Leo Sher, M.D.

Our research report, “Does first episode polarity predict risk for suicide attempt in bipolar disorder?” was published 15 years ago in the December 2007 issue of the Journal of Affective Disorders (1). We tested the hypothesis that the polarity of a patient’s first mood episode would be a marker for bipolar disorder subtypes with distinct risk for suicidality.

Individuals with DSM-IV defined bipolar disorder were classified based on whether their first reported episode was manic/hypomanic (FM) or depressed (FD). Study participants were compared on demographic and clinical variables. Logistic regression adjusting for potential confounds examined the association between first episode polarity and history of suicide attempt.

Multiple logistic regression analysis showed that FD group membership was associated with eightfold odds of a past suicide attempt, adjusting for years ill and total number of lifetime major depressive episodes. The FM group had more alcoholism and psychosis, but less likelihood of past suicide attempt.

Hostility was associated with suicide attempt risk. Reasons for living appeared to be an important protective factor. Mania may have adaptive aspects including a protective effect against suicidal behavior mediated by grandiose optimism or less hopelessness.

We have concluded that polarity of patients’ first reported mood episode suggests a depression-prone subtype with a greater probability of past suicide attempt. It may be appropriate to monitor bipolar patients whose first reported episode was depressed more closely in relation to risk of suicidality.

Reference

1. Chaudhury SR, Grunebaum MF, Galfalvy HC, Burke AK, Sher L, Parsey RV, Everett B, Mann JJ, Oquendo MA. Does first episode polarity predict risk for suicide attempt in bipolar disorder? J Affect Disord. 2007 Dec;104(1-3):245-50. doi: 10.1016/j.jad.2007.02.022. Epub 2007 Apr 16.