{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:07:14Z","timestamp":1791234434187,"version":"4.1.0"},"reference-count":56,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2017,2,1]],"date-time":"2017-02-01T00:00:00Z","timestamp":1485907200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["clinicalkey.jp","clinicalkey.com","jad-journal.com","clinicalkey.es","clinicalkey.fr","clinicalkey.com.au","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Affective Disorders"],"published-print":{"date-parts":[[2017,2]]},"DOI":"10.1016\/j.jad.2016.11.043","type":"journal-article","created":{"date-parts":[[2016,11,30]],"date-time":"2016-11-30T18:15:50Z","timestamp":1480529750000},"page":"182-187","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":31,"special_numbering":"C","title":["Onset polarity in bipolar disorder: A strong association between first depressive episode and suicide attempts"],"prefix":"10.1016","volume":"209","author":[{"given":"Laura","family":"Cremaschi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardo","family":"Dell\u2019Osso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Vismara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Dobrea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Buoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terence A.","family":"Ketter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Carlo","family":"Altamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.jad.2016.11.043_bib1","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.jad.2005.12.013","article-title":"Suicide attempts amongst elderly bipolar patients","volume":"91","author":"Aizenberg","year":"2006","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2016.11.043_bib2","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1001\/archpsyc.1985.01790330076009","article-title":"Affective disorders in referred children and younger siblings of manic-depressives. Mode of onset and prospective course","volume":"42","author":"Akiskal","year":"1985","journal-title":"Arch. Gen. Psychiatry"},{"key":"10.1016\/j.jad.2016.11.043_bib3","series-title":"Diagnostic and Statistical Manual of Mental Disorders","author":"American Psychiatric Association","year":"2000"},{"key":"10.1016\/j.jad.2016.11.043_bib4","series-title":"Diagnostic and Statistical Manual of Mental Disorders","author":"American Psychiatric Association","year":"2013"},{"key":"10.1016\/j.jad.2016.11.043_bib5","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.jad.2015.05.070","article-title":"Safety and effectiveness of continuation antidepressant versus mood stabilizer monotherapy for relapse-prevention of bipolar II depression: a randomized, double-blind, parallel-group, prospective study","volume":"185","author":"Amsterdam","year":"2015","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2016.11.043_bib6","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/BF00344124","article-title":"The course of affective disorders: I. change of diagnosis of monopolar, unipolar, and bipolar illness","volume":"226","author":"Angst","year":"1978","journal-title":"Arch. Psychiatr. Nervenkr."},{"key":"10.1016\/j.jad.2016.11.043_bib7","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.jad.2010.08.020","article-title":"Correlates of first-episode polarity in a French cohort of 1089 bipolar I disorder patients: role of temperaments and triggering events","volume":"129","author":"Azorin","year":"2011","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2016.11.043_bib8","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1111\/j.1399-5618.2010.00812.x","article-title":"Morbidity in 303 first-episode bipolar I disorder patients","volume":"12","author":"Baldessarini","year":"2010","journal-title":"Bipolar Disord."},{"key":"10.1016\/j.jad.2016.11.043_bib9","first-page":"162","article-title":"Psychosocial rehabilitation and severe mental disorders: a public health approach","volume":"5","author":"Barbato","year":"2006","journal-title":"World Psychiatry"},{"key":"10.1016\/j.jad.2016.11.043_bib10","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.jad.2011.07.006","article-title":"Opposite effects of suicidality and lithium on gray matter volumes in bipolar depression","volume":"135","author":"Benedetti","year":"2011","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2016.11.043_bib11","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/j.biopsych.2004.09.022","article-title":"Mood state at study entry as predictor of the polarity of relapse in bipolar disorder","volume":"56","author":"Calabrese","year":"2004","journal-title":"Biol. Psychiatry"},{"key":"10.1016\/j.jad.2016.11.043_bib12","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.jad.2007.12.225","article-title":"Family history of suicidal behavior and early traumatic experiences: additive effect on suicidality and course of bipolar illness?","volume":"109","author":"Carballo","year":"2008","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2016.11.043_bib13","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.jad.2014.03.035","article-title":"Predominant polarity as a course specifier for bipolar disorder: a systematic review","volume":"163","author":"Carvalho","year":"2014","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2016.11.043_bib14","doi-asserted-by":"crossref","first-page":"96","DOI":"10.4306\/pi.2009.6.2.96","article-title":"Polarity of the first episode and time to diagnosis of bipolar I disorder","volume":"6","author":"Cha","year":"2009","journal-title":"Psychiatry Invest."},{"key":"10.1016\/j.jad.2016.11.043_bib15","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.jad.2007.02.022","article-title":"Does first episode polarity predict risk for suicide attempt in bipolar disorder?","volume":"104","author":"Chaudhury","year":"2007","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2016.11.043_bib16","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/0006-3223(95)00295-2","article-title":"Lifetime rates of suicide attempts among subjects with bipolar and unipolar disorders relative to subjects with other axis I disorders","volume":"39","author":"Chen","year":"1996","journal-title":"Biol. Psychiatry"},{"key":"10.1016\/j.jad.2016.11.043_bib17","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jad.2006.01.032","article-title":"Clinical and therapeutic implications of predominant polarity in bipolar disorder","volume":"93","author":"Colom","year":"2006","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2016.11.043_bib18","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.comppsych.2006.03.009","article-title":"Clinical correlates of first-episode polarity in bipolar disorder","volume":"47","author":"Daban","year":"2006","journal-title":"Compr. Psychiatry"},{"key":"10.1016\/j.jad.2016.11.043_bib19","doi-asserted-by":"crossref","unstructured":"Dell'Osso, B., Dobrea, C., Cremaschi, L., Buoli, M., Miller, S., Ketter, T.A., Altamura, A.C., 2016a. Italian Bipolar II vs I Patients have better Individual Functioning, in Spite of Overall Similar Illness Severity. CNS Spectr. 1-8 (Epub ahead of print). a","DOI":"10.1017\/S1092852915000887"},{"key":"10.1016\/j.jad.2016.11.043_bib20","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.jad.2016.04.009","article-title":"Age at onset in patients with bipolar I and II disorder: a comparison of large sample studies","volume":"201","author":"Dell'Osso","year":"2016","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2016.11.043_bib21","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/j.jad.2015.04.054","article-title":"Antidepressants worsen rapid-cycling course in bipolar depression: a STEP-BD randomized clinical trial","volume":"184","author":"El-Mallakh","year":"2015","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2016.11.043_bib22","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1001\/archpsyc.1976.01770060086012","article-title":"The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance","volume":"33","author":"Endicott","year":"1976","journal-title":"Arch. Gen. Psychiatry"},{"key":"10.1016\/j.jad.2016.11.043_bib23","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.jad.2014.03.046","article-title":"Effects of childhood trauma and clinical features on determining quality of life in patients with bipolar I disorder","volume":"162","author":"Erten","year":"2014","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2016.11.043_bib24","series-title":"Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II)","author":"First","year":"1997"},{"key":"10.1016\/j.jad.2016.11.043_bib25","series-title":"Structured Clinical Interview for DSM\u2013IV\u2013TR Axis I Disorders, Research Version, Patient Edition (SCID-I\/P)","author":"First","year":"2002"},{"key":"10.1016\/j.jad.2016.11.043_bib26","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1111\/j.1399-5618.2008.00654.x","article-title":"Polarity at illness onset in bipolar I disorder and clinical course of illness","volume":"11","author":"Forty","year":"2009","journal-title":"Bipolar Disord."},{"key":"10.1016\/j.jad.2016.11.043_bib27","doi-asserted-by":"crossref","first-page":"985","DOI":"10.4088\/JCP.v63n1105","article-title":"Features associated with the delayed initiation of mood stabilizers at illness onset in bipolar disorder","volume":"63","author":"Goldberg","year":"2002","journal-title":"J. Clin. Psychiatry"},{"key":"10.1016\/j.jad.2016.11.043_bib28","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.jad.2009.06.006","article-title":"Suicide attempt characteristics may orientate toward a bipolar disorder in attempters with recurrent depression","volume":"122","author":"Guillaume","year":"2010","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2016.11.043_bib29","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/0278-5846(87)90061-3","article-title":"Sequence of affective polarity and lithium response: preliminary report on munich sample","volume":"11","author":"Haag","year":"1987","journal-title":"Prog. Neuropsychopharmacol. Biol. Psychiatry"},{"key":"10.1016\/j.jad.2016.11.043_bib30","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/S0033-3182(95)71666-8","article-title":"Global assessment of functioning: a modified scale","volume":"36","author":"Hall","year":"1995","journal-title":"Psychosomatics"},{"key":"10.1016\/j.jad.2016.11.043_bib31","first-page":"2","article-title":"Course and outcome of adolescent-onset bipolar affective disorder: a retrospective clinic based study","volume":"13","author":"Jagadheesan","year":"2003","journal-title":"Hong Kong J. Psychiatry"},{"key":"10.1016\/j.jad.2016.11.043_bib32","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/S0165-0327(02)00324-5","article-title":"The comparative clinical phenotype and long term longitudinal episode course of bipolar I and II: a clinical spectrum or distinct disorders?","volume":"73","author":"Judd","year":"2003","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2016.11.043_bib33","doi-asserted-by":"crossref","first-page":"1754","DOI":"10.1176\/ajp.2006.163.10.1754","article-title":"Bipolar disorder consortium NIMH genetics nitiative, McMahon FJ. familiality of polarity at illness onset in bipolar affective disorder","volume":"163","author":"Kassem","year":"2006","journal-title":"Am. J. Psychiatry"},{"key":"10.1016\/j.jad.2016.11.043_bib34","doi-asserted-by":"crossref","first-page":"506","DOI":"10.4088\/JCP.v64n0503","article-title":"Factors associated with suicide attempts in 648 patients with bipolar disorder in the Stanley Foundation Bipolar Network","volume":"64","author":"Leverich","year":"2003","journal-title":"J. Clin. Psychiatry"},{"key":"10.1016\/j.jad.2016.11.043_bib35","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/0165-0327(89)90005-0","article-title":"Previous pattern of course of the illness as a predictor of response to lithium prophylaxis in bipolar patients","volume":"17","author":"Maj","year":"1989","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2016.11.043_bib36","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1111\/bdi.12050","article-title":"The impact of child sexual abuse on the course of bipolar disorder: a systematic review","volume":"15","author":"Maniglio","year":"2013","journal-title":"Bipolar Disord."},{"key":"10.1016\/j.jad.2016.11.043_bib37","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1053\/comp.2003.50004","article-title":"Characteristics of first suicide attempts in single versus multiple suicide attempters with bipolar disorder","volume":"44","author":"Michaelis","year":"2003","journal-title":"Compr. Psychiatry"},{"key":"10.1016\/j.jad.2016.11.043_bib38","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1590\/S1516-44462009000200006","article-title":"Bipolar disorder first episode and suicidal behavior: are there differences according to type of suicide attempt?","volume":"31","author":"Neves","year":"2009","journal-title":"Rev. Bras. Psiquiatr."},{"key":"10.1016\/j.jad.2016.11.043_bib39","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.biopsych.2005.07.029","article-title":"Revisiting depressive-prone bipolar disorder: polarity of initial mood episode and disease course among bipolar I systematic treatment enhancement program for bipolar disorder participants","volume":"58","author":"Perlis","year":"2005","journal-title":"Biol. Psychiatry"},{"key":"10.1016\/j.jad.2016.11.043_bib40","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1111\/j.1600-0447.1966.tb11019.x","article-title":"A study of bipolar (manic-depressive) and unipolar recurrent depressive psychoses. X. mortality, suicide and life-cycles","volume":"194","author":"Perris","year":"1966","journal-title":"Acta Psychiatr. Scand. Suppl."},{"key":"10.1016\/j.jad.2016.11.043_bib41","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/S0010-440X(00)90125-1","article-title":"Polarity of the first episode, clinical characteristics, and course of manic depressive illness: a systematic retrospective investigation of 320 bipolar I patients","volume":"41","author":"Perugi","year":"2000","journal-title":"Compr. Psychiatry"},{"key":"10.1016\/j.jad.2016.11.043_bib42","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1111\/acps.12179","article-title":"Clinical implications of predominant polarity and the polarity index in bipolar disorder: a naturalistic study","volume":"129","author":"Popovic","year":"2014","journal-title":"Acta Psychiatr. Scand."},{"key":"10.1016\/j.jad.2016.11.043_bib43","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1097\/00004714-198606000-00009","article-title":"Bipolar disorder: are there manic-prone and depressive-prone forms?","volume":"6","author":"Quitkin","year":"1986","journal-title":"J. Clin. Psychopharmacol."},{"issue":"Suppl 1","key":"10.1016\/j.jad.2016.11.043_bib44","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1034\/j.1399-5618.4.s1.3.x","volume":"4","author":"Rihmer","year":"2002","journal-title":"Bipolar Disord. suicidal Behav. Bipolar Disord."},{"key":"10.1016\/j.jad.2016.11.043_bib45","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.jad.2010.05.014","article-title":"Functional impairment in bipolar II disorder: is it as disabling as bipolar I?","volume":"127","author":"Rosa","year":"2010","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2016.11.043_bib46","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1600-0447.1985.tb10510.x","article-title":"The longitudinal course of recurrent affective illness: life chart data from research patients at the NIMH","volume":"317","author":"Roy-Byrne","year":"1985","journal-title":"Acta Psychiatr. Scand. Suppl."},{"key":"10.1016\/j.jad.2016.11.043_bib47","doi-asserted-by":"crossref","first-page":"641","DOI":"10.3349\/ymj.2010.51.5.641","article-title":"Initial depressive episodes affect the risk of suicide attempts in Korean patients with bipolar disorder","volume":"51","author":"Ryu","year":"2010","journal-title":"Yonsei Med. J."},{"key":"10.1016\/j.jad.2016.11.043_bib48","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1177\/0004867415594428","article-title":"A review of factors associated with greater likelihood of suicide attempts and suicide deaths in bipolar disorder: part II of a report of the international society for bipolar disorders task force on suicide in bipolar disorder","volume":"49","author":"Schaffer","year":"2015","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"10.1016\/j.jad.2016.11.043_bib49","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.4088\/JCP.v68n0811","article-title":"Mood symptoms, functional impairment, and disability in people with bipolar disorder: specific effects of mania and depression","volume":"68","author":"Simon","year":"2007","journal-title":"J. Clin. Psychiatry"},{"key":"10.1016\/j.jad.2016.11.043_bib50","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1192\/bjp.178.6.518","article-title":"Patterns and predictors of hospitalisation in first-episode psychosis","volume":"178","author":"Sipos","year":"2001","journal-title":"Prospect. cohort Study Br. J. Psychiatry"},{"key":"10.1016\/j.jad.2016.11.043_bib51","doi-asserted-by":"crossref","first-page":"2099","DOI":"10.1176\/appi.ajp.160.12.2099","article-title":"The McLean-Harvard first-episode mania study: prediction of recovery and first recurrence","volume":"160","author":"Tohen","year":"2003","journal-title":"Am. J. Psychiatry"},{"key":"10.1016\/j.jad.2016.11.043_bib52","doi-asserted-by":"crossref","first-page":"469","DOI":"10.4088\/JCP.v63n0602","article-title":"Risk factors for completed suicide in bipolar disorder","volume":"63","author":"Tsai","year":"2002","journal-title":"J. Clin. Psychiatry"},{"key":"10.1016\/j.jad.2016.11.043_bib53","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.comppsych.2015.07.018","article-title":"Onset polarity and illness course in bipolar I and II disorders: the predictive role of broadly defined mixed states","volume":"63","author":"Tundo","year":"2015","journal-title":"Compr. Psychiatry"},{"key":"10.1016\/j.jad.2016.11.043_bib54","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/00005053-199903000-00008","article-title":"Polarity sequence, depression, and chronicity in bipolar I disorder","volume":"187","author":"Turvey","year":"1999","journal-title":"J. Nerv. Ment. Dis."},{"key":"10.1016\/j.jad.2016.11.043_bib55","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1111\/j.1399-5618.2006.00341.x","article-title":"Prospective study of risk factors for attempted suicide among patients with bipolar disorder","volume":"8","author":"Valtonen","year":"2006","journal-title":"Bipolar Disord."},{"key":"10.1016\/j.jad.2016.11.043_bib56","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jad.2009.02.028","article-title":"Predominant previous polarity as an outcome predictor in a controlled treatment trial for depression in bipolar I disorder patients","volume":"119","author":"Vieta","year":"2009","journal-title":"J. Affect. Disord."}],"container-title":["Journal of Affective Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0165032716314380?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0165032716314380?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2019,9,16]],"date-time":"2019-09-16T03:46:42Z","timestamp":1568605602000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0165032716314380"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,2]]},"references-count":56,"alternative-id":["S0165032716314380"],"URL":"https:\/\/doi.org\/10.1016\/j.jad.2016.11.043","relation":{},"ISSN":["0165-0327"],"issn-type":[{"value":"0165-0327","type":"print"}],"subject":[],"published":{"date-parts":[[2017,2]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Onset polarity in bipolar disorder: A strong association between first depressive episode and suicide attempts","name":"articletitle","label":"Article Title"},{"value":"Journal of Affective Disorders","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jad.2016.11.043","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2016 Published by Elsevier B.V.","name":"copyright","label":"Copyright"}]}}