Research paperOnset polarity in bipolar disorder: A strong association between first depressive episode and suicide attempts

- Onset polarity (OP) in BD has been increasingly investigated over the last years for its clinical, prognostic, and therapeutic implications.
- The present study aimed to assess OP correlates, in particular as regards suicidal risk, in a sample of 362 recovered bipolar patients.
- A strong association between depressive OP and suicide attempts emerged, thus supporting the influence of OP on BD course and outcome.

BackgroundThe role of onset polarity (OP) in patients with bipolar disorder (BD) has been increasingly investigated over the last few years, for its clinical, prognostic, and therapeutic implications. The present study sought to assess whether OP was associated with specific correlates, in particular with a differential suicidal risk in BD patients.MethodsA sample of 362 recovered BD patients was dichotomized by OP: depressed (DO) or elevated onset (EO: hypomanic/manic/mixed). Socio-demographic and clinical variables were compared between the subgroups. Additionally, binary logistic regression was performed to assess features associated with OP.ResultsDO compared with EO patients had older current age and were more often female, but less often single and unemployed. Clinically, DO versus EO had a more than doubled rate of suicide attempts, as well as significantly higher rates of BD II diagnosis, lifetime stressful events, current psychotropics and antidepressants use, longer duration of the most recent episode (more often depressive), but lower rates of psychosis and involuntary commitments.LimitationsRetrospective design limiting the accurate assessment of total number of prior episodes of each polarity.ConclusionsOur results support the influence of OP on BD course and outcome. Moreover, in light of the relationship between DO and a higher rate of suicide attempts, further investigation may help clinicians in identifying patients at higher risk of suicide attempts.