Subjects with high-lethality attempts were older (37.4 ± 10.4 vs. 33.3 ± 9.9, t = 2.37, df = 113, p = 0.019) and more likely to be married than low-lethality attempters (37.5% vs. 17%, χ2 = 3.99, df = 1, p = 0.014), but were not different on gender (48% male vs. 34% male, χ2 = 2.14, df = 1, p = 0.144) or any other demographic variable (data not shown). For individual attempts, older age at the time of attempt was associated with higher lethality when adjusted for a random subject effect (OR = 1.5 for each 10 years increase, z = 3.0, p = .002).
Acute and Comorbid Psychopathology
High-lethality attempters were more likely to be inpatients at the time of entry to the study than low-lethality attempters (), and remained so even after excluding recent attempters from the analysis (data not shown). The two groups did not differ in severity of depressive symptoms and both had high, but similar, lifetime rates of alcohol and/or substance use disorders, severity of life stressors, and rates of childhood abuse ().
Comparison of Bipolar Patients Who Have Made High- and Low-Lethality Suicide Attempts: Clinical and Psychosocial Characteristics
Aggression and Other Trait Characteristics
There was no difference in lifetime aggression, impulsivity, or hostility scores, and there were similar rates of comorbid cluster B personality disorder (CBPD) in high- and low-lethality attempter groups ().
Course of Illness
High-lethality attempters had a greater number of prior psychiatric hospitalizations than low-lethality attempters (adjusted for age and number of attempts) despite the fact that the two groups did not differ in number of depressive episodes, or age of onset of first depressive, manic, or hypomanic episode ().
High-lethality attempters had greater suicide intent at the time of the most lethal attempt than low-lethality attempters, and had made a greater number of previous attempts (). The two groups did not differ in terms of suicidal ideation in the 2 weeks prior to study entry, or in suicide related factors such as hopelessness and reasons for living. There was no difference in rates of suicide attempt or suicide in first-degree relatives ().
Comparison of Bipolar Patients Who Have Made High- and Low-Lethality Suicide Attempts: Characteristics of Suicidal Behavior
Repeat Suicide Attempt and Lethality
In model 1, the number of previous attempts did not predict high-lethality at the next attempt (OR = 1.06, z = 0.6, p = 0.580). Permutation analysis did not find a pattern of increasing lethality with each subsequent attempt (Spearman Correlation = 0.05480678, p-value = 0.4305). These two findings combined suggest that the lethality of the next attempt cannot be predicted based on the number of earlier attempts and that lethality does not automatically increase at each subsequent attempt. However, model 2 showed that for multiple attempt individuals who had made an early attempt of high lethality, there was significant likelihood that any subsequent attempts would also have high lethality (OR = 2.6, z = 2.8, p = .006). That model also showed that age at time of attempt was not a significant correlate of high lethality (age: OR = 1.25, z = 1.2, p = .220) once lethality of early of attempt is considered.