Suicide in Bipolar Disorder: The Role of Emotional Dysregulation, Childhood Trauma and Resilience.

INTRODUCTION

Childhood trauma (CT), low psychologic resilience (PR) and emotion regulation difficulties (DER) have been associated with suicidal behavior (SB); however limited research has explored this association in patients diagnosed with bipolar disorder type 1 (BPDI). This study aimed to investigate the differences in terms of CT, PR, DER among euthymic BPDI patients with and without suicide attempts and healthy individuals and the relationship of SB with these factors.

METHODS

Seventy euthymic BPDI patients with suicide attempt [(BPDI (+)] and 81 euthymic BPD1 patients without suicide attempt [BPDI (-)] and 90 healthy controls were included. The SCID-5, Beck Depression Inventory, Young Mania Rating Scale (YMRS), Sociodemographic form, Columbia-Suicide Severity Ranking Scale, and Childhood Trauma Questionnaire (CTQ), Resilience Scale for Adults (RSA) and Difficulties in Emotion Regulation Scale (DERS) were administered to participants.

RESULTS

BPDI (+) group had significantly higher CTQ scores than both BPD1(-) and control groups. The BPDI (+) group had significantly higher DERS clarity, non-acceptance, strategies, impulsivity, goals and total scores than both the BPDI (-) and control groups. Both patient groups had significantly lower RSA perceptions of self, planned future, social resources and total scores than the control group. Emotional abuse scores of CTQ and strategies scores of DERS had a significant and independent effect in distinguishing the BPDI (+) patients from the BPDI (-).

CONCLUSIONS

Our findings indicate that BPDI patients with a history of CT and DER are at a higher risk for SB. In light of these results, it is concluded that suicide risk assessments in clinical practice should include CT history and emotion regulation skills, that interventions aimed at enhancing PR should be developed, and that further prospective studies are needed to investigate the effects of these factors on the clinical course of BPDI.