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Bipolar disorder is highly related to increased risk of suicidal behaviour, and the identification of patients at risk is considered clinically meaningful. A variety of associated risk factors have been identified, but it is unclear whether they differ or take their origins with regard to patient age, thus leading to highlight some vulnerability windows. Dr Romero will discuss which factors are associated with suicidal behavior in adolescents with bipolar disorders, thus describing a specific window of vulnerability. Pr Etain will highlight that suicidal risk may take its origins very early, and especially in the case of exposure to childhood maltreatment. He will show that salient dimensions of emotional regulation and impulsivity mediate the link between early stressors and suicide attempt later in life. Based on a large cohort of bipolar disorder patients, Pr Courtet will then address the question whether depressed suicidal patients will have a similar course of bipolar disorder at a two-years follow up in comparison to depressed non-suicidal patients. Finally, Dr Lengvenyte will present clinical and cognitive risk factors for suicidal events in patients with late-onset bipolar disorder. This symposium will discuss suicidal risk in bipolar disorders through the lifespan including its origins in childhood, early and late windows of vulnerability and longitudinal course.
S0089 - Prevalence and Correlates of Suicidal Behaviour in Adolescents with Bipolar Disorder
ABSTRACT
Abstract Body
Objective: To examine the prevalence and correlates of suicidal behavior among adolescents with bipolar disorder (BD). Methods: 47 adolescents, ages 12 to 19 years (15.8 ± 2), meeting DSM-5 criteria for BD-I (n=40) and BD-II (n=7) were assessed using the KSADS-PL and tested with a battery of tests measuring mood, psychotic symptoms, life events and functioning. History of suicidal attempts (SA) was ascertained using the K-SADS-PL .Results: One third (n=15, 32%) of the BD sample had a lifetime history of SA. There were no differences in socio-demographics factors between SA versus non- SA. BD adolescents with lifetime SA, were more likely to have lower weight at birth, a lifetime history of comorbid eating disorder, non-suicidal self-injurious behavior, 2nd degree family history of suicide attempt, and more stressful life events as compared with non-attempters. Adolescents with lifetime history of SA also showed statistically significant higher scores in depression, suicidal ideation and anxiety as compared with BD adolescents without lifetime SA. Logistic regression analysis found that the most robust correlates of SA in adolescents with BD were having 2nd degree family history of SA, the interaction of self-injury behavior and comorbid eating disorder and increased number of life events. Limitations: Retrospective data. Small sample size. Since this is a cross-sectional study, no inferences regarding causality can be made. Conclusion: One third of the adolescents with BD have attempted suicide. These results are in agreement with previous studies. History of SA in adolescents with BD is strongly associated with family history of suicidal behavior, lifetime self-injury behavior with comorbid eating disorder and increased number of stressful life events.
S0090 - Links Between Childhood Maltreatment and Suicide Risk in Bipolar Disorders: Direct or Indirect?
S0091 - What is Special About Suicidal Depression?
ABSTRACT
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Objective: Bipolar disorder is one of the most frequent psychiatric disorders among suicidal patients. A large part of patients with bipolar disorder (30–50%) will attempt suicide. Suicidal ideation being a major risk factor of suicidal act, it is crucial to better characterize patients with suicidal bipolar depression (i.e. depression with current suicidal ideation). The aim of this study was to characterize suicidal bipolar depressed patients in comparison with non-suicidal depressed patients in terms of clinical characteristics, evolution of depression and suicidal ideation course over time, and risk of suicide attempt during follow-up.
Methods: Among patients with bipolar disorder recruited from the network of FondaMental expert centres for bipolar disorder between 2009 and 2017, we selected patients with at least mild depression and without current manic symptomatology at baseline (N = 938). Suicidal depression was defined by a baseline score ⩾2 for item 12 of the QIDS-SR (28.9%). A subsample of about 300 patients (w/ or w/o suicidal ideation at baseline) was followed up for 2 years.
Results: Baseline clinical features (e.g. depression severity, childhood trauma, global functioning) were more severe in patients with without suicidal depression. Suicidal patients tended to remain more suicidal throughout the followup (3.4-fold higher risk of persistent suicidal ideation at the 2-year visit despite an improvement in depressive symptomatology).
Conclusions: Depressed bipolar disorder patients reporting suicidal ideation had more severe clinical features and were more prone to report persistent suicidal ideation during the follow-up, independently of thymic state. Clinicians should closely monitor this subgroup of patients
S0092 - Risk Factors for Suicidal Behaviours in Late-onset Bipolar Disorder
ABSTRACT
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Late-onset bipolar disorder (BD), when symptoms emerge after the age of 50 years, has gained recognition in the past decades. Currently, BD of about one in ten older patients is considered to be late-onset. Since suicide risk is extremely elevated in BD, especially at the onset of the illness, patients that live to old age are generally considered a survivor population. Meanwhile, patients with late-onset BD did not have BD while living through life periods that could be associated with typical risk factors for suicidal behaviours. Moreover, the late-onset BD might have specific etiopathogenesis, as demonstrated by less genetic component and more life stressors, medical comorbidity and alcohol use. Clinically, patients with late-onset BD have more depressive episodes and more favourable treatment outcomes, yet clinicians generally fail to adhere to guidelines while treating these patients. In n=614 older age BD patients from FondationFondamental Expert Centers, late-onset BD patients reported less lifetime suicidal ideation and attempts compared to non-late-onset patients, while there was no difference regarding the last year suicidal ideation. Better verbal memory was associated with more suicidal behaviour reporting in both groups. Meanwhile, late-onset patients had lower affect intensity and less childhood trauma – factors that were strongly positively associated with last year suicidal ideation in patients with earlier, but not late-onset BD. Meanwhile, late-onset BD patients had higher arterial blood pressure, which was associated with lifetime suicide attempt history in them, but not in earlier-onset patients. Late-onset BD seems to have a distinct pathway to suicidal behaviours.
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