Suicide attempts in bipolar I and bipolar II disorder: a review and meta‐analysis of the evidence

Abstract

Objective The prevalence of suicide attempts (SA) in bipolar II disorder (BPII), particularly in comparison to the prevalence in bipolar I disorder (BPI), is an understudied and controversial issue with mixed results. To date, there has been no comprehensive review of the published prevalence data for attempted suicide in BPII. Methods We conducted a literature review and meta-analysis of published reports that specified the proportion of individuals with BPII in their presentation of SA data. Systematic searching yielded 24 reports providing rates of SA in BPII and 21 reports including rates of SA in both BPI and BPII. We estimated the prevalence of SA in BPII by combining data across reports of similar designs. To compare rates of SA in BPII and BPI, we calculated a pooled odds ratio (OR) and 95% confidence interval (CI) with random-effect meta-analytic techniques with retrospective data from 15 reports that detailed rates of SA in both BPI and BPII. Results Among the 24 reports with any BPII data, 32.4% (356 /1099) of individuals retrospectively reported a lifetime history of SA, 19.8% (93 /469) prospectively reported attempted suicide, and 20.5% (55 /268) of index attempters were diagnosed with BPII. In 15 retrospective studies suitable for meta-analysis, the prevalence of attempted suicide in BPII and BPI was not significantly different: 32.4% and 36.3%, respectively (OR = 1.21, 95% CI: 0.98–1.48, p = 0.07). Conclusion The contribution of BPII to suicidal behavior is considerable. Our findings suggest that there is no significant effect of bipolar subtype on rate of SA. Our findings are particularly alarming in concert with other evidence, including (i) the well-documented predictive role of SA for completed suicide and (ii) the evidence suggesting that individuals with BPII use significantly more violent and lethal methods than do individuals with BPI. To reduce suicide-related morbidity and mortality, routine clinical care for BPII must include ongoing risk assessment and interventions targeted at risk factors.

Management of Bipolar I Disorder through CBT (Cognitive Behaviour Therapy): A Case Report

“…Many research studies argued that mortality rate is high among people admitted to hospitals with bipolar disorder. High risk for suicidality is not only limited to those diagnosed with bipolar I disorder rather a metaanalysis of 15 studies by Novick and Swartz [1] suggested that bipolar I and bipolar II disorder did not differ with regard to rates of attempted suicide. Approximately 2% lifetime prevalence of bipolar I disorder is [2].…”

The Efficacy of Group-Cognitive Behavior Therapy for Patients with Bipolar Disorder Based on Psychological Behaviorism

“…According to the research, the majority of patients with BD deal with chronic unemployment and absenteeism from their workplace for a long periods because of their illness, or they maintain their careers while showing deterioration in their occupational functioning [5]. About fifty percent of BD patients attempt suicide and 6-20% of them die by suicide [6]. With respect to suicide, BD is a serious mental illness that has heavy impacts on the individual and society.…”

Bipolar Depression: An Orphan Syndrome?

“…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).…”

“…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).…”