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Sex-specific risk profiles for suicide mortality in bipolar disorder: incidence, healthcare utilization and comorbidity

Published online by Cambridge University Press:  11 August 2021

Pao-Huan Chen
Affiliation:
Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
Shang-Ying Tsai
Affiliation:
Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
Chun-Hung Pan
Affiliation:
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan Department of Psychology, National Chengchi University, Taipei, Taiwan
Yi-Lung Chen
Affiliation:
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan Department of Counseling Psychology, Chinese Culture University, Taipei, Taiwan
Hu-Ming Chang
Affiliation:
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
Sheng-Siang Su
Affiliation:
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
Chiao-Chicy Chen
Affiliation:
Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
Chian-Jue Kuo*
Affiliation:
Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
*
Author for correspondence: Chian-Jue Kuo, E-mail: tcpckuo@seed.net.tw

Abstract

Background

Evidence on sex-specific incidence and comorbidity risk factors of suicide among patients with bipolar disorder is scarce. This study investigated the sex-specific risk profiles for suicide among the bipolar disorder population in terms of incidence, healthcare utilization and comorbidity.

Methods

Using data from the Taiwan National Health Insurance Research Database between 1 January 2000 and 31 December 2016, this nationwide cohort study included patients with bipolar disorder (N = 46 490) and individuals representative of the general population (N = 185 960) matched by age and sex at a 1:4 ratio. Mortality rate ratios (MRRs) of suicide were calculated between suicide rates of bipolar disorder cohort and general population. In addition, a nested case–control study (1428 cases died by suicide and 5710 living controls) was conducted in the bipolar disorder cohort to examine the sex-specific risk of healthcare utilization and comorbidities.

Results

Suicide risk was considerably higher in the cohort (MRR = 21.9) than in the general population, especially among women (MRR = 35.6). Sex-stratified analyses revealed distinct healthcare utilization patterns and physical comorbidity risk profiles between the sexes. Although female patients who died by suicide had higher risks of nonhypertensive cardiovascular disease, pneumonia, chronic kidney disease, peptic ulcer, irritable bowel syndrome, and sepsis compared to their living counterparts, male patients who died by suicide had higher risks of chronic kidney disease and sepsis compared to the living controls.

Conclusions

Patients with bipolar disorder who died by suicide had sex-specific risk profiles in incidence and physical comorbidities. Identifying these modifiable risk factors may guide interventions for suicide risk reduction.

Type
Original Article
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

Angus, D. C., Linde-Zwirble, W. T., Lidicker, J., Clermont, G., Carcillo, J., & Pinsky, M. R. (2001). Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Critical Care Medicine, 29, 13031310.CrossRefGoogle ScholarPubMed
Ayerbe, L., Forgnone, I., Foguet-Boreu, Q., Gonzalez, E., Addo, J., & Ayis, S. (2018). Disparities in the management of cardiovascular risk factors in patients with psychiatric disorders: A systematic review and meta-analysis. Psychological Medicine, 48, 26932701.CrossRefGoogle ScholarPubMed
Baskaran, A., Cha, D. S., Powell, A. M., Jalil, D., & McIntyre, R. S. (2014). Sex differences in rates of obesity in bipolar disorder: Postulated mechanisms. Bipolar Disorders, 16, 8392.CrossRefGoogle ScholarPubMed
Bertrand, L., Bourguignon, C., Beaulieu, S., Storch, K. F., & Linnaranta, O. (2020). Suicidal ideation and insomnia in bipolar disorders: Ideation suicidaire et insomnie dans les troubles bipolaires. Canadian Journal of Psychiatry, 65, 802810.CrossRefGoogle ScholarPubMed
Cassidy, F. (2011). Risk factors of attempted suicide in bipolar disorder. Suicide and Life-Threatening Behavior, 41, 611.CrossRefGoogle ScholarPubMed
Chen, V. C., Tan, H. K., Chen, C. Y., Chen, T. H., Liao, L. R., Lee, C. T., … Cheng, A. T. (2011). Mortality and suicide after self-harm: Community cohort study in Taiwan. British Journal of Psychiatry, 198, 3136.CrossRefGoogle ScholarPubMed
Chen, P. H., Tsai, S. Y., Pan, C. H., Chang, C. K., Su, S. S., Chen, C. C., & Kuo, C. J. (2019). Mood stabilisers and risk of stroke in bipolar disorder. British Journal of Psychiatry, 215, 409414.CrossRefGoogle ScholarPubMed
Coleman, D., Lawrence, R., Parekh, A., Galfalvy, H., Blasco-Fontecilla, H., Brent, D. A., … Oquendo, M. A. (2017). Narcissistic personality disorder and suicidal behavior in mood disorders. Journal of Psychiatric Research, 85, 2428.CrossRefGoogle ScholarPubMed
Coryell, W., Solomon, D., Turvey, C., Keller, M., Leon, A. C., Endicott, J., … Mueller, T. (2003). The long-term course of rapid-cycling bipolar disorder. Archives of General Psychiatry, 60, 914920.CrossRefGoogle ScholarPubMed
Crump, C., Sundquist, K., Winkleby, M. A., & Sundquist, J. (2013). Comorbidities and mortality in bipolar disorder: A Swedish national cohort study. JAMA Psychiatry, 70, 931939.CrossRefGoogle ScholarPubMed
Dargel, A. A., Roussel, F., Volant, S., Etain, B., Grant, R., Azorin, J. M., … Henry, C. (2018). Emotional hyper-reactivity and cardiometabolic risk in remitted bipolar patients: A machine learning approach. Acta Psychiatrica Scandinavica, 138, 348359.CrossRefGoogle ScholarPubMed
Dutta, R., Boydell, J., Kennedy, N., van Os, J., Fearon, P., & Murray, R. M. (2007). Suicide and other causes of mortality in bipolar disorder: A longitudinal study. Psychological Medicine, 37, 839847.CrossRefGoogle ScholarPubMed
Evans, S. J., Bassis, C. M., Hein, R., Assari, S., Flowers, S. A., Kelly, M. B., … McInnis, M. G. (2017). The gut microbiome composition associates with bipolar disorder and illness severity. Journal of Psychiatric Research, 87, 2329.CrossRefGoogle ScholarPubMed
Fagiolini, A., Frank, E., Scott, J. A., Turkin, S., & Kupfer, D. J. (2005). Metabolic syndrome in bipolar disorder: Findings from the bipolar disorder center for Pennsylvanians. Bipolar Disorders, 7, 424430.CrossRefGoogle ScholarPubMed
Forty, L., Ulanova, A., Jones, L., Jones, I., Gordon-Smith, K., Fraser, C., … Craddock, N. (2014). Comorbid medical illness in bipolar disorder. British Journal of Psychiatry, 205, 465472.CrossRefGoogle ScholarPubMed
Gao, K., Tolliver, B. K., Kemp, D. E., Ganocy, S. J., Bilali, S., Brady, K. L., … Calabrese, J. R. (2009). Correlates of historical suicide attempt in rapid-cycling bipolar disorder: A cross-sectional assessment. Journal of Clinical Psychiatry, 70, 10321040.CrossRefGoogle ScholarPubMed
Gonda, X., Pompili, M., Serafini, G., Montebovi, F., Campi, S., Dome, P., … Rihmer, Z. (2012). Suicidal behavior in bipolar disorder: Epidemiology, characteristics and major risk factors. Journal of Affective Disorders, 143, 1626.CrossRefGoogle ScholarPubMed
Hedegaard, H., Curtin, S. C., & Warner, M. (2020). Increase in Suicide Mortality in the United States, 1999–2018. National Center for Health Statistics (NCHS) Data Brief, 362, 18.Google Scholar
Hung, G. C., Liu, H. C., Yang, S. Y., Pan, C. H., Liao, Y. T., Chen, C. C., & Kuo, C. J. (2016). Antipsychotic reexposure and recurrent pneumonia in schizophrenia: A nested case-control study. Journal of Clinical Psychiatry, 77, 6066.CrossRefGoogle ScholarPubMed
Isometsa, E. (2014). Suicidal behaviour in mood disorders – who, when, and why? Canadian Journal of Psychiatry, 59, 120130.CrossRefGoogle Scholar
Kemp, D. E., Gao, K., Chan, P. K., Ganocy, S. J., Findling, R. L., & Calabrese, J. R. (2010). Medical comorbidity in bipolar disorder: Relationship between illnesses of the endocrine/metabolic system and treatment outcome. Bipolar Disorders, 12, 404413.CrossRefGoogle ScholarPubMed
Kemp, D. E., Sylvia, L. G., Calabrese, J. R., Nierenberg, A. A., Thase, M. E., Reilly-Harrington, N. A., … Li, T. S. G. (2014). General medical burden in bipolar disorder: Findings from the LiTMUS comparative effectiveness trial. Acta Psychiatrica Scandinavica, 129, 2434.CrossRefGoogle ScholarPubMed
Kessing, L. V. (2004). Severity of depressive episodes according to ICD-10: Prediction of risk of relapse and suicide. British Journal of Psychiatry, 184, 153156.CrossRefGoogle ScholarPubMed
Kocabas, O., Sevincok, L., Memis, C. O., & Dogan, B. (2019). The association of lifetime suicide attempts with anxiety disorders in patients with bipolar disorder. Journal of Psychiatric Practice, 25, 713.CrossRefGoogle ScholarPubMed
Kuo, C. J., Gunnell, D., Chen, C. C., Yip, P. S., & Chen, Y. Y. (2012). Suicide and non-suicide mortality after self-harm in Taipei City, Taiwan. British Journal of Psychiatry, 200, 405411.CrossRefGoogle ScholarPubMed
Kuo, C. J., Yang, S. Y., Liao, Y. T., Chen, W. J., Lee, W. C., Shau, W. Y., … Chen, C. C. (2013). Second-generation antipsychotic medications and risk of pneumonia in schizophrenia. Schizophrenia Bulletin, 39, 648657.CrossRefGoogle Scholar
Laursen, T. M., Munk-Olsen, T., Agerbo, E., Gasse, C., & Mortensen, P. B. (2009). Somatic hospital contacts, invasive cardiac procedures, and mortality from heart disease in patients with severe mental disorder. Archives of General Psychiatry, 66, 713720.CrossRefGoogle ScholarPubMed
Leboyer, M., Soreca, I., Scott, J., Frye, M., Henry, C., Tamouza, R., & Kupfer, D. J. (2012). Can bipolar disorder be viewed as a multi-system inflammatory disease? Journal of Affective Disorders, 141, 110.CrossRefGoogle ScholarPubMed
Lee, E. T. (1992). Statistical methods for survival data analysis. New York: John Wiley and Sons.Google Scholar
Lund-Sorensen, H., Benros, M. E., Madsen, T., Sorensen, H. J., Eaton, W. W., Postolache, T. T., … Erlangsen, A. (2016). A nationwide cohort study of the association between hospitalization with infection and risk of death by suicide. JAMA Psychiatry, 73, 912919.CrossRefGoogle ScholarPubMed
McIntyre, R. S., Konarski, J. Z., Soczynska, J. K., Wilkins, K., Panjwani, G., Bouffard, B., … Kennedy, S. H. (2006). Medical comorbidity in bipolar disorder: Implications for functional outcomes and health service utilization. Psychiatric Services, 57, 11401144.CrossRefGoogle ScholarPubMed
McIntyre, R. S., Muzina, D. J., Kemp, D. E., Blank, D., Woldeyohannes, H. O., Lofchy, J., … Konarski, J. Z. (2008). Bipolar disorder and suicide: Research synthesis and clinical translation. Current Psychiatry Reports, 10, 6672.CrossRefGoogle ScholarPubMed
McWhinney, S. R., Abe, C., Alda, M., Benedetti, F., Boen, E., Del Mar Bonnin, C., … Hajek, T. (2021). Association between body mass index and subcortical brain volumes in bipolar disorders – ENIGMA study in 2735 individuals. Molecular Psychiatry. doi: 10.1038/s41380-021-01098-xCrossRefGoogle ScholarPubMed
Miller, J. N., & Black, D. W. (2020). Bipolar disorder and suicide: A review. Current Psychiatry Reports, 22, 6.CrossRefGoogle ScholarPubMed
Naiberg, M. R., Newton, D. F., Collins, J. E., Bowie, C. R., & Goldstein, B. I. (2016a). Impulsivity is associated with blood pressure and waist circumference among adolescents with bipolar disorder. Journal of Psychiatric Research, 83, 230239.CrossRefGoogle Scholar
Naiberg, M. R., Newton, D. F., Collins, J. E., Dickstein, D. P., Bowie, C. R., & Goldstein, B. I. (2016b). Elevated triglycerides are associated with decreased executive function among adolescents with bipolar disorder. Acta Psychiatrica Scandinavica, 134, 241248.CrossRefGoogle Scholar
Oquendo, M. A., Currier, D., Liu, S. M., Hasin, D. S., Grant, B. F., & Blanco, C. (2010). Increased risk for suicidal behavior in comorbid bipolar disorder and alcohol use disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Journal of Clinical Psychiatry, 71, 902909.CrossRefGoogle Scholar
Osby, U., Brandt, L., Correia, N., Ekbom, A., & Sparen, P. (2001). Excess mortality in bipolar and unipolar disorder in Sweden. Archives of General Psychiatry, 58, 844850.CrossRefGoogle ScholarPubMed
Ostergaard, M. L. D., Nordentoft, M., & Hjorthoj, C. (2017). Associations between substance use disorders and suicide or suicide attempts in people with mental illness: A Danish nation-wide, prospective, register-based study of patients diagnosed with schizophrenia, bipolar disorder, unipolar depression or personality disorder. Addiction, 112, 12501259.CrossRefGoogle ScholarPubMed
Pan, Y. J., Yeh, L. L., Chan, H. Y., & Chang, C. K. (2020). Excess mortality and shortened life expectancy in people with major mental illnesses in Taiwan. Epidemiology and Psychiatric Sciences, 29, e156.CrossRefGoogle ScholarPubMed
Patel, R. S., Virani, S., Saeed, H., Nimmagadda, S., Talukdar, J., & Youssef, N. A. (2018). Gender differences and comorbidities in U. S. Adults with Bipolar Disorder. Brain Sciences, 8, 168. doi: 10.3390/brainsci8090168.CrossRefGoogle ScholarPubMed
Plans, L., Barrot, C., Nieto, E., Rios, J., Schulze, T. G., Papiol, S., … Benabarre, A. (2019). Association between completed suicide and bipolar disorder: A systematic review of the literature. Journal of Affective Disorders, 242, 111122.CrossRefGoogle ScholarPubMed
Pompili, M., Gonda, X., Serafini, G., Innamorati, M., Sher, L., Amore, M., … Girardi, P. (2013). Epidemiology of suicide in bipolar disorders: A systematic review of the literature. Bipolar Disorders, 15, 457490.CrossRefGoogle ScholarPubMed
Rosso, G., Albert, U., Bramante, S., Aragno, E., Quarato, F., Di Salvo, G., & Maina, G. (2020). Correlates of violent suicide attempts in patients with bipolar disorder. Comprehensive Psychiatry, 96, 152136.CrossRefGoogle ScholarPubMed
Schaffer, A., Isometsa, E. T., Tondo, L., D, H. M., Turecki, G., Reis, C., Cassidy, F., … Yatham, L. N. (2015). International society for bipolar disorders task force on suicide: Meta-analyses and meta-regression of correlates of suicide attempts and suicide deaths in bipolar disorder. Bipolar Disorders 17, 116.CrossRefGoogle ScholarPubMed
Simon, G. E., Hunkeler, E., Fireman, B., Lee, J. Y., & Savarino, J. (2007a). Risk of suicide attempt and suicide death in patients treated for bipolar disorder. Bipolar Disorders, 9, 526530.CrossRefGoogle Scholar
Simon, N. M., Zalta, A. K., Otto, M. W., Ostacher, M. J., Fischmann, D., Chow, C. W., … Pollack, M. H. (2007b). The association of comorbid anxiety disorders with suicide attempts and suicidal ideation in outpatients with bipolar disorder. Journal of Psychiatric Research, 41, 255264.CrossRefGoogle Scholar
Tondo, L., Isacsson, G., & Baldessarini, R. (2003). Suicidal behaviour in bipolar disorder: Risk and prevention. CNS Drugs, 17, 491511.CrossRefGoogle ScholarPubMed
Valtonen, H. M., Suominen, K., Haukka, J., Mantere, O., Leppamaki, S., Arvilommi, P., & Isometsa, E. T. (2008). Differences in incidence of suicide attempts during phases of bipolar I and II disorders. Bipolar Disorders, 10, 588596.CrossRefGoogle ScholarPubMed
Valtonen, H. M., Suominen, K., Mantere, O., Leppamaki, S., Arvilommi, P., & Isometsa, E. (2007). Suicidal behaviour during different phases of bipolar disorder. Journal of Affective Disorders, 97, 101107.CrossRefGoogle ScholarPubMed
World Health Organization. (2019). WHO mortality database from http://www.who.int/news-room/fact-sheets/detail/suicide.Google Scholar
Wu, C. S., Wang, S. C., Cheng, Y. C., & Gau, S. S. (2011). Association of cerebrovascular events with antidepressant use: A case-crossover study. American Journal of Psychiatry, 168, 511521.CrossRefGoogle ScholarPubMed
Wu, C. S., Wang, S. C., Gau, S. S., Tsai, H. J., & Cheng, Y. C. (2013). Association of stroke with the receptor-binding profiles of antipsychotics-a case-crossover study. Biological Psychiatry, 73, 414421.CrossRefGoogle ScholarPubMed
Zimmerman, M., Martinez, J., Young, D., Chelminski, I., Morgan, T. A., & Dalrymple, K. (2014). Comorbid bipolar disorder and borderline personality disorder and history of suicide attempts. Journal of Personality Disorders, 28, 358364.CrossRefGoogle ScholarPubMed
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