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Am J Psychiatry 1996; 153:674-676
Copyright © 1996 by American Psychiatric Association
Suicidality among patients with mixed and manic bipolar disorder
SM Strakowski, SL McElroy, PE Keck Jr and SA West
Department of Psychiatry, University of Cincinnati, College of Medicine, OH 45267-0559, USA.
OBJECTIVE: Patients with mixed or manic bipolar disorder were studied to
determine whether suicidality in mania is associated with increasing
depression in general (i.e., a dimensional construct based on symptom
severity) or with the presence of a mixed state per se (i.e., a categorical
construct requiring the presence of a full depressive syndrome). METHOD:
Diagnostic (categorical) assessments of 91 consecutively hospitalized
patients with DSM-III-R mixed or manic bipolar disorder were made by using
the Structural Clinical Interview for DSM-III-R. Symptom (dimensional)
assessments were made by using the Hamilton Depression Rating Scale, the
Young Mania Rating Scale, and the Scale of the Assessment of Positive
Symptoms. Logistic regression models were employed to test the relative
associations between suicidality and dimensional and categorical depression
measures. Receiver operating characteristics analysis was performed to
identify a potential threshold depression rating that predicted
suicidality. RESULTS: Suicidality was more common in mixed than manic
bipolar disorder. However, when adjusted for total depression scores, this
association with affective state did not persist, but the statistical model
significantly improved. In the improved model, depressive symptom ratings
were significantly associated with suicidality. Hamilton depression scale
ratings greater than 18 identified over 90% of the patients with
suicidality, although there was also a high rate of false positives (32%).
CONCLUSIONS: It is the severity of concurrent depressive symptoms in mania,
rather than the presence of a depressive syndrome per se (i.e., mixed
state), that is associated with suicidality in bipolar patients.
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