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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 ,
Shang-Ying Tsai ,
Chun-Hung Pan ,
Yi-Lung Chen ,
Hu-Ming Chang ,
Sheng-Siang Su ,
Chiao-Chicy Chen  and
Chian-Jue Kuo Open the ORCID record for Chian-Jue Kuo [Opens in a new window]
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
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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.

Keywords

Bipolar disordercomorbidityincidencemortality rate ratiosex-stratifiedsuicide
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 4 , March 2023 , pp. 1500 - 1509
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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