patients with BD spent 4.6% of the time in mixed episodes, and more time in major depressive episodes (MDEs) (35% versus 21%, respectively) and in subthreshold depression (39% versus 31%, respectively) than those with MDD. Compared with full remission, the combined incidence rates of SAs were 5‐, 25‐, and 65‐fold in subthreshold depression, MDEs, and BD mixed states, respectively. Between cohorts, incidence of attempts was not different during comparable symptom states. In Cox models, hazard was elevated during MDEs and subthreshold depression, and among patients with preceding SAs, female patients, those with poor social support, and those aged < 40 years, but was unrelated to BD diagnosis.
Conclusions
The observed higher cumulative incidence of SAs among patients with BD than among those with MDD is mostly due to patients with BD spending more time in high‐risk illness phases, not to differences in incidence during these phases, or to bipolarity itself. BD mixed phases contribute to differences involving very high incidence, but short duration. Diminishing the time spent in high‐risk phases is crucial for prevention.</abstract><cop>Denmark</cop><pub>Blackwell Publishing Ltd</pub><pmid>24636453</pmid><doi>10.1111/bdi.12195</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Bipolar disorders, 2014-09, Vol.16 (6), p.652-661 |
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| subjects | Adult Age Factors Age of Onset bipolar disorder Bipolar Disorder - classification Bipolar Disorder - epidemiology Bipolar Disorder - psychology Cohort Studies Depressive Disorder, Major - epidemiology Depressive Disorder, Major - psychology Female Finland - epidemiology Humans Incidence major depressive disorder Male Middle Aged Risk Factors Statistics, Nonparametric suicide suicide attempts Suicide, Attempted - psychology Suicide, Attempted - statistics & numerical data Survival Analysis Young Adult |
| title | Differences in incidence of suicide attempts between bipolar I and II disorders and major depressive disorder |
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