How suicidal bipolar patients are depends on how suicidal ideation is defined

Valtonen, Hanna M.; Suominen, Kirsi; Sokero, Petteri; Mantere, Outi; Arvilommi, Petri; Leppämäki, Sami; Isometsä, Erkki T.

doi:10.1016/j.jad.2009.02.008

« Previous Next »Journal of Affective Disorders
Volume 118, Issue 1 , Pages 48-54, November 2009

How suicidal bipolar patients are depends on how suicidal ideation is defined

Hanna M. Valtonen
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
- Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital, Espoo, Finland
Kirsi Suominen
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
- Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital, Espoo, Finland
Petteri Sokero
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
Outi Mantere
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
- Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital, Espoo, Finland
Petri Arvilommi
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
- Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital, Espoo, Finland
Sami Leppämäki
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
Erkki T. Isometsä
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
- Corresponding author. Institute of Clinical Medicine, Department of Psychiatry, P.O. Box 22, 00014 University of Helsinki, Finland. Tel.: +358 9 471 63728; fax: +358 9 47163735.

Received 21 January 2009; received in revised form 12 February 2009; accepted 12 February 2009.

Abstract

Background

Suicidal ideation indicates risk for suicidal acts. How different definitions and measures for suicidal ideation influence its prevalence, correlates and predictive validity among bipolar disorder (BD) patients is unknown.

Methods

Among the 191 BD patients in the Jorvi Bipolar Study (JoBS), suicidal ideation at baseline was measured using the Scale for Suicidal Ideation (SSI), Hamilton Depression Scale (HAM-D) item 3 and Beck Depression Inventory (BDI) item 9 and by asking whether patients had seriously considered suicide. The predictive value of different definitions of ideation on suicide attempts during a six-month follow-up was investigated.

Results

Altogether 74% of patients had suicidal ideation as defined in at least one of the above-mentioned ways, but only 29% met the criteria for all ways; agreement between definitions ranged from low to moderate (kappa coefficient 0.15 to 0.70). The correlates of suicidal ideation overlapped, but were not identical. Of the measures investigated, a baseline SSI score ≥8 had the best combination of sensitivity (0.81) and specificity (0.69) and a positive predictive value (PPV) of 32% for an attempted suicide during follow-up.

Limitations

All plausible measures for suicidal ideation could not be investigated.

Conclusions

Who is classified as having suicidal ideation depends strongly on the definition and means of measurement among BD patients. Different measures for ideation have the potential to cause inconsistency when correlates of suicidal ideation are investigated. For clinically predicting suicide attempts during the next few months, an SSI score ≥8 may best combine sensitivity and specificity.

Keywords: Bipolar disorder, Suicidal ideation, Suicide attempt, Mixed state, Depressive phase