Personality disorders and suicide attempts in unipolar and bipolar mood disorders

- Among mood disorder patients, comorbid personality disorders (PDs) increase the risk of suicide attempts (SAs) to approximately two-fold.
- The excess risk is mostly due to patients with comorbid PDs spending more time in major depressive episodes (MDEs) than those without.
- All DSM-IV PD clusters increased the rate of new SAs, although cluster C PDs more than the others.
- After adjusting for time spent in MDEs, only cluster C further increased the SA rate.
- Direct risk-modifying effects of PDs were also found.

BackgroundComorbid personality disorders may predispose patients with mood disorders to suicide attempts (SAs), but factors mediating this effect are not well known.MethodsAltogether 597 patients from three prospective cohort studies (Vantaa Depression Study, Jorvi Bipolar Study, and Vantaa Primary Care Depression Study) were interviewed at baseline, at 18 months, and in VDS and PC-VDS at 5 years. Personality disorders (PDs) at baseline, number of previous SAs, life-charted time spent in major depressive episodes (MDEs), and precise timing of SAs during follow-up were determined and investigated.ResultsOverall, 219 (36.7%) patients had a total of 718 lifetime SAs; 88 (14.7%) patients had 242 SAs during the prospective follow-up. Having any PD diagnosis increased the SA rate, both lifetime and prospectively evaluated, by 90% and 102%, respectively. All PD clusters increased the rate of new SAs, although cluster C PDs more than the others. After adjusting for time spent in MDEs, only cluster C further increased the SA rate (by 52%). Mediation analyses of PD effects on prospectively ascertained SAs indicated significant mediated effects through time at risk in MDEs, but also some direct effects.LimitationsFindings generalizable only to patients with mood disorders.ConclusionsAmong mood disorder patients, comorbid PDs increase the risk of SAs to approximately two-fold. The excess risk is mostly due to patients with comorbid PDs spending more time in depressive episodes than those without. Consequently, risk appears highest for PDs that most predispose to chronicity and recurrences. However, also direct risk-modifying effects of PDs exist.