Self-poisoning suicide deaths in people with bipolar disorder: Characterizing a subgroup and identifying treatment patterns
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OBJECTIVE: To characterize self-poisoning suicide deaths in BD compared to other suicide decedents. METHODS: Extracted coroner data from all suicide deaths (n = 3319) in Toronto, Canada from 1998 to 2012. Analyses of demographics, clinical history, recent stressors, and suicide details were conducted in 5 subgroups of suicide decedents: BD self-poisoning, BD other methods, non-BD self-poisoning, non-BD other methods, and unipolar depression self-poisoning. Toxicology results for lethal and present substances were also compared between BD and non-BD self-poisoning subgroups as well as between BD and unipolar depression self-poisoning subgroups. RESULTS: Among BD suicide decedents, self-poisoning was significantly associated with female sex, past suicide attempts, and comorbid substance abuse. In both the BD and non-BD self-poisoning groups, opioids were the most common class of lethal medication. For both groups, benzodiazepines and antidepressants were the most common medications present at time of death, and in 23% of the BD group, an antidepressant was present without a mood stabilizer or antipsychotic. Only 31% of the BD group had any mood stabilizer present, with carbamazepine being most common. No antidepressant, mood stabilizer, or antipsychotic was present in 15.5% of the BD group. Relative to unipolar depression self-poisoning group, the BD self-poisoning group evidenced higher proportion of previous suicide attempt(s) and psychiatry/ER visits in the previous week. CONCLUSION: People with BD who die by suicide via self-poisoning comprise a distinct but understudied group. The predominant absence of guideline-concordant pharmacologic care comprises a crucial target for future policy and knowledge translation efforts.
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Psychiatrists are seldom directly solicited by suicidal patients.
“At the same time, psychiatrists are seldom directly solicited by these patients [56,58,59,60].”
From Toxicological Findings of Self-Poisoning Suicidal Deaths: A Systematic Review by Countries (2022) · cites this paper as [56]
The Results table reports that 14.5% of the bipolar-disorder self-poisoning group had a psychiatry or emergency-room visit in the preceding week, supporting the narrower point that recent contact was uncommon. It does not distinguish psychiatrist visits from emergency-room visits or show whether patients themselves solicited the contact. (LLM, conf=0.78)
Experimental — accuracy not yet measuredBoth unemployment and low educational levels are significant risk factors for suicide attempts.
“Both unemployment and low educational levels are significant risk factors for suicide attempts as they are associated with social drawbacks that may predispose an individual to suicidal behavior [49,56,57,58].”
From Toxicological Findings of Self-Poisoning Suicidal Deaths: A Systematic Review by Countries (2022) · cites this paper as [56]
The Methods (Data source; page unavailable) list employment/financial stressors and past suicide attempts as separate variables, but do not identify unemployment as a risk factor for attempts. The Results (page unavailable) compare employment/financial stressors among groups of suicide decedents; they do not establish the claimed risk relationship. Searches for unemployment and educational attainment found no passage addressing the claim about low education. (LLM, conf=0.74)
Experimental — accuracy not yet measuredFamily and social support is crucial to protection from suicide attempts.
“Depression and bad social conditions are related to a greater risk of suicide attempts, and family and social support is crucial to protection from suicide attempts.”
From Toxicological Findings of Self-Poisoning Suicidal Deaths: A Systematic Review by Countries (2022) · cites this paper as [56]
The Results table (page not provided) records interpersonal conflict or relationship breakup as a recent stressor among people who died by suicide. Our copy does not address whether family or social support protects against suicide attempts; searches for those terms found no passage establishing that claim. (LLM, conf=0.75)
Experimental — accuracy not yet measuredIsolation may trigger events related to vulnerability and lead to suicide.
“Isolation may trigger events related to vulnerability and lead to suicide.”
From Toxicological Findings of Self-Poisoning Suicidal Deaths: A Systematic Review by Countries (2022) · cites this paper as [56]
The Background discusses suicide risk in people with bipolar disorder, and the Results list recent stressors, but neither links isolation to vulnerability or suicide. Searches for isolation, loneliness, and the claim’s wording found no passage addressing that proposed pathway. The indexed passages have no page numbers. (LLM, conf=0.72)
Experimental — accuracy not yet measuredDepression and bad social conditions are related to a greater risk of suicide attempts.
“Depression and bad social conditions are related to a greater risk of suicide attempts, and family and social support is crucial to protection from suicide attempts.”
From Toxicological Findings of Self-Poisoning Suicidal Deaths: A Systematic Review by Countries (2022) · cites this paper as [56]
The Results (page unavailable) list past suicide attempts and recent stressors among people who died by suicide, but do not test whether depression or adverse social conditions increase the risk of attempting suicide. Searches for depression, social conditions, and attempt risk found no passage making that association. (LLM, conf=0.75)
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- Authors
- Schaffer, A., Weinstock, L. M., Sinyor, M., Reis, C., Goldstein, B. I., Yatham, L. N., & Levitt, A. J.
- Affiliations
- Sunnybrook Health Science Centre (CA)
- Brown University (US)
- University of British Columbia (CA)
- Corresponding author
- Schaffer, Ayal
- ORCID
- Venue
- International Journal of Bipolar Disorders
- Published
- 2017-04-27
- Volume
- 5
- Issue
- 1
- Pages
- 16-16
- ISSN
- 2194-7511 (ISSN-L)
- PMC
- PMC5406320
- OpenAlex
- W2595884581
- Cited by
- 18
- References
- 57
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 3 · 2020: 2 · 2019: 1 · 2018: 1 · 2016: 1
- FWCI
- 1.36
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- International Journal of Bipolar Disorders (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- TSpace (University of Toronto) (submittedVersion, cc-by)
- cIRcle (University of British Columbia) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Open Collections
- Funders
- Ontario Mental Health Foundation (410004248)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Keywords
- bipolar disorder, suicide, self-poisoning, suicide methods, toxicology, opioids, antidepressants, mood stabilizers, antipsychotic drugs, suicide attempts, major depressive disorder, Toronto
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