Suicide in bipolar disorder: characteristics and subgroups

Schaffer, Ayal; Sinyor, Mark; Reis, Catherine; Goldstein, Benjamin I.; Levitt, Anthony J.

doi:10.1111/bdi.12219

Cited by 30 publications

(36 citation statements)

References 60 publications

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“…Shooting was less common in the male BD group compared to males in the general population and self-poisoning was less common in the female BD group compared to females in the general population (Ösby et al, 2001). In a large Canadian sample of suicide deaths, rates of self-poisoning among those with BD were significantly higher (33.5% vs 17.4%) and rates of hanging were significantly lower (17.1% vs 29.7%) (Schaffer et al, 2014). …”

Section: Resultsmentioning

confidence: 99%

Epidemiology, neurobiology and pharmacological interventions related to suicide deaths and suicide attempts in bipolar disorder: Part I of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder

Schaffer

Isometsä

Tondo

et al. 2015

Aust N Z J Psychiatry

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140

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Objectives Bipolar disorder is associated with elevated risk of suicide attempts and deaths. Key aims of the International Society for Bipolar Disorders Task Force on Suicide included examining the extant literature on epidemiology, neurobiology and pharmacotherapy related to suicide attempts and deaths in bipolar disorder. Methods Systematic review of studies from 1 January 1980 to 30 May 2014 examining suicide attempts or deaths in bipolar disorder, with a specific focus on the incidence and characterization of suicide attempts and deaths, genetic and non-genetic biological studies and pharmacotherapy studies specific to bipolar disorder. We conducted pooled, weighted analyses of suicide rates. Results The pooled suicide rate in bipolar disorder is 164 per 100,000 person-years (95% confidence interval = [5, 324]). Sex-specific data on suicide rates identified a 1.7:1 ratio in men compared to women. People with bipolar disorder account for 3.4–14% of all suicide deaths, with self-poisoning and hanging being the most common methods. Epidemiological studies report that 23–26% of people with bipolar disorder attempt suicide, with higher rates in clinical samples. There are numerous genetic associations with suicide attempts and deaths in bipolar disorder, but few replication studies. Data on treatment with lithium or anticonvulsants are strongly suggestive for prevention of suicide attempts and deaths, but additional data are required before relative anti-suicide effects can be confirmed. There were limited data on potential anti-suicide effects of treatment with antipsychotics or antidepressants. Conclusion This analysis identified a lower estimated suicide rate in bipolar disorder than what was previously published. Understanding the overall risk of suicide deaths and attempts, and the most common methods, are important building blocks to greater awareness and improved interventions for suicide prevention in bipolar disorder. Replication of genetic findings and stronger prospective data on treatment options are required before more decisive conclusions can be made regarding the neurobiology and specific treatment of suicide risk in bipolar disorder.

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Section: Resultsmentioning

confidence: 99%

Epidemiology, neurobiology and pharmacological interventions related to suicide deaths and suicide attempts in bipolar disorder: Part I of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder

Schaffer

Isometsä

Tondo

et al. 2015

Aust N Z J Psychiatry

Self Cite

140

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“…There is a strong relationship between mental health disorders and self-harm (e.g., suicide ideation, attempts, and other self-injurious behaviors) [20,21,22,23,24,25,26,27,28]. In particular, depression and bipolar with anxiety disorders are strongly associated with suicidal ideation, attempts, and completion [3,20,21,22,23,24,26,29,30,31].…”

Section: Introductionmentioning

confidence: 99%

Associations among Substance Use, Mental Health Disorders, and Self-Harm in a Prison Population: Examining Group Risk for Suicide Attempt

Gates

Turney²,

Ferguson

et al. 2017

IJERPH

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Substance use disorders (SUD) and mental health disorders are significant public health issues that co-occur and are associated with high risk for suicide attempts. SUD and mental health disorders are more prevalent among offenders (i.e., prisoners or inmates) than the non-imprisoned population, raising concerns about the risk of self-harm. This cross-sectional study examined the population of a state prison system (10,988 out of 13,079) to identify associations among SUD (alcohol, cannabis, intravenous drugs, narcotics, and tobacco smoking), mental health disorders (anxiety, bipolar, depression, and psychotic disorders), and suicide attempts. The primary aim was to determine which groups (SUD, mental health disorders, and co-occurrences) were strongly association with suicide attempts. Groups with a documented SUD or mental health disorders compared to peers without these issues had 2.0 and 9.2 greater odds, respectively, for attempting suicide, which was significant at p < 0.0001 for both conditions. There were also significant differences within SUD and mental health disorders groups in regard to suicide attempts. Groups with the greatest odds for suicide attempts were offenders with comorbid bipolar comorbid and anxiety, alcohol combined with depression, and cannabis co-occurring with depression. Documentation of suicide attempts during imprisonment indicates awareness, but also suggest a need to continue enhancing screening and evaluating environmental settings.

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“…However, other studies suggest that female gender is a risk factor (Schaffer et al 2014 ). Probably there is a complex interplay of a number of factors including age, gender, family history of suicide, marital status, living circumstances, higher number of prior depressive episodes, history of psychotic features, comorbid anxiety, personality disorders (especially borderline), past and recent suicide attempts, substance and alcohol abuse, recent hospitalization and interpersonal, employment/fi nancial and legal/police stressors (Tidemalm et al 2014 ;Umamaheswari et al 2014 ;Zimmerman et al 2014 ;Bernal et al 2006 ;Rihmer et al 2002 ;Rihmer 2007 ;Balazs et al 2006 ;Rihmer and Akiskal 2006 ;Henriksson et al 1993 ;Carra et al 2014 ;Schaffer et al 2014 ). Patients with severe suicide attempts were reported to manifest lower affective intensity and lability and higher neurocognitive function in comparison to patients with less severe attempts and normal controls (Olie et al 2014 ).…”

mentioning

confidence: 96%

“…Especially the presence of a mixed features during a depressive episode as well as agitation substantially increase the risk of both attempted and committed suicide (Balazs et al 2006 ;Isometsa et al 1994b ;Rihmer and Akiskal 2006 ;Rihmer 2007 ). However, other studies suggest that female gender is a risk factor (Schaffer et al 2014 ). Probably there is a complex interplay of a number of factors including age, gender, family history of suicide, marital status, living circumstances, higher number of prior depressive episodes, history of psychotic features, comorbid anxiety, personality disorders (especially borderline), past and recent suicide attempts, substance and alcohol abuse, recent hospitalization and interpersonal, employment/fi nancial and legal/police stressors (Tidemalm et al 2014 ;Umamaheswari et al 2014 ;Zimmerman et al 2014 ;Bernal et al 2006 ;Rihmer et al 2002 ;Rihmer 2007 ;Balazs et al 2006 ;Rihmer and Akiskal 2006 ;Henriksson et al 1993 ;Carra et al 2014 ;Schaffer et al 2014 ).…”

mentioning

confidence: 99%

Special Issues

Fountoulakis¹

2014

Bipolar Disorder

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It is well known that concerning the prevalence of unipolar depression, females have almost double rates in comparison to males (Lloyd and Miller 1997 ;Blazer et al. 1994 ). However, this does not hold true concerning BD, for which similar rates between males and females are reported. There are some data suggesting that males might be over-represented in those diagnosed with a BD-I and females overrepresented in those diagnosed with a BD-II disorder (Parker et al. 2014 ).Some authors suggest that females with less social support and experiencing social stressors might be at the greatest risk to develop depression, but this concerns unipolar and not bipolar cases. It has been documented that women are more likely to experience stressful and even threatening life events and are at a higher risk of early sexual abuse and current spousal abuse (Roesler and McKenzie 1994 ;Finkelhor et al. 1990 ). Women also might use oral contraceptive and often experience mood disorders temporally related to their gender identity (e.g. premenstrualor postpartum-onset mood disorders) which might have an impact on the course of BD (Meinhard et al. 2014 ). A number of adverse experiences related to sexual life and determined by gender seem to happen in the lives of bipolar women. In comparison to healthy women, bipolar women might be more likely to have been forced by their partners to have sex, raped or suffering from sexually transmitted diseases. The use of contraceptives is usually sporadic and their rates of pregnancy and abortion are high (Ozcan et al. 2014 ).Also, in almost all societies, unequal roles for women are in place, and additionally there is a gender difference in copying styles; men might react to emotional distress by trying not to think about it, while women are more likely to ruminate over their problems (Nolen-Hoeksema and Girgus 1994 ;Nolen-Hoeksema et al. 1999, 2007. In this frame, women are more likely to report depressive symptoms due to marital problems than men (Joiner et al. 1992 ;Hammen and Peters 1978 ) and are more likely to be diagnosed with depression because they seek professional help more often for their depressive symptoms and maybe because they are more 660 sensitive to negative relationships (Phillips and Segal 1969 ). Concerning the neurocognitive function, the data are inconsistent (Bucker et al. 2014 ;Suwalska and Lojko 2014 ).Overall there does not seem to be any signifi cant gender difference concerning the risk of recurrence, thus suggesting that gender is among the risk factors for initiating depressive symptoms in unipolar depression but not among those determining the course and outcome either in unipolar or in bipolar cases (Nazroo et al. 1997 ;Philibert et al. 1997 ).There are a number of comorbid conditions which seem to be more frequent in bipolar women, including abdominal obesity. This happens possibly because of a higher frequency of predominant depressive polarity in women and more seasonal variations in mood disturbance and reproductive life events and related treatments (Baskara...

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Suicide in bipolar disorder: characteristics and subgroups

Cited by 30 publications

References 60 publications

Epidemiology, neurobiology and pharmacological interventions related to suicide deaths and suicide attempts in bipolar disorder: Part I of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder

Epidemiology, neurobiology and pharmacological interventions related to suicide deaths and suicide attempts in bipolar disorder: Part I of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder

Associations among Substance Use, Mental Health Disorders, and Self-Harm in a Prison Population: Examining Group Risk for Suicide Attempt

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