Trajectories of suicidal ideation over 6 months among 482 outpatients with bipolar disorder

Ole Köhler-Forsberg, Trine Madsen, Ida Behrendt-Møller, Louisa Sylvia, Charles L. Bowden, Keming Gao, William V. Bobo, Madhukar H. Trivedi, Joseph R. Calabrese, Michael Thase, Richard C. Shelton, Melvin McInnis, Mauricio Tohen, Terence A. Ketter, Edward S. Friedman, Thilo Deckersbach, Susan L. McElroy, Noreen A. Reilly-Harrington, Andrew A. Nierenberg

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Introduction Suicidal ideation occurs frequently among individuals with bipolar disorder; however, its course and persistence over time remains unclear. We aimed to investigate 6-months trajectories of suicidal ideation among adults with bipolar disorder. Methods The Bipolar CHOICE study randomized 482 outpatients with bipolar disorder to 6 months of lithium- or quetiapine-based treatment including other psychotropic medications as clinically indicated. Participants were asked at 9 visits about suicidal ideation using the Concise Health Risk Tracking scale. We performed latent Growth Mixture Modelling analysis to empirically identify trajectories of suicidal ideation. Multinomial logistic regression analyses were applied to estimate associations between trajectories and potential predictors. Results We identified four distinct trajectories. The Moderate-Stable group represented 11.1% and was characterized by constant suicidal ideation. The Moderate-Unstable group included 2.9% with persistent thoughts about suicide with a more fluctuating course. The third (Persistent-low, 20.8%) and fourth group (Persistent-very-low, 65.1%) were characterized by low levels of suicidal ideation. Higher depression scores and previous suicide attempts (non-significant trend) predicted membership of the Moderate-Stable group, whereas randomized treatment did not. Limitations No specific treatments against suicidal ideation were included and suicidal thoughts may persist for several years. Conclusion More than one in ten adult outpatients with bipolar disorder had moderately increased suicidal ideation throughout 6 months of pharmacotherapy. The identified predictors may help clinicians to identify those with additional need for treatment against suicidal thoughts and future studies need to investigate whether targeted treatment (pharmacological and non-pharmacological) may improve the course of persistent suicidal ideation.

Original languageEnglish (US)
Pages (from-to)146-152
Number of pages7
JournalJournal of affective disorders
StatePublished - Dec 1 2017


  • Bipolar disorder
  • Growth mixture modelling
  • Suicidal ideation
  • Trajectories

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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