Risk of suicide in mood disorders

Clinical correlates of current level of functioning in primary care-treated bipolar patients

OBJECTIVES

In this study we examined general assessment of functioning (GAF), and its relation to clinical and demographic factors in bipolar patients. A number of studies, mostly from specialized programs, show that bipolar disorder often leads to occupational and social impairment. Here we report data from patients in a primary care setting.

METHODS

A total of 252 patients from the Maritime Bipolar Registry with DSM-IV diagnoses of bipolar I or bipolar II disorder participated in the study. GAF ratings during maintenance treatment were compared across clinical and demographic variables.

RESULTS

The mean GAF score in this sample was 67 +/- 17 (range 10-100). The GAF scores followed bimodal distribution with mean values of 50.5 +/- 10.3 and 79.0 +/- 10.3. Decreased functioning was found in patients with chronic illness course, history of rapid cycling, suicidal behaviour, psychiatric comorbidity, hypothyroidism, and diabetes mellitus, regardless of treatment of these conditions. There were no differences in the level of functioning between men and women, bipolar I and II patients, those with and without psychotic episodes, hypertension, treatment with antidepressants or antipsychotics.

CONCLUSIONS

Functioning in primary care-treated bipolar patients in maintenance phase of treatment is decreased not only due to specific disorder-related variables, but also due to frequent comorbidity with other psychiatric and medical conditions.

Alcohol use and suicide rates

Alcohol use and abuse substantially influence suicide rates. Suicide is a cause of death for a substantial percentage of individuals with alcoholism. However, the results of epidemiological studies of the relation between alcohol use and suicide have been inconsistent. Studies conducted in one nation are not always applicable to other nations. Many different factors including prevalence of various psychiatric and medical disorders, quality of psychiatric and medical care, unemployment and divorce rates and other psychosocial and demographic factors determine suicide rates in a certain region or a country. There may be a broad-based social characteristic related to social stress which is associated with high rates of a variety of stress-related behaviors, including heavy alcohol use and suicide.

Increasing seasonality of suicide in Australia 1970-1999

Previous studies have found that rates of suicide have a distinct annual rhythm with a peak in spring. Two recent European studies, however, have found that the amplitude of this rhythm has decreased over time. The purpose of this study was to examine whether such effects are found in Australia. Australian Bureau of Statistics data on all suicides in Australia 1970-1999 were analysed by spectral analysis. We found that suicide, violent suicide and suicide by males are seasonal and that the seasonal amplitude has increased over time. Males who use violent methods determine the seasonal effect. These results support previous findings that suicide and particularly violent suicide have a characteristic seasonal rhythm. However, the progressive increase in the amplitude of this rhythm over time in Australia is in direct contrast to other European findings. We suggest that this may be related to differences in patterns of anti-depressant use and also the effect of migration on the number of seasonally vulnerable individuals in Australia.