Correlates of violent suicide attempts in patients with bipolar disorder

7noBackground: Suicide is one of the leading causes of death in bipolar disorder (BD); violent suicide attempts are associated with the highest level of lethality. We aimed to evaluate factors related to the risk of violent suicide in a large naturalistic sample of patients with BD; in addition, we analyzed the rates of lifetime suicide attempts and the variables associated with suicidal behavior. Methods: We recruited 847 patients with BD. Patients were grouped according to whether they had a lifetime history of suicide attempts and, among suicide attempters, subjects who had used a violent suicide method were compared with those who had attempted suicide with a nonviolent method. Comparisons were performed using χ2 tests for categorical variables and ANOVA for continuous variables. Logistic regression (LogReg) was used to identify explanatory variables associated with violent suicide attempts (dependent variable). Results: Two hundred and two patients (24%) had a lifetime history of suicide attempts. Subjects with at least one lifetime suicide attempt showed longer duration of illness (22.4 ± 14.1 years vs 19.9 ± 14.2 years: p 0.028), more lifetime hypomanic episodes (3.3 ± 4.3 vs 2.3 ± 3.1: p 0.001), more lifetime depressive episodes (6.0 ± 4.4 vs 4.7 ± 4.1: p < 0.001), higher rates of lifetime psychiatric comorbidities (50.0% vs 41.3%: p 0.029), higher rates of lifetime medical comorbidities (58.0% vs 48.9%: p 0.028) and higher rates of reduced HDL cholesterol (46.2% vs 36.7%: p 0.030). Among suicide attempters, fifty-two patients (30.6%) attempted suicide with a violent method. We found more men in the group of violent suicide attempters than in the group of nonviolent suicide attempters (65% vs 28%; p: <0.001). Moreover subjects with previous violent attempts showed higher mean values of weight (80.5 ± 18.3 vs 69.4 ± 14.7: p < 0.001), body mass index (27.8 ± 5.6 vs 25.2 ± 4.7: p < 0.003) and waist circumference (98.7 ± 18.5 vs 92.4 ± 14.3: p 0.032). The LogReg analysis confirmed the association of violent attempts with male gender (p: <0.001; Phi: 0.35) and higher waist circumference (p: