Personality disorders and suicide attempts in unipolar and bipolar mood disorders

• Published in: Journal of affective disorders 2016-01, Vol.190, p.632-639
• Main Authors: Jylhä, Pekka, Rosenström, Tom, Mantere, Outi, Suominen, Kirsi, Melartin, Tarja, Vuorilehto, Maria, Holma, Mikael, Riihimäki, Kirsi, Oquendo, Maria A, Keltikangas-Järvinen, Liisa, Isometsä, Erkki T
• Format: Article
• Language: English
• Subjects: Adult; Bipolar Disorder - epidemiology; Bipolar Disorder - psychology; Comorbidity; Depressive Disorder - epidemiology; Depressive Disorder - psychology; Female; Humans; Longitudinal studies; Male; Middle Aged; Mood disorders; Personality Assessment - statistics & numerical data; Personality disorders; Personality Disorders - epidemiology; Personality Disorders - psychology; Prospective Studies; Psychiatry; Suicidal behavior; Suicide attempt; Suicide, Attempted - psychology; Suicide, Attempted - statistics & numerical data
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2015.11.006

Abstract Background Comorbid personality disorders may predispose patients with mood disorders to suicide attempts (SAs), but factors mediating this effect are not well known. Methods Altogether 597 patients from three prospective cohort studies (Vantaa Depression Study, Jorvi Bipolar Study, and Vantaa Primary Care Depression Study) were interviewed at baseline, at 18 months, and in VDS and PC-VDS at 5 years. Personality disorders (PDs) at baseline, number of previous SAs, life-charted time spent in major depressive episodes (MDEs), and precise timing of SAs during follow-up were determined and investigated. Results Overall, 219 (36.7%) patients had a total of 718 lifetime SAs; 88 (14.7%) patients had 242 SAs during the prospective follow-up. Having any PD diagnosis increased the SA rate, both lifetime and prospectively evaluated, by 90% and 102%, respectively. All PD clusters increased the rate of new SAs, although cluster C PDs more than the others. After adjusting for time spent in MDEs, only cluster C further increased the SA rate (by 52%). Mediation analyses of PD effects on prospectively ascertained SAs indicated significant mediated effects through time at risk in MDEs, but also some direct effects. Limitations Findings generalizable only to patients with mood disorders. Conclusions Among mood disorder patients, comorbid PDs increase the risk of SAs to approximately two-fold. The excess risk is mostly due to patients with comorbid PDs spending more time in depressive episodes than those without. Consequently, risk appears highest for PDs that most predispose to chronicity and recurrences. However, also direct risk-modifying effects of PDs exist.