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Cited by 467Bipolar Disorder and TreatmentSuicide and Self-Harm StudiesPersonality Disorders and Psychopathology

Suicide and Attempted Suicide in Bipolar Disorder: A Systematic Review of Risk Factors

Hawton, Keith, Sutton, Lesley, Haw, Camilla, Sinclair, Julia, Harriss, Louise·2005·The Journal of Clinical Psychiatry
DOI 10.4088/jcp.v66n0604
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Abstract

OBJECTIVE: To determine the main risk factors for suicide and nonfatal suicidal behavior in patients with bipolar disorder through a systematic review of the international literature. DATA SOURCES: Studies were identified through electronic searches of MEDLINE (1966-December 2003), EMBASE (1980-December 2003), PsycINFO (1872-November 2003), and Biological Abstracts (1985-December 2003) using index and free-text search terms for bipolar disorder, bipolar depression, manic depression, mania, and affective disorders; combined with terms for self-harm, self-injury, suicide, attempted suicide, automutilation, self-mutilation, self-poisoning, and self-cutting; and combined with terms for risk, case control, cohort, comparative, longitudinal, and follow-up studies. No language restrictions were applied to the search. STUDY SELECTION: Included studies were cohort, case-control, and cross-sectional investigations of patients with bipolar disorder in which suicide (13 studies) or attempted suicide (23 studies) was reported as an outcome. The selected studies also used diagnostic tools including the DSM, International Classification of Diseases, and Research Diagnostic Criteria. DATA SYNTHESIS: Meta-analysis of factors reported in more than 1 study identified the main risk factors for suicide as a previous suicide attempt and hopelessness. The main risk factors for nonfatal suicidal behavior included family history of suicide, early onset of bipolar disorder, extent of depressive symptoms, increasing severity of affective episodes, the presence of mixed affective states, rapid cycling, comorbid Axis I disorders, and abuse of alcohol or drugs. CONCLUSIONS: Prevention of suicidal behavior in patients with bipolar disorder should include attention to these risk factors in assessment and treatment, including when deciding whether to initiate treatment aimed specifically at reducing suicide risk.

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  • The vast majority of those who die by suicide suffer from mental disorders; however, the vast majority of those with mental disorders, including disorders with the highest suicide rates, will not attempt or die by suicide, though many will think about suicide.

    “The vast majority of those who die by suicide suffer from mental disorders (Cavanagh, Carson, Sharpe, & Lawrie, 2003); however, the vast majority of those with mental disorders, including disorders with the highest suicide rates, will not attempt or die by suicide, though many will think about suicide (Bostwick & Pankratz, 2000; Hawton, Sutton, Haw, Sinclair, & Harriss, 2005; Herzog, Greenwood,”

    From The interpersonal theory of suicide. (2010) · cites this paper as Hawton, Sutton, Haw, Sinclair, & Harriss, 2005

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Authors
Hawton, K., Sutton, L., Haw, C., Sinclair, J., & Harriss, L.
Affiliations
University of Oxford (GB)
ORCID
Venue
The Journal of Clinical Psychiatry
Publisher
Physicians Postgraduate Press, Inc
Published
2005-06-15
Volume
66
Issue
06
Pages
693-704
ISSN
0160-6689 (ISSN-L)
DOI
10.4088/jcp.v66n0604
OpenAlex
W2043651742
Cited by
467
References
4
Citations by year
2026: 6 · 2025: 9 · 2024: 23 · 2023: 10 · 2022: 11 · 2021: 12 · 2020: 21 · 2019: 20 · 2018: 25 · 2017: 22 · 2016: 38 · 2015: 33 · 2014: 33 · 2013: 25 · 2012: 25
FWCI
12.69
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • ePrints Soton (University of Southampton) (submittedVersion)
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 risk factors, hopelessness, previous suicide attempts, family history of suicide, early onset, depressive symptoms, mixed affective states, rapid cycling, comorbidities, substance abuse, suicide prevention
MeSH terms
Suicide Prevention, Bipolar Disorder, Humans, Risk Factors, Suicide, Suicide, Attempted

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