A risk-scoring scheme for suicide attempts among patients with bipolar disorder in a Thai patient cohort

Abstract

Background: In Thailand, risk factors associated with suicide attempts in bipolar disorder (BD) are rarely investigated, nor has a specific risk-scoring scheme to assist in the identification of BD patients at risk for attempting suicide been proposed. Objective: To develop a simple risk-scoring scheme to identify patients with BD who may be at risk for attempting suicide. Methods: Medical files of 489 patients diagnosed with BD at Suanprung Psychiatric Hospital between October 2006 and May 2009 were reviewed. Cases included BD patients hospitalized due to attempted suicide (n = 58), and seven controls were selected (per suicide case) among BD in- and out-patients who did not attempt suicide, with patients being visited the same day or within 1 week of case study (n = 431). Broad sociodemographic and clinical factors were gathered and analyzed using multivariate logistic regression, to obtain a set of risk factors. Scores for each indicator were weighted, assigned, and summed to create a total risk score, which was divided into low, moderate, and high-risk suicide attempt groups. Results: Six statistically significant indicators associated with suicide attempts were included in the risk-scoring scheme: depression, psychotic symptom(s), number of previous suicide attempts, stressful life event(s), medication adherence, and BD treatment years. A total risk score (possible range -1.5 to 11.5) explained an 88.6% probability of suicide attempts based on the receiver operating characteristic (ROC) analysis. Likelihood ratios of suicide attempts with low risk scores (below 2.5), moderate risk scores (2.5-8.0), and high risk scores (above 8.0) were 0.11 (95% CI 0.04-0.32), 1.72 (95% CI 1.41-2.10), and 19.0 (95% CI 6.17-58.16), respectively. Conclusion: The proposed risk-scoring scheme is BD-specific, comprising six key indicators for simple, routine assessment and classification of patients to three risk groups. Further validation is required before adopting this scheme in other clinical settings. © 2012 Ruengorn et al, publisher and licensee Dove Medical Press Ltd.