Onset polarity in bipolar disorder: A strong association between first depressive episode and suicide attempts

Laura Cremaschi, Bernardo Dell'Osso, Matteo Vismara, Cristina Dobrea, Massimiliano Buoli, Terence A. Ketter, A. Carlo Altamura

Research output: Contribution to journalArticlepeer-review


Background The role of onset polarity (OP) in patients with bipolar disorder (BD) has been increasingly investigated over the last few years, for its clinical, prognostic, and therapeutic implications. The present study sought to assess whether OP was associated with specific correlates, in particular with a differential suicidal risk in BD patients. Methods A sample of 362 recovered BD patients was dichotomized by OP: depressed (DO) or elevated onset (EO: hypomanic/manic/mixed). Socio-demographic and clinical variables were compared between the subgroups. Additionally, binary logistic regression was performed to assess features associated with OP. Results DO compared with EO patients had older current age and were more often female, but less often single and unemployed. Clinically, DO versus EO had a more than doubled rate of suicide attempts, as well as significantly higher rates of BD II diagnosis, lifetime stressful events, current psychotropics and antidepressants use, longer duration of the most recent episode (more often depressive), but lower rates of psychosis and involuntary commitments. Limitations Retrospective design limiting the accurate assessment of total number of prior episodes of each polarity. Conclusions Our results support the influence of OP on BD course and outcome. Moreover, in light of the relationship between DO and a higher rate of suicide attempts, further investigation may help clinicians in identifying patients at higher risk of suicide attempts.

Original languageEnglish
Pages (from-to)182-187
Number of pages6
JournalJournal of Affective Disorders
Publication statusPublished - Feb 1 2017


  • Bipolar disorder (BD)
  • Onset polarity (OP)
  • Suicide attempt

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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