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

Abstract

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.

Does bipolar disorder have a benign course?

“…Consistent with this idea, a Danish case-register study found that the risk of dementia in bipolar disorder increased with the number of affective episodes (Kessing and Andersen, 2004), and was less marked among patients receiving continuous treatment with lithium (but not with other mood stabilizers) (Kessing et al, 2010). Bipolar disorder has also been associated with increased mortality (Almeida et al, 2014), including death by suicide (Schaffer et al, 2015). A systematic review and meta-analysis of 31 studies that included over 300,000 people with bipolar disorder found that the condition more than doubled the risk of premature death both from natural and non-natural causes (such as suicide or accidents) (Hayes et al, 2015).…”

Bipolar Depression: An Orphan Syndrome?

“…Such delay is particularly ominous given the very high rate of suicide among both type I and type II bipolar disorder patients (ca. 0.36%/year, with a male:female ratio of approximately 1.6 [0.44/0.28]), with standardized mortality ratios (SMRs) estimated at over 20 times above rates in the general population (0.36/0.015=24) (21)(22)(23)(24)(25). In addition, ratios of attempts/suicides (A/S) are much lower in bipolar disorder than in the general population, reflecting greater lethality of methods and intent (25,26).…”

“…0.36%/year, with a male:female ratio of approximately 1.6 [0.44/0.28]), with standardized mortality ratios (SMRs) estimated at over 20 times above rates in the general population (0.36/0.015=24) (21)(22)(23)(24)(25). In addition, ratios of attempts/suicides (A/S) are much lower in bipolar disorder than in the general population, reflecting greater lethality of methods and intent (25,26). Mortality also is increased in bipolar disorder owing to moderately elevated SMRs (2-3-fold) for co-occurring common general medical disorders in older bipolar disorder patients (27,28).…”

“…However, owing to the numbers of persons involved, counts of deaths per year due to suicide or other violence and that associated with medical illnesses are about the same (27). In turn, much of the excess mortality in bipolar disorder is strongly associated with its depressive components, with highest risks associated with current or past mixed-states (23)(24)(25)(26).…”

“…Initial depression (as well as anxiety and mixed-states), strongly predict a later excess of depressive morbidity, and predicts depression as the predominant polarity of recurrences, long-term (5,16,17,29). There is also an association of initial depression in bipolar disorder with later suicidal behavior (25). Initial depression in bipolar disorder also predicts a future illness-course marked by predominant cycles of depression followed by hypomania or mania and then a euthymic interval ("DMI" course-pattern vs. its opposite, "MDI") (30).…”