Suicidal Attempt in Bipolar Disorder: Low Significance of Comorbidity with Opioid Dependence

By Shabani, Amir; Jolfaei, Atefeh Ghanbari et al. | Iranian Journal of Psychiatry, April 1, 2009 | Go to article overview

Suicidal Attempt in Bipolar Disorder: Low Significance of Comorbidity with Opioid Dependence


Shabani, Amir, Jolfaei, Atefeh Ghanbari, Vazmalaei, Hajar Ahmadi, Ebrahimi, Azizeh Afkham, Naserbakht, Morteza, Iranian Journal of Psychiatry


Objectives: The relationship between suicidal attempt and opioid use disorder in patients with bipolar disorder (BD) is unknown. This study aimed at shedding some light on this issue.

Method: 176 inpatients aged 18-65 with BD type I with or without opioid use disorders were interviewed face-to-face through the Persian Structured Clinical Interview for DSM-IV axis I disorders (SCID-I), the Global Assessment of Functioning (GAF) scale, and a questionnaire including demographic characteristics and some clinical factors .

Results: Gender was the only demographic factor with a statistically significant difference between suicidal and non-suicidal bipolar patients. In addition, comorbidity with anxiety disorders and the type of index and current mood episodes were significantly different between the two groups (p<0.05). However, after using a logistic regression analysis, the only statistically significant different factors (p<0.05) between the two groups were gender, comorbidity with anxiety disorders, and GAF .

Conclusion: Opioid dependence comorbidity can not be considered as a risk factor for suicidal attempt in patients with BD.

Keywords: Suicide, Bipolar disorder, Substance dependence, Opioid, Risk factor, Iran

Iran J Psychiatry 2009; 4:74-78

Mood disorder, especially bipolar disorder (BD) is the most important risk factor for attempted suicide (1), and substance use disorder (SUD) is placed as the second factor (2). Moreover, the SUD prevalence among people with BD has been reported to be 17 to 65 percent (3). Not only having BD or SUD is in association with attempted suicide (1, 2), but also specifically suffering from SUD has been considered as a risk factor for suicidal attempt among patients with BD (4-8).

According to the review of the literature by Hawton et al. (9), substance abuse was one of the most consistent factors related to suicidal attempt in patients with BD. On this review, other factors related to suicidal attempt were "early onset of BD, family history of completed suicide, depression at index episode, comorbidity with axis II disorders, mixed affective states, rapid cycling, and anxiety disorders."

Nevertheless, such a relationship between substance abuse and attempted suicide in patients with BD has not been replicated in all studies (10). Although the effect of cultural differences on the relationship between substance abuse and suicidal attempt (at least in patients with schizophrenia) has not been confirmed

(11), there would be some other factors that could be

the reasons for the variety in the findings of the different studies. In this regard, we can point out to the factors such as not studying a homogenous sample of patients regarding the diagnosis; for example, entering the patients with BD-Not Otherwise Specified in the study of Oquendo et al. (10), the difference in sample selection (like the different sampling in the study of Dalton et al. (12) using advertisement at the newspaper), and the different features of prominent mood of the patients (13). Sometimes even the type of abused substance has identified the relationship between SUD and attempted suicide in patients with BD (12). Dalton et al. (12) reported that the substance use disorder (exception of alcohol) in contrast to the alcohol use disorder (AUD) was in association with attempted suicide in BD patients. Most of their patients with the substance use disorder (exception of alcohol) abused cannabis (74%), and after that hallucinogens (18%), sedatives (18%), and cocaine (18%). Furthermore, it has been drawn from several studies that three substances of alcohol, cocaine and cannabis are abused frequently by BD patients (18% to 75%) (14). Given that opioid abuse is less prevalent than the abuse of mentioned substances in the western countries, it is rational to gather that the patients with opioid use disorders (OUD) have been less assessed in the studies. …

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