Comorbid PTSD Raises Risk for Suicidal Ideation in Patients with Bipolar Disorder

Two different colored heads facing each other. Concept: Bipolar Disorder
Compared with patients without PTSD, patients with both bipolar disorder and PTSD were more likely to be women, on disability, have a lower education level, and have a lower annual household income.

Patients with bipolar disorder have a significantly elevated risk for suicidal ideation when they experience comorbid posttraumatic stress disorder (PTSD), according to study results published in the Journal of Affective Disorders. Of note, the study’s sample of 58 patients with co-occurring bipolar disorder and PTSD unanimously reported current suicidal thoughts.

Investigators at the Dauten Family Center for Bipolar Treatment Innovation at Massachusetts General Hospital in Boston conducted a secondary analysis of baseline data from the Bipolar CHOICE randomized clinical trial, which sought to compare the efficacy of lithium with quetiapine for bipolar disorder. Self-reported demographics and family history were recorded at baseline; comorbid conditions were identified in clinician-administered semi-structured interviews. The Concise Health Risk Tracking Scale (CHRT), a self-report tool, was used to capture suicidal ideation in patients. CHRT sub-factors included current suicidal ideation and propensity score, which denotes pessimism, helplessness, and despair. The investigators used hierarchical regression models to assess the relationship between comorbid PTSD and CHRT outcomes.

The Bipolar CHOICE study enrolled 482 patients with bipolar disorder (mean age, 38.8±12.2 years; 58.7% women; 75.9% white), with 12% of enrollees having a comorbid PTSD diagnosis. Compared with patients without PTSD, patients with both bipolar disorder and PTSD were more likely to be women (P =.02), be on disability (P =.001), have a lower education level (P <.001), and have a lower annual household income (P =.006). Patients with comorbid PTSD had a higher number of comorbid anxiety disorders (P <.001), more past psychiatric hospitalizations (P <.001), and higher rates of bipolar disorder type I vs type II (P <.001).

All patients with comorbid PTSD indicated that they had current suicidal ideation compared with 86.3% of patients without comorbid PTSD (P =.005). Bipolar patients with comorbid PTSD had higher CHRT total and propensity scores compared with patients without PTSD (both P <.001). The comorbid group was also more likely to report a prior suicide attempt (P <.001). In hierarchical regression models, PTSD diagnosis was a significant predictor of both CHRT total score (P =.03) and propensity factor (P =.04).

As study limitations, the investigators cited the small sample size and outpatient setting. The researchers concluded, “The identification of effective psychosocial treatments for this comorbidity is especially important given that antidepressants, the first-line pharmacologic treatments for PTSD, carry a risk of treatment-emergent mania as well as worsening depressive morbidity in rapid-cycling patients.” As a result, psychosocial treatments targeting PTSD symptoms may be crucial to reducing suicidality in patients with co-occurring bipolar disorder.

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Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures


Katz D, Petersen T, Amado S, et al. An evaluation of suicidal risk in bipolar patients with comorbid posttraumatic stress disorder [published online January 21, 2020]. doi:10.1016/j.jad.2020.01.091

This article originally appeared on Psychiatry Advisor