An evaluation of suicidal risk in bipolar patients with comorbid posttraumatic stress disorder

J Affect Disord. 2020 Apr 1;266:49-56. doi: 10.1016/j.jad.2020.01.091. Epub 2020 Jan 21.


Background: While bipolar disorder (BD) and posttraumatic stress disorder (PTSD) frequently co-occur and individually have a higher risk of suicide compared to the general population, few studies have examined the impact of comorbid PTSD on suicidal ideation in patients with BD.

Methods: We analyzed baseline data from the Clinical and Health Outcomes Initiative in Comparative Effectiveness for bipolar disorder study (Bipolar CHOICE), a 6-month, pharmacological comparative effectiveness trial of individuals with BD. Bipolar CHOICE enrolled 482 individuals. A hierarchical multiple regression analysis assessed whether comorbid PTSD was associated with increased suicidal ideation as assessed by the Concise Health Risk Tracking Scale (CHRT) total and factor scores, while controlling for common correlates of suicidal ideation in this population such as a current major depressive episode, comorbid anxiety disorders, severity of illness and previous suicide attempts.

Results: Consistent with our hypothesis, diagnosis of comorbid PTSD was a significant predictor of the CHRT total score (β=2.59, p=.03). Comorbid PTSD was also a significant predictor of the CHRT propensity factor (β=2.32, adjusted p=.04), but was not a significant predictor of the active suicidal thoughts factor. Additionally, all participants with comorbid PTSD (N = 58) endorsed current suicidal ideation (p=.005) and were more likely to have had a previous suicide attempt (p<.001) compared to those without PTSD.

Limitations: Generalizability beyond outpatient settings is limited, mixed affective states were not assessed, and analyses were cross-sectional.

Conclusions: Patients have an increased risk of suicidal ideation when PTSD is comorbid with BD.

Keywords: Bipolar disorder; Comorbidity; Posttraumatic stress disorder; Suicidal ideation.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Bipolar Disorder* / epidemiology
  • Comorbidity
  • Cross-Sectional Studies
  • Depressive Disorder, Major* / epidemiology
  • Humans
  • Risk Factors
  • Stress Disorders, Post-Traumatic* / epidemiology
  • Suicidal Ideation