International Society for Bipolar Disorders Task Force on Suicide: meta‐analyses and meta‐regression of correlates of suicide attempts and suicide deaths in bipolar disorder
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Objectives: Bipolar disorder is associated with a high risk of suicide attempts and suicide death. The main objective of the present study was to identify and quantify the demographic and clinical correlates of attempted and completed suicide in people with bipolar disorder. Methods: Within the framework of the International Society for Bipolar Disorders Task Force on Suicide, a systematic review of articles published since 1980, characterized by the key terms bipolar disorder and ‘suicide attempts’ or ‘suicide’, was conducted, and data extracted for analysis from all eligible articles. Demographic and clinical variables for which ≥ 3 studies with usable data were available were meta‐analyzed using fixed or random‐effects models for association with suicide attempts and suicide deaths. There was considerable heterogeneity in the methods employed by the included studies. Results: Variables significantly associated with suicide attempts were: female gender, younger age at illness onset, depressive polarity of first illness episode, depressive polarity of current or most recent episode, comorbid anxiety disorder, any comorbid substance use disorder, alcohol use disorder, any illicit substance use, comorbid cluster B/borderline personality disorder, and first‐degree family history of suicide. Suicide deaths were significantly associated with male gender and first‐degree family history of suicide. Conclusions: This paper reports on the presence and magnitude of the correlates of suicide attempts and suicide deaths in bipolar disorder. These findings do not address causation, and the heterogeneity of data sources should limit the direct clinical ranking of correlates. Our results nonetheless support the notion of incorporating diagnosis‐specific data in the development of models of understanding suicide in bipolar disorder.
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Rates of attempted and completed suicide are similar in bipolar I and bipolar II disorder, with approximately one-third of patients with bipolar II disorder attempting suicide over the course of their illnesses and one in twenty-five completing suicide.
“Rates of attempted and completed suicide are similar in BDI and BDII, with approximately one‐third of patients with BDII attempting suicide over the course of their illnesses429 and one in twenty‐five completing suicide.430”
From Canadian Network for Mood and Anxiety Treatments ( <scp>CANMAT</scp> ) and International Society for Bipolar Disorders ( <scp>ISBD</scp> ) 2018 guidelines for the management of patients with bipolar disorder (2018) · cites this paper as [429]
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Experimental — accuracy not yet measuredSubstance use disorder can negatively impact the course of bipolar disorder, resulting in an increased risk of suicide attempts.
“SUD can negatively impact the course of BD, resulting in lower rates of remission,407 a higher number of hospitalizations,676, 677 and an increased risk of suicide attempts429 and perhaps suicide deaths.678”
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Self-citation
- Authors
- Schaffer, A., Isometsä, E. T., Tondo, L., H Moreno, D., Turecki, G., Reis, C., Cassidy, F., Sinyor, M., Azorin, J., Kessing, L. V., Ha, K., Goldstein, T., Weizman, A., Beautrais, A., Chou, Y., Diazgranados, N., Levitt, A. J., Zarate, C. A., Rihmer, Z., & Yatham, L. N.
- Affiliations
- Sunnybrook Health Science Centre (CA)
- University of Helsinki (FI)
- Harvard University (US)
- Department and Institute of Psychiatry University of São Paulo São Paulo Brazil
- McGill University (CA)
- Duke University (US)
- Université de la Méditerranée Aix-Marseille II (FR)
- University of Copenhagen (DK)
- Seoul National University (KR)
- University of Pittsburgh (US)
- Tel Aviv University (IL)
- Yale University (US)
- Taipei Veterans General Hospital (TW)
- National Institute on Alcohol Abuse and Alcoholism (US)
- National Institute of Mental Health (US)
- Semmelweis University (HU)
- University of British Columbia (CA)
- Corresponding author
- Schaffer, Ayal
- ORCID
- Venue
- Bipolar Disorders
- Publisher
- Wiley
- Published
- 2014-10-20
- Volume
- 17
- Issue
- 1
- Pages
- 1-16
- ISSN
- 1398-5647 (ISSN-L)
- 1399-5618
- PMC
- PMC6296224
- OpenAlex
- W2135640692
- Cited by
- 335
- References
- 104
- Citations by year
- 2026: 14 · 2025: 26 · 2024: 20 · 2023: 26 · 2022: 25 · 2021: 25 · 2020: 46 · 2019: 30 · 2018: 48 · 2017: 26 · 2016: 24 · 2015: 19 · 2014: 5
- FWCI
- 3.40
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Bipolar Disorders (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Semmelweis University Repository (Semmelweis University) (submittedVersion)
- Funders
- National Institutes of Health (Z99 MH999999)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- bipolar disorder, suicide attempts, suicide mortality, risk factors, demographic correlates, comorbid anxiety disorders, substance use disorders, alcoholism, borderline personality disorder, family history of suicide, gender differences
- MeSH terms
- Suicide Prevention, Anxiety Disorders, Bipolar Disorder, Female, Humans, International Cooperation, Male, Middle Aged, Personality Disorders, Preventive Psychiatry, Psychiatric Status Rating Scales, Risk Factors, Societies, Medical, Suicide, Suicide, Attempted, Comorbidity, Risk Assessment, Substance-Related Disorders
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