Risk factors for suicidal behavior/ideation and hostility/aggression in patients with bipolar disorders: An analysis using the Japanese Adverse Drug Event Report database

Abstract

The present study attempted to identify risk factors for suicidality and hostility/aggression in patients with bipolar disorders. Data on 3521 patients were extracted from the Japanese Adverse Drug Event Report (JADER) database. There were 134 reports regarding suicidal behavior/ideation, and 129 patients were judged to have it. Standardized Medical Dictionary for Regulatory Activities queries indicated that 248 adverse drug events pertained to hostility/aggression, and 218 patients were considered to show hostility/aggression. A multiple logistic regression analysis revealed the association of the risk for suicidal behavior/ideation with bipolar II disorder [adjusted odds ratio (aOR): 4.55, 95% confidence interval (CI): 1.90–10.9], male sex (aOR: 1.23, 95% CI: 1.02–1.48), age <50 years (aOR: 1.75, 95% CI: 1.43–2.15), the administration of aripiprazole (aOR: 1.27, 95% CI: 1.00–1.60), and akathisia (aOR: 3.05, 95% CI: 1.80–5.18), while lithium carbonate decreased its odds (aOR: 0.664, 95% CI: 0.537–0.821). The risk of hostility/aggression was associated with male sex (aOR: 1.22, 95% CI: 1.06–1.40), lithium carbonate (aOR: 0.823, 95% CI: 0.710–0.953), and carbamazepine (aOR: 0.693, 95% CI: 0.500–0.961). No association between suicidal behavior/ideation and hostility/aggression was recognized. The present study proposes factors related with suicidal behavior/ideation and hostility/aggression in patients with bipolar disorders using the JADER database. Lithium carbonate appeared to decrease the risks of suicidal behavior/ideation and hostility/aggression in patients with bipolar disorders, and akathisia may be associated with the former risk. Further studies are required to evaluate the identified signals.