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Obesity is associated with previous suicide attempts in bipolar disorder

  • Fabiano A. Gomes (a1), Márcia Kauer-Sant’Anna (a1), Pedro V. Magalhães (a1), Felice N. Jacka (a2), Seetal Dodd (a2), Clarissa S. Gama (a1), Ângelo Cunha (a3), Michael Berk (a2) and Flávio Kapczinski (a1)...


Gomes FA, Kauer-Sant’Anna M, Magalhães PV, Jacka FN, Dodd S, Gama CS, Cunha Â, Berk M, Kapczinski F. Obesity is associated with previous suicide attempts in bipolar disorder.


There is a paucity of data about risk factors for suicide attempts in bipolar disorder. The aim of this study is to examine the association between suicide attempts and obesity in people with bipolar disorder.


Two hundred fifty-five DSM-IV out-patients with bipolar disorder were consecutively recruited from the Bipolar Disorder Program at Hospital das Clínicas de Porto Alegre and the University Hospital at the Universidade Federal de Santa Maria, Brazil. Diagnosis and clinical variables were assessed with Structured Clinical Interview for DSM-IV-axis I (SCID I) and Program structured protocol. History of suicide attempts was obtained from multiple information sources including patients, relatives and review of medical records. Patients with body mass index (BMI) ≥ 30 were classified as obese.


Over 30% of the sample was obese and over 50% had a history of suicide attempt. In the multivariate model, obese patients were nearly twice (OR = 1.97, 95% CI: 1.06–3.69, p = 0.03) as likely to have a history of suicide attempt(s).


Our results emphasise the relevance of obesity as an associated factor of suicide attempts in bipolar disorder. Obesity may be seen as correlate of severity and as such, must be considered in the comprehensive management of bipolar patients.


Corresponding author

Professor Flávio Kapczinski, INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350 CEP 90035-003, Porto Alegre, RS, Brazil. Tel: +55 51 21018845; Fax: +55 51 21018846; E-mail:


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1.Kupfer, DJ.The increasing medical burden in bipolar disorder. JAMA 2005;293:25282530.
2.Angst, F, Stassen, HH, Clayton, PJ, Angst, J.Mortality of patients with mood disorders: follow-up over 34–38 years. J Affect Disord 2002;68:167181.
3.Roshanaei-Moghaddam, B, Katon, W.Premature mortality from general medical illnesses among persons with bipolar disorder: a review. Psychiatr Serv 2009;60:147156.
4.IOFT – International Obesity Task Force. Global prevalence of adult obesity. International Obesity Task Force Prevalence Data, 2009 Available from: (accessed 23 January 2009).
5.Wildes, JE, Marcus, MD, Fagiolini, A.Obesity in patients with bipolar disorder: a biopsychosocial-behavioral model. J Clin Psychiatry 2006;67:904915.
6.Elmslie, JL, Silverstone, JT, Mann, JI, Williams, SM, Romans, SE.Prevalence of overweight and obesity in bipolar patients. J Clin Psychiatry 2000;61:179184.
7.McElroy, SL, Frye, MA, Suppes, Tet al. Correlates of overweight and obesity in 644 patients with bipolar disorder. J Clin Psychiatry 2002;63:207213.
8.Fagiolini, A, Kupfer, DJ, Houck, PR, Novick, DM, Frank, E.Obesity as a correlate of outcome in patients with bipolar I disorder. Am J Psychiatry 2003;160:112117.
9.Taylor, V, Macdonald, K, McKinnon, MC, Joffe, RT, MacQueen, GM.Increased rates of obesity in first-presentation adults with mood disorders over the course of four-year follow-up. J Affect Disord 2008;109:127131.
10.Maina, G, Salvi, V, Vitalucci, A, D’Ambrosio, V, Bogetto, F.Prevalence and correlates of overweight in drug-naïve patients with bipolar disorder. J Affect Disord 2008;110:149155.
11.Fagiolini, A, Frank, E, Houck, PRet al. Prevalence of obesity and weight change during treatment in patients with bipolar I disorder. J Clin Psychiatry 2002;63:528533.
12.Fagiolini, A, Kupfer, DJ, Rucci, P, Scott, JA, Novick, DM, Frank, E.Suicide attempts and ideation in patients with bipolar I disorder. J Clin Psychiatry 2004;65:509514.
13.Fagiolini, A, Frank, E, Scott, JA, Turkin, S, Kupfer, DJ.Metabolic syndrome in bipolar disorder: findings from the Bipolar Disorder Center for Pennsylvanians. Bipolar Disord 2005;7:424430.
14.Wang, PW, Sachs, GS, Zarate, CAet al. Overweight and obesity in bipolar disorders. J Psychiatr Res 2006;40:762764.
15.McElroy, SL, Kotwal, R, Malhotra, S, Nelson, EB, Keck, PE, Nemeroff, CB.Are mood disorders and obesity related? A review for the mental health professional. J Clin Psychiatry 2004;65:634651.
16.Carpenter, KM, Hasin, DS, Allison, DB, Faith, MS.Relationships between obesity and DSM-IV major depressive disorder, suicide ideation, and suicide attempts: results from a general population study. Am J Public Health 2000;90:251257.
17.Mather, AA, Cox, BJ, Enns, MW, Sareen, J.Associations of obesity with psychiatric disorders and suicidal behaviors in a nationally representative sample. J Psychosom Res 2009;66:277285.
18.McIntyre, RS, Muzina, DJ, Kemp, DEet al. Bipolar disorder and suicide: research synthesis and clinical translation. Curr Psychiatry Rep 2008;10:6672.
19.Hawton, K, Sutton, L, Haw, C, Sinclair, J, Harriss, L.Suicide and attempted suicide in bipolar disorder: a systematic review of risk factors. J Clin Psychiatry 2005;66:693704.
20.Gazalle, FK, Andreazza, AC, Ceresér, KM, Hallal, PC, Santin, A, Kapczinski, F.Clinical impact of late diagnose of bipolar disorder. J Affect Disord 2005;86:313316.
21.Fleck, MP, Bourdel, MC.Method of simulation and choice of factors in the analysis of principal components (Portuguese). Rev Saude Publica 1998;32:267272.
22.Vilela, JA, Crippa, JA, Del-Ben, CM, Loureiro, SR.Reliability and validity of a Portuguese version of the Young Mania Rating Scale. Braz J Med Biol Res 2005;38:14291439.
23.Asberg, M, Träskman, L, Thorén, P.5-HIAA in the cerebrospinal fluid. A biochemical suicide predictor? Arch Gen Psychiatry 1976;33:11931197.
24.World Health Organization. Obesity: preventing and managing the global epidemic. Publication WHO/NUT/NCS/98.1. Geneva, Switzerland: World Health Organization; 1997.
25.Berkowitz, RI, Fabricatore, AN.Obesity, psychiatric status, and psychiatric medications. Psychiatr Clin North Am 2005;28:3954, vii–viii.
26.Cardoso, BM, Kauer Sant’Anna, M, Dias, VV, Andreazza, AC, Ceresér, KM, Kapczinski, F.The impact of co-morbid alcohol use disorder in bipolar patients. Alcohol 2008;42:451457.
27.Rosa, AR, Andreazza, AC, Kunz, Met al. Predominant polarity in bipolar disorder: diagnostic implications. J Affect Disord 2008;107:4551.
28.Grunebaum, MF, Ramsay, SR, Galfalvy, HCet al. Correlates of suicide attempt history in bipolar disorder: a stress-diathesis perspective. Bipolar Disord 2006;8:551557.
29.Sánchez-Gistau, V, Colom, F, Mané, A, Romero, S, Sugranyes, G, Vieta, E.Atypical depression is associated with suicide attempt in bipolar disorder. Acta Psychiatr Scand 2009; 120:3036.
30.Rosa, AR, Franco, C, Martínez-Aran, Aet al. Functional impairment and previous suicide attempts in bipolar disorder. Acta Neuropsychiatrica 2008;20:300306.
31.Simon, GE, Hunkeler, E, Fireman, B, Lee, JY, Savarino, J.Risk of suicide attempt and suicide death in patients treated for bipolar disorder. Bipolar Disord 2007;9:526530.
32.Neves, FS, Malloy-Diniz, LF, Corrêa, H.Suicidal behavior in bipolar disorder: what is the influence of psychiatric comorbidities? J Clin Psychiatry 2009;70:1318.
33.Post, RM.The impact of bipolar depression. J Clin Psychiatry 2005;66(Suppl. 5):510.
34.Berk, M, Malhi, GS, Mitchell, PBet al. Scale matters: the need for a bipolar depression rating scale (BDRS). Acta Psychiatr Scand 2004;110:18.
35.Colom, F, Vieta, E, Daban, C, Pacchiarotti, I, Sánchez-Moreno, J.Clinical and therapeutic implications of predominant polarity in bipolar disorder. J Affect Disord 2006;93:1317.
36.Pasco, J, Jacka, F, Williams, LJet al. Leptin in depressed women: cross-sectional and longitudinal data from an epidemiologic study. J Affect Disord 2007;107:211225.
37.McIntyre, RS, Soczynska, JK, Konarski, JZet al. Should depressive syndromes be reclassified as “metabolic syndrome type II”? Ann Clin Psychiatry 2007;19:257264.
38.McEwen, BS.Mood disorders and allostatic load. Biol Psychiatry 2003;54:200207.
39.Kapczinski, F, Vieta, E, Andreazza, ACet al. Allostatic load in bipolar disorder: implications for pathophysiology and treatment. Neurosci Biobehav Rev 2008;32:675692.


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Obesity is associated with previous suicide attempts in bipolar disorder

  • Fabiano A. Gomes (a1), Márcia Kauer-Sant’Anna (a1), Pedro V. Magalhães (a1), Felice N. Jacka (a2), Seetal Dodd (a2), Clarissa S. Gama (a1), Ângelo Cunha (a3), Michael Berk (a2) and Flávio Kapczinski (a1)...


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