  Background: Bipolar disorder (BD) is a chronic, lifelong condition,
associated with increased risk of obesity, cognitive impairment, and suicidal
behaviors. Abdominal obesity and a higher risk of violent suicide attempt (SA)
seem to be shared correlates with older age, BD, and male sex until middle age
when menopause-related female body changes occur. This study aimed at assessing
the role of abdominal obesity and cognition in the violent SA burden of
individuals with BD.Methods: From the well-defined nationwide cohort FACE-BD
(FondaMental Advanced center of Expertise for Bipolar Disorders), we extracted
data on 619 euthymic BD patients that were 50 years or older at inclusion.
Cross-sectional clinical, cognitive, and metabolic assessments were performed.
SA history was based on self-report.Results: Violent SA, in contrast to
non-violent and no SA, was associated with higher waist circumference,
abdominal obesity and poorer California Verbal Learning Test short-delay free
recall (CVLT-SDFR) (ANOVA, p < .001, p = .014, and p = .006). Waist
circumference and abdominal obesity were associated with violent SA history
independently of sex, BD type and anxiety disorder (Exp(B) 1.02, CI 1.00-1.05,
p = .018; Exp(B) 2.16, CI 1.00-4.64, p = .009, accordingly). In an exploratory
model, waist circumference and CVLT-SDFR performance mediated the association
between male sex and violent SA.Limitations: Cross-sectional design and
retrospective reporting.Conclusions: Violent SA history was associated with
abdominal obesity and poorer verbal memory in older age BD patients. These
factors were interlinked and might mediate the association between male sex and
violent SA.
