The prevalence and clinical correlates of suicide attempts in patients with bipolar disorder misdiagnosed with major depressive disorder: Results from a national survey in China

Chen L 1 , Xu YY 2 , Lin JY 1 , Ji ZP 3 , Yang F 1 , Tan S 1 Show all authors , Wang G 4 , Fang Y 5 , Lu Z 6 , Yang H 7 , Hu J 8 , Chen Z 9 , Huang Y 10 , Sun J 11 , Wang X 12 , Li H 13 , Zhang J 14 , Wang Y 15 , Su Y 16 , Zhao Y 17 , Si T 18

Affiliations 

  • 1 Beijing Huilongguan Hospital, Peking University, Beijing, China
  • 2 Universiti Tunku Abdul Rahman (UTAR), Kampar, Malaysia
  • 3 School of Public Health, Peking University Health Science Center, Beijing, China
  • 4 Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, China
  • 5 Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • 6 Shanghai Tongji Hospital, Tongji University Medical School, Shanghai, China
  • 7 Division of Mood Disorders, Shenzhen Mental Health Center, Guangdong province, China
  • 8 The First Hospital of Harbin Medical University, Heilongjiang province, China
  • 9 Hangzhou Seventh People's Hospital, Zhejiang province, China
  • 10 West China Hospital, Sichuan University, Sichuan province, China
  • 11 The Affiliated Brain Hospital, Nanjing Medical University, Jiangsu province, China
  • 12 Mental Health Institute, The Second Xiangya Hospital, Central South University, Hunan province, China
  • 13 The Second Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang province, China
  • 14 The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong province, China
  • 15 The 261st hospital of PLA, Beijing, China
  • 16 Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), China
  • 17 Beijing Huilongguan Hospital, Peking University, Beijing, China. Electronic address: yanli_zhao0903@126.com
  • 18 Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), China. Electronic address: si.tian-mei@163.com
Asian J Psychiatr, 2024 Mar;93:103958.
PMID: 38364597 DOI: 10.1016/j.ajp.2024.103958

Abstract

BACKGROUND AND AIM: Suicide is nearly always associated with underlying mental disorders. Risk factors for suicide attempts (SAs) in patients with bipolar disorder (BD) misdiagnosed with major depressive disorder (MDD) remain unelucidated. This study was to evaluate the prevalence and clinical risk factors of SAs in Chinese patients with BD misdiagnosed with MDD.

METHODS: A total of 1487 patients with MDD from 13 mental health institutions in China were enrolled. Mini International Neuropsychiatric Interview (MINI) was used to identify patients with BD who are misdiagnosed as MDD. The general sociodemographic and clinical data of the patients were collected and MINI suicide module was used to identify patients with SAs in these misdiagnosed patients.

RESULTS: In China, 20.6% of patients with BD were incorrectly diagnosed as having MDD. Among these misdiagnosed patients, 26.5% had attempted suicide. These patients tended to be older, had a higher number of hospitalizations, and were more likely to experience frequent and seasonal depressive episodes with atypical features, psychotic symptoms, and suicidal thoughts. Frequent depressive episodes and suicidal thoughts during depression were identified as independent risk factors for SAs. Additionally, significant sociodemographic and clinical differences were found between individuals misdiagnosed with MDD in BD and patients with MDD who have attempted suicide.

CONCLUSIONS: This study highlights the importance of accurate diagnosis in individuals with BD and provide valuable insights for the targeted identification and intervention of individuals with BD misdiagnosed as having MDD and those with genuine MDD, particularly in relation to suicidal behavior.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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