what are potential risk factors that may lead to bipolar disorder

Suicide is recognised as a public health priority and remains 1 of the leading causes of death worldwide. "Every 40 seconds a person dies by suicide somewhere in the world" (WHO, 2014).

In numbers, information technology means that over 800,000 people die by suicide each year and effectually i,500 people in Sweden (Jiang et al., 2012), where the study that I'm blogging about today is focused . It could be naturally hypothesised that amidst all the suicide victims, some have mental health difficulties. This number is rounded up from Cavanagh et al. (2003) up to 90%, with individuals affected past bipolar disorder constituting a high-risk grouping and being 17-20 times more likely to attempt suicide compared to the general population.

Certainly, research aims to identify causation and potential risk factors associated with suicide. Withal, there is express testify on the identification of hazard factors for specific populations, due east.grand. studies targeting people affected by a mental health disorder. Indeed, mental health difficulties tin severely affect the private and the touch might differ beyond diagnoses (Pompili et al., 2013).

Over a decade ago, Hawton et al. (2005) identified a list of risk factors for both completed suicide and suicide attempts in bipolar disorder, which included male gender, history of prior suicide attempts and expressed hopelessness. The downside of the review is that the studies included accept a very pocket-sized sample, while the bulk of them exercise non have a prospective design. Thus, one cannot be sure of the temporal sequence betwixt exposure and upshot.

Hamsson et al (2018) conducted a prospective longitudinal cohort study which allowed them to place potential predictors for completed suicide. Contempo studies based on the same cohort identified associations between run a risk factors and suicide attempt (Tidemalm et al., 2014), merely little is known about how these factors may differ for completed suicide.

People with bipolar disorder are virtually 20 times more likely to attempt suicide compared to the full general population.

Methods

The longitudinal cohort report was based on the linkage of Swedish registers known equally the Swedish National Quality Register for Bipolar Affective Disorder (BipoläR) and the Cause of Death Register. BipoläR follows people who registered between 2004 and 2013 and had a bipolar diagnosis according to DMS-IV-TR criteria, including bipolar disorder type ane, blazon 2, not otherwise specified, or schizoaffective disorder of bipolar type. The register allows the exploration of basic epidemiological data on the history and clinical class of patients' diagnosis.

The outcome of the written report was death by suicide and the identification was based on Cause of Expiry Register, which provides mortality information for almost every death occurring in Sweden (99%) between 2004 and 2014. Suicide was classified co-ordinate to ICD-x codes as either definite suicide or decease past cocky-harm with undetermined intent.

An extended list of factors was tested, including:

• Demographics – sexual activity, historic period, BMI, education

• Social factors – living alone, whatever psychosocial and ecology issues, violent behaviour towards others, recent criminal conviction

• Clinical characteristics – subtype of bipolar disorder, whatever recent affective episode, family unit history of affective disorder in first-degree relatives, age at onset of any psychiatric disorder, any comorbid psychiatric disorders including substance apply disorder, feet disorder, eating disorder or personality disorder, any previous suicide attempts, recent psychiatric inpatient intendance, and contempo involuntary hospitalisation.

The clan between predictors and death by suicide was assessed through Cox models, which were adjusted for age and sex activity. The appointment of the starting time entry into BipoläR was set up every bit the beginning of time, while the engagement of suicide, date of other causes of decease, or 31 December 2014 was set up every bit the end of the follow-up. Additionally, in the models assessing the connection between specific affective episodes and suicide, only participants who had at least one follow-up were included.

Results

Out of 12,850 people with bipolar disorder, a record of 90 deaths past suicide was identified during the follow-upwards period until the end of 2014.

Meaning associations for completed suicide after the adjustment of covariates were:

• Being male
• Living solitary
• Previous suicide attempts
• Whatever comorbid psychiatric disorders (comorbid substance-use disorder, anxiety disorder, personality disorder)
• Recent affective episode
• Recent depressive episode
• Criminal conviction
• Psychiatric inpatient care
• Involuntary hospitalisation.

Interestingly, take a chance factors variedpast gender. The evidence suggests that:

• Living alone, comorbid substance use disorder, involuntary commitment, and having had at least one affective episode in the previous year were significant predictors of suicide in men, but not in women.
• Conversely, criminal confidence, comorbid personality disorder, and having had at least one depressive episode in the previous year were significant predictors of suicide in women, but not in men.

This inquiry suggests that the risk factors for suicide in people with bipolar disorder vary significantly in men and women.

Key conclusions

• Risk factors differ significantly by gender
• Bipolar subtype was not associated with suicide
• Recent affective episodes can predict death by suicide
• Several chance factors are shared between attempted and completed suicide for people with bipolar.

Strengths and limitations

This written report has methodological strengths, such as its prospective design and both large and representative sample of 12,850 people. BipoläR records data for both inpatients and outpatients with various symptoms and severity levels. Crusade of Death Register captures 99% of deaths nationally, so the possibility of missing a suicide is highly unlikely. Moreover, Swedish registers are establish to exist valid, reliable, and suitable for research (Hollander et al., 2017). Linked registers not only provide authentic and rich information only also the opportunity to explore inquiry questions in depth. The effects of nature and nurture were explored through the examination of basic epidemiological and demographic characteristics, family history and prior individual clinical history.

However,BipoläR doesn't contain all patients with bipolar disorder in Sweden; the national coverage is 29% (Pålsson and Landén, 2016), which is relatively low. Thus, inclusion bias cannot be eliminated, as some population groups with sure characteristics may exist more likely to choose not to participate in such registers. A comparing betwixt this annals and the national patient register confirms that there are no differences in terms of sex and historic period.

Furthermore, certain risk factors were not considered, including early life adversities, family unit history of suicide, concrete comorbidity, polarity of the first episode, total number of lifetime episodes, and psychotic features in the depressive or manic episodes.

The BipoläR register doesn't contain all patients with bipolar disorder in Sweden; the national coverage is just 29%, and then this enquiry may be affected by inclusion bias.

Implications for policy and research

The acknowledgment of adventure factors for people with bipolar disorder can lead to an improved provision of professional mental health care and greater prevention of futurity suicide attempts and/or completed suicides. In line with previous studies, the new testify can exist turned into a very powerful tool for professionals who work closely with this clinical population. As low and other psychiatric comorbidities can predict a completed suicide, professionals should reconsider adopting a holistic approach and provide a person-centred intervention that tin potentially meet all patients' needs.

Future research through mixed-methods should focus more on nether-studied and relatively forgotten populations, such as prisoners and ex-convicts. Suicide rates are very high in prisons, still nosotros have limited noesis regarding the aetiology behind suicidal thoughts, what might trigger suicide attempts and what may accept the power to prevent a completed suicide. The exam of views amidst prisoners and staff could take major implications on service delivery and development.

Hereafter enquiry through mixed-methods should focus more on under-studied and relatively forgotten populations, such as prisoners and ex-convicts.

Conflicts of interests

None.

Links

Master paper

Hansson C, Joas E, Pålsson E, Hawton K, Runeson B, Landén M. (2018) Take chances factors for suicide in bipolar disorder: a cohort study of 12,850 patients. Acta Psychiatr Scand 2018: 138: 456–463. doi:ten.1111/acps.12946

Other references

World Wellness Organization. Preventing suicide: a global imperative; 2014.

Jiang G, Hadlaczky G, Wasserman D. Sj€alvmord i Sverige, Data: 1980-2012, (NASP, ed); 2012.

Cavanagh JT, Carson AJ, Sharpe M, Lawrie SM. Psychological autopsy studies of suicide: a systematic review. Psychol Med 2003;33:395–405.

Pompili G, Gonda X, Serafini 1000 et al. Epidemiology of suicide in bipolar disorders: a systematic review of the literature. Bipolar Disord 2013;15:457–490.

Hawton Grand, Sutton L, Haw C, Sinclair J, Harriss L. Suicide and attempted suicide in bipolar disorder: a systematic review of risk factors. J Clin Psychiatry 2005;66:693–704.

Tidemalm D, Haglund A, Karanti A, Landen M, Runeson B. Attempted suicide in bipolar disorder: chance factors in a cohort of 6086 patients. PLoS One 2014;9:e94097.

Hollander A, Kirkbride J, Pitman A, Lundberg M, Lewis Chiliad, Magnusson C, Dalman, C. (2017). Are refugees at increased risk of suicide compared with non-refugee migrants and the host population. Eur J Public Health 2017;27 (suppl_3).

Pålsson E. and Landén Grand. (2016). The quality register BipoläR almanac report 2016. https://bipolar.registercentrum.se/om-bipolar/arsrapporter/p/SkMRS-nGb; 2017.

Photo credits

• Photo by Julian Jemison on Unsplash
• Photograph by Andrii Podilnyk on Unsplash
• Photograph past Robert Bye on Unsplash

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Source: https://www.nationalelfservice.net/mental-health/suicide/risk-factors-suicide-bipolar-disorder/

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