Suicide, Hospital-Presenting Suicide Attempts, and Criminality in Bipolar Disorder: Examination of Risk for Multiple Adverse Outcomes
Open accessAbstract
OBJECTIVE: To compare risks for suicidality and criminality in a national cohort of people diagnosed with bipolar disorder, and to assess how risk factor profiles differ between these outcomes. METHOD: We conducted 2 case-cohort studies using interlinked Swedish national registers. Primarily, using International Classification of Diseases (ICD) coding, we identified 15,337 people diagnosed with bipolar disorder, 1973-2009, matched by age and gender to 20 individuals per case sampled randomly from the general population. We estimated risks of suicide and hospital-presenting attempted suicide, and violent and nonviolent criminal offending. We separately assessed these risks among 14,677 unaffected siblings matched to a second general population sample. RESULTS: 22.2% of bipolar disorder cohort members engaged in suicidal or criminal acts after diagnosis. They were at greatly elevated risk for completed suicide (risk ratio = 18.8; 95% CI, 16.0-22.2), attempted suicide (risk ratio = 14.3; 95% CI, 13.5-15.2), violent crime (risk ratio = 5.0; 95% CI, 4.6-5.4), and nonviolent crime (risk ratio = 2.9; 95% CI, 2.8-3.1) compared with the general population. Elevations in risk were far less marked among the unaffected siblings than in the bipolar disorder cohort. Three factors independently predicted raised risk of all 4 adverse outcomes: if the first 2 patient episodes for bipolar disorder required admission, a history of attempted suicide, and a history of diagnosed alcohol/drug disorder. Criminal offending before bipolar diagnosis was an especially strong independent predictor of criminality after diagnosis. CONCLUSIONS: The combined risk of suicidality or criminality is substantially elevated in both relative and absolute terms. Clinical prediction rules focusing on multiple vulnerabilities following onset of bipolar disorder, especially when there is history of attempted suicide, substance misuse disorders, or criminal offending, may improve risk management.
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Approximately 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 [46]
The background passage (page unavailable) estimates that 10%–15% of people with bipolar disorder may die by suicide, not 6%–7%. The Results report 272 suicides among the study’s 15,337 identified patients—about 1.8% during follow-up—also not 6%–7%. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
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 [46]
The Results section (‘Relative Risks: Bipolar Disorder Cohort Versus the General Population’; page unavailable) reports considerably higher suicide risk in the bipolar-disorder cohort. Our copy does not give the claimed general-population rate of 10.7 per 100,000 per year; searches for that figure and its units found no matching passage. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSuicide 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 [46]
The introductory passage (listed under Abstract > Conclusions; page unavailable) says people with bipolar disorder have a markedly elevated suicide risk and cites an estimate that 10%–15% may die by suicide, while noting a more recent lower estimate. This supports suicide as a major mortality concern, but the paper does not rank it among causes of death in bipolar disorder. (LLM, conf=0.81)
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Self-citation
- Authors
- Webb, R. T., Lichtenstein, P., Larsson, H., Geddes, J. R., & Fazel, S.
- Affiliations
- University of Manchester (GB)
- Warneford Hospital (GB)
- Corresponding author
- Fazel, Seena
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2014-08-26
- Volume
- 75
- Issue
- 08
- Pages
- e809-e816
- ISSN
- 0160-6689 (ISSN-L)
- PMC
- PMC4226039
- OpenAlex
- W1982506500
- Cited by
- 70
- References
- 65
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 3 · 2023: 8 · 2022: 4 · 2021: 5 · 2020: 8 · 2019: 10 · 2018: 7 · 2017: 8 · 2016: 8 · 2015: 5
- FWCI
- 5.34
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Wellcome Trust (095806)
- International Association for Suicide Prevention
- National Institute for Health and Care Research (NF-SI-0611-10150)
- University of Oxford
- Forskningsrådet för Arbetsliv och Socialvetenskap
- Karolinska Institutet
- Vetenskapsrådet (2011-02492)
- 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 › Psychopathy, Forensic Psychiatry, Sexual Offending
- Keywords
- bipolar disorder, suicide, suicide attempts, offending, violent crime, non-violent crime, risk factors, substance use disorders, hospitalization, unaffected siblings, risk prediction
- MeSH terms
- Adolescent, Adult, Bipolar Disorder, Female, Hospitalization, Humans, Male, Registries, Risk Factors, Suicide, Suicide, Attempted, Violence, Odds Ratio, Case-Control Studies, Diagnosis, Dual (Psychiatry), Substance-Related Disorders, Siblings, Young Adult, Criminals
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