Association between history of suicide attempts and family functioning in bipolar disorder

- We examined Thirty-one BD type I patients with lifetime history of suicide attempt and 31 BD type I with no lifetime history of suicide attempt.
- Patients with lifetime suicide attempt perceived their families as having a worse family functioning than patients without suicide attempt history.
- Family members of BD patients tend to perceive their families largely in the same way of patients.
- Current mood symptoms are less likely to affect the response of Family Functioning Scale.

ObjectivesTo investigate the association between history of suicide attempts (SA) and family functioning in bipolar disorder (BD) patients.MethodsThirty-one BD type I patients with lifetime history of SA, 31 BD type I with no lifetime history of SA, participating in the Outpatient Clinic of the Bipolar Disorder Program at the Institute of Psychiatry of the University of São Paulo Medical School were recruited for this study. We used the Family Assessment Device (FAD) to evaluate family functioning. We compared these two groups on demographic and clinical variables to identify which variables were associated with family functioning impairment. Fifty-one relatives of the same patients were also asked to complete a FAD.ResultsBD patients with SA presented more psychiatric hospitalizations, higher frequency of psychotic symptoms, and higher scores on depressive, manic, and suicidal ideation than BD patients without SA. BD patients with SA presented significantly higher scores in several subscales of the FAD, including Problem Solving (p=0.042), Communication (p=0.009), Roles (p=0.006), and General Functioning (p=0.025), when compared with BD patients without SA. Relatives of BD patients with SA presented significantly higher scores in Communication, Roles, Affective Responsiveness, and General Functioning than relatives of BD patients without SA.LimitationsCross-sectional study and long time elapsed since last SA.ConclusionHistory of SA in BD is associated with worse family functioning in several domains of FAD, including Problem Solving, Communication, Roles, and General Functioning. As suicide attempts are routinely assessed in clinical practice, these findings may help to identify patients with poorer family functioning and may suggest a role for environmental risk factors in suicidal behavior among BD patients.