Comorbid alcohol use disorders increase bipolar suicide risk
MedWire News: Patients with bipolar disorder are more than twice as likely to experience suicidal behavior if they also have alcohol use disorders, survey findings show.
Maria Oquendo, from Columbia University in New York, USA, and colleagues report, however, that despite this increased risk for suicidal behavior, patients with bipolar disorder and alcohol use disorders did not receive more psychiatric treatment.
"This was the case even though bipolar respondents with alcohol use disorder had considerably higher rates of drug use disorders and were more often afflicted with character pathology," the researchers say.
They therefore suggest that "interventions to improve adherence and venues to make care more accessible for this population with high disease burden would be of utility."
The team analyzed data on 1643 patients from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) with a lifetime diagnosis of bipolar disorder.
More than half (54%) of the patients met the criteria for alcohol use disorder on the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version.
These patients were at greater risk for suicide attempt than individuals without alcohol use disorders, at an odds ratio of 2.25.
The researchers note that the bipolar patients with alcohol use disorders were more likely than those without such disorders to have comorbid nicotine dependence and drug use disorders. However, these comorbidities did not increase the risk for suicidal behavior among the bipolar patients and did not confer additional risk to that associated with alcohol use disorders.
Patients with alcohol use disorders had an earlier age at onset of bipolar disorder and a propensity to endorse alcohol use as self-medication, relative to other patients. But neither these factors nor the number of previous major depressive episodes experienced affected the link between alcohol use and suicidal behavior.
"Given the high disease burden suffered by these individuals and the increased risk for morbidity and mortality when bipolar disorder and alcohol use disorder are comorbid, targeting them for treatment is a public health imperative," Oquendo and team conclude in the Journal of Clinical Psychiatry.
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By Lucy Piper