A collaborative therapeutic relationship and risk of suicidal ideation in patients with bipolar disorder.

BACKGROUND: A diagnosis of Bipolar Disorder (BD) is among the strongest known risk factors for suicide. The present study examines the relative impact of current mood state (depressed, manic or mixed) and patient perceptions of the therapeutic relationship on suicidal ideation in veterans with BD.

METHODS: We conducted analyses of the baseline data from a naturalistic cohort study of veterans receiving care for BD (N=432) at a large urban VA mental health clinic. Logistic regression was used to examine the relative impact of patient- and treatment-related factors on suicidal ideation within the two weeks prior to recruitment.

RESULTS: Over 49% (213/432) of veterans receiving current outpatient treatment for BD reported at least some suicidal ideation within the two weeks prior to recruitment. After accounting for current mood state and other identified risk factors, even minimal increases (i.e., per point increase on a 0-60 rating scale) in the extent to which the therapeutic relationship is perceived as collaborative (OR=0.97; p<.01) were associated with a reduction in risk of suicidal ideation.

LIMITATIONS: This study is cross sectional and relies exclusively on patient self-report.

CONCLUSIONS: Mental health treatment providers should be aware of the high rate of suicidal ideation in patients with BD. Successful management of suicidal ideation likely involves a focus on improving symptoms as well as establishing a collaborative therapeutic relationship.