Psychological resilience and suicidality in euthymic bipolar disorder: does metabolic syndrome matter?

Abstract Background Low psychological resilience has been linked to suicidality in bipolar disorder (BD), whereas the role of metabolic syndrome (metS) remains unclear. Resilience is multidimensional, yet it is not known whether its distinct components relate differently across the spectrum of suicidality, or how metabolic status contributes. In this study, we aimed to examine how resilience dimensions and metabolic parameters relate to suicidal ideation, ideation intensity, and suicide attempt in euthymic patients with BD. Methods A total of 174 euthymic patients with BD were recruited into two equal-sized groups: metS+ ( n = 87) and metS− ( n = 87). Resilience was assessed with the Resilience Scale for Adults and suicidality with the Columbia Suicide Severity Rating Scale. Data were analyzed with group comparisons, correlations with false discovery rate correction, and binary logistic regression. Results Perception of Self was independently associated with lower odds of both suicidal ideation (OR = 0.87, 95% CI 0.81–0.93) and suicide attempt (OR = 0.85, 95% CI 0.78–0.91). The number of manic episodes was associated specifically with ideation (OR = 1.15, 95% CI 1.03–1.28), whereas higher Structured Style scores were associated specifically with increased odds of attempt (OR = 1.21, 95% CI 1.06–1.39). Resilience and suicidality did not differ by metS status; no metabolic parameter correlated with resilience or suicidality after correction for multiple comparisons, and metS was not an independent correlate of suicidality at any level of analysis. Conclusions In euthymic BD, resilience dimensions, particularly Perception of Self, are associated with suicidality. No association was detected between metabolic syndrome and suicidality in this sample, although the study had limited power for small effects. Metabolic monitoring remains essential for physical health; resilience assessment may represent a distinct and clinically accessible dimension of risk evaluation.