What factors correlate with completed suicide in bipolar disorder? bipolar disorders.Feb.2015


Bipolar disorder (BPD) is associated with  the highest suicide rate among mental disorders. Between 5%-8% ob those with BPD can complete suicide during an 18 years follow up period. Standardised Mortality Rate (SMR)  is 10-30 fold than that in general population. It is also  estimated that up to half will attempt suicide during life time.

International Society for Bipolar Disorder carried out a metaanalysis of  literature on correlates of suicide/attempts in bipolar disorder. The comprehensive search with clearly defined inclusion criteria identified 1700 abstracts of which 44 studies met all criteria to be included in the analysis.


Factors correlated with suicide attempts: women, early onset of disorder, depression as onset episode, comorbid anxiety/substance use/cluster B personality disorder and family history of suicide.

Factors correlated with suicide: male gender and first degree family history of suicide.

Bipolar 1 or 2 and presence of psychosis were not particularly associated with suicidal behaviours.

Limitations: Presence of variables in relation to time span/ proximity to outcome is not known ( i.e. life time anxiety disorder as comorbid condition may not mean that  comorbidity  was present at suicide. Both prospective and retrospective studies were included, hence focus is on correlation than risk prediction. Many factors of importance may be excluded ( e.g. past suicide attempt) because of insufficient studies  with  required data.


Most of these findings reflect the experience of practising psychiatrists. These generally confirm what we know already. Depressive polarity ( first episode with depression) is associated with higher suicide attempts. It is possible that those who present with depression face delay in diagnosis ( as bipolar) and this might be contributing to the increased morbidity.

The OR of  suicide among male gender is 1.8 as opposed to female gender.The difference between genders is not wide enough to be used in clinical practice to inform our risk assessments / predictions. The accompanying commentary by Barthge CA concludes rightly: There is no marker indicating that a patient can be considered safe ( with regard to completed suicide).

Summary of the article:

International Society for Bipolar Disorders Task Force on Suicidemeta-analyses and meta-regression of correlates of suicideattempts and suicide deaths in bipolar disorder.

Schaffer A, Isometsä ET, Tondo L, H Moreno D, Turecki G, Reis C, Cassidy F, Sinyor M, Azorin JM, Kessing LV, Ha K, Goldstein T, Weizman A, Beautrais A, Chou YH, Diazgranados N, Levitt AJ, Zarate CA Jr, Rihmer Z, Yatham LN. Bipolar Disord. 2015 Feb;17(1):1-16.

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