Epidemiology, neurobiology and pharmacological interventions related to suicide deaths and suicide attempts in bipolar disorder: Part I of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder
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Objectives: Bipolar disorder is associated with elevated risk of suicide attempts and deaths. Key aims of the International Society for Bipolar Disorders Task Force on Suicide included examining the extant literature on epidemiology, neurobiology and pharmacotherapy related to suicide attempts and deaths in bipolar disorder. Methods: Systematic review of studies from 1 January 1980 to 30 May 2014 examining suicide attempts or deaths in bipolar disorder, with a specific focus on the incidence and characterization of suicide attempts and deaths, genetic and non-genetic biological studies and pharmacotherapy studies specific to bipolar disorder. We conducted pooled, weighted analyses of suicide rates. Results: The pooled suicide rate in bipolar disorder is 164 per 100,000 person-years (95% confidence interval = [5, 324]). Sex-specific data on suicide rates identified a 1.7:1 ratio in men compared to women. People with bipolar disorder account for 3.4–14% of all suicide deaths, with self-poisoning and hanging being the most common methods. Epidemiological studies report that 23–26% of people with bipolar disorder attempt suicide, with higher rates in clinical samples. There are numerous genetic associations with suicide attempts and deaths in bipolar disorder, but few replication studies. Data on treatment with lithium or anticonvulsants are strongly suggestive for prevention of suicide attempts and deaths, but additional data are required before relative anti-suicide effects can be confirmed. There were limited data on potential anti-suicide effects of treatment with antipsychotics or antidepressants. Conclusion: This analysis identified a lower estimated suicide rate in bipolar disorder than what was previously published. Understanding the overall risk of suicide deaths and attempts, and the most common methods, are important building blocks to greater awareness and improved interventions for suicide prevention in bipolar disorder. Replication of genetic findings and stronger prospective data on treatment options are required before more decisive conclusions can be made regarding the neurobiology and specific treatment of suicide risk in bipolar disorder.
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Suicide is one of the leading causes of death in BD.
“Suicide is one of the leading causes of death in BD”
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 [47]
The Results (Section C: clinical interventions; page not provided) report that suicide was the most frequent cause of death during follow-up in an analysis of bipolar-disorder treatment trials. The Discussion also describes the overall suicide rate in BD as high. Neither passage establishes that suicide is a leading cause of death among people with BD generally, beyond the trial setting. (LLM, conf=0.83)
Experimental — accuracy not yet measuredApproximately 6%-7% of identified patients with BD die by suicide.
“approximately 6%‐7% of identified patients with BD dying by suicide”
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 [47]
Results, Section A: epidemiology reports suicide deaths among people with BD, including 3.9% of subjects in a pooled analysis with a mean follow-up of 9.93 years. It does not establish that approximately 6%–7% of identified BD patients die by suicide; its 3.4%–5.9% figure instead measures the share of all suicide deaths occurring among people with BD. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSuicide risk is substantially higher in BD than in the general population (10.7 per 100 000 per year).
“suicide risk is substantially higher in BD than in the general population (10.7 per 100 000 per year)”
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 [47]
The Discussion reports a pooled suicide rate in bipolar disorder of 164 per 100,000 person-years, approximately tenfold the general-population rate. It does not give 10.7 per 100,000 per year as either rate; the 10.7 in the Results (Section C) is a standardized mortality ratio more than five years after hospital admission. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe periods during and following hospital admission represent times of particularly high risk for suicide in BD.
“The periods during and following hospital admission further represent times of particularly high risk”
There were limited data on both antipsychotics and antidepressant agents regarding suicide risk in BD.
“There were limited data on both antipsychotics and antidepressant agents.47”
Men with BD are at a higher risk of death by suicide than women, with an estimated rate of 0.366 per 100 person years compared to 0.217 for women.
“Men are at a higher risk of death by suicide, with an estimated rate of 0.366 per 100 person years, compared to 0.217 for women.47”
26% of suicides in BD occur within 6 weeks of discharge.
“another 26% within 6 weeks of discharge”
14% of suicides in BD occur during an inpatient stay.
“14% of suicides occurring during an inpatient stay”
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References 190 · Cited by 175
- Authors
- Schaffer, A., Isometsä, E. T., Tondo, L., Moreno, D. H., Sinyor, M., Kessing, L. V., Turecki, G., Weizman, A., Azorin, J.-M., Ha, K., Reis, C., Cassidy, F., Goldstein, T., Rihmer, Z., Beautrais, A., Chou, Y.-H., Diazgranados, N., Levitt, A. J., Zarate, C. A., & Yatham, L.
- Affiliations
- Sunnybrook Health Science Centre (CA)
- University of Helsinki (FI)
- Harvard University (US)
- Universidade de São Paulo (BR)
- University of Copenhagen (DK)
- McGill University (CA)
- Tel Aviv University (IL)
- Aix-Marseille Université (FR)
- Seoul National University Bundang Hospital (KR)
- Duke University (US)
- University of Pittsburgh (US)
- Semmelweis University (HU)
- Yale University (US)
- Taipei Veterans General Hospital (TW)
- National Institutes of Health (US)
- National Institute of Mental Health (US)
- University of British Columbia (CA)
- ORCID
- Venue
- Australian & New Zealand Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2015-07-16
- Volume
- 49
- Issue
- 9
- Pages
- 785-802
- ISSN
- 0004-8674 (ISSN-L)
- 1440-1614
- PMC
- PMC5116383
- OpenAlex
- W2171075312
- Cited by
- 175
- References
- 190
- Citations by year
- 2026: 7 · 2025: 18 · 2024: 9 · 2023: 15 · 2022: 21 · 2021: 38 · 2020: 23 · 2019: 11 · 2018: 11 · 2017: 15 · 2016: 5 · 2015: 2
- FWCI
- 1.52
- Type
- journal article
- Language
- en
- Open access
- Locations
- Australian & New Zealand Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- PubMed Central (acceptedVersion)
- Funders
- International Society for Bipolar Disorders
- 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, suicide attempts, suicide rates, suicide methods, self-poisoning, hanging, sex differences, genetic association, neurobiology of suicide, lithium, antiepileptic drugs, antipsychotic drugs, antidepressants, suicide prevention
- MeSH terms
- Anticonvulsants, Bipolar Disorder, Brain, Female, Humans, Male, Risk Factors, Sex Factors, Suicide, Suicide, Attempted, Lithium Compounds, Antimanic Agents, Advisory Committees, Neuroimaging, Protective Factors
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