Lethality of Suicide Attempts in Indian Patients with Recurrent Mood Disorders: A Comparison of Bipolar and Unipolar Disorder
Dr. Nishtha Chawla
Assistant Professor, Department of Psychiatry & JPNATC, All India Institute of Medical Sciences (AIIMS), New Delhi-110029
Email: nishtha.chawla@gmail.com; drnishtha@aiims.edu
Background & Aims: Limited studies have compared lethality of suicide attempt/s in bipolar disorder (BD) and unipolar disorder. The current study aimed to assess and compare the lethality of suicide attempts in bipolar and unipolar disorder in treatment-seeking patients at a tertiary care centre in India.
Methods: Hundred euthymic, adult out-patients with recurrent mood disorders (DSM-5 BD or DSM-5 Major Depressive Disorder, recurrent) with positive history of suicide attempt/s were recruited. Euthymia was established using HAM-D≤8 and YMRS≤4. Those with uncertain attempts and psychiatric comorbidities were excluded. Participants were assessed using Columbia suicide severity rating scale (C-SSRS), Risk-rescue rating scale (RRRS), Scale for assessment of lethality of suicide attempt (SALSA), and Barratt’s impulsiveness scale (BIS).
Results: Of 100 subjects, 53 had BD and 47 had recurrent depressive disorder (RDD). Both groups were comparable on key demographic variables (age, education, marital and occupational status), apart from gender. No group differences were observed in lifetime depressive episodes (p=0.073) and mean suicide attempts (2.26 ± 1.52 vs 1.83 ± 1.20; p=0.120). Oral ingestion was the most frequent method of last suicidal attempt in both groups, followed by hanging in BD and cutting in RDD. Compared to RDD, the suicide attempt/s made by BD had a higher risk score (p=0.043), lower rescue score (p=0.002) and higher risk-recue rating (p=0.012). BD attempters had significantly higher SALSA score (p=0.001). The CSSR-lifetime severity of suicidal ideation and planned attempts were significantly higher in BD. There was no difference in impulsivity as assessed by BIS total and subscale scores.
Conclusion: The suicide attempters with BD had more planned, more lethal, and less rescuable attempts than those with unipolar depressive disorder. Findings support the distinctions in terms of suicide severity and lethality among bipolar and unipolar patients, with a need for active suicide prevention interventions instituted early in the course of mood disorders to prevent a lethal outcome.
Key words: Lethality, Bipolar Disorder, Unipolar disorder, Depressive disorder, Suicidal attempt, India
Pathways to Sustainable Recovery: Unpacking the Roles of Subjective Happiness, Daily Spiritual Experiences, and Social Support in Abstinent Substance Users
Dr. Mahadev Singh Sen
Assistant Professor, Department of Psychiatry, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi-110095
Email: mahadevsinghsen@gmail.com
Background: Substance use disorders are a global public health concern, necessitating a deeper understanding of the factors influencing sustainable recovery. This study investigates the roles of various factors influencing the recovery journey of abstinent substance users.
Methods: Sociodemographic and clinical data of adult males with a diagnosis of opioid dependence(ODS) or alcohol dependence(ADS) were collected using daily spiritual experiences(DSE), assessment of recovery capital scale(RC), subjective happiness(SH), and social support(SS). Mediating/moderating was studied using model 5 of Hayes Process Macros.
Results: All 150 participants(100ODS, 50ADS) had high substance use severity. The mean age 40 years(±12), and majority of participants resided in urban areas(73%), were married (64.7%), were educated above high school(57%), belonged to nuclear families(54%) and followed Hinduism(71%). The mean age of onset of substance use was 22 years(±7),while onset of substance dependence was 25 years(±8), with an average duration of abstinence of 20 months. Majority reported tobacco dependence(80%), while 3% had cannabis dependence. SH partially (complimentary) mediated 18% of variance of relationship between SS and RC(p<0.001), Indirect effect: 0.1585(0.096-0.2327; p<0.001). DSE moderated the relationship between SS and RC(b=-0.008,p = 0.036) at high as well as low DSE scores and this significance is prominent when DSE scores exceeds 21.3.
Discussion: These findings highlight intricate pathways to sustainable recovery. This emphasizes the role of positive emotional states in recovery and conditional effect of spirituality on recovery. These insights have implications for tailored interventions and support systems to enhance recovery outcomes, promote long-term abstinence, optimizing addiction treatment and recovery programs.
Keywords: Substance Use Disorder, Recovery Capital, Subjective Happiness, Daily Spiritual Experiences, Social Support,