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

Objectives: Bipolar disorder is associated with a high risk of suicide attempts and suicide death. The main objective of the present study was to identify and quantify the demographic and clinical correlates of attempted and completed suicide in people with bipolar disorder.

Methods: Within the framework of the International Society for Bipolar Disorders Task Force on Suicide, a systematic review of articles published since 1980, characterized by the key terms bipolar disorder and 'suicide attempts' or 'suicide', was conducted, and data extracted for analysis from all eligible articles. Demographic and clinical variables for which ≥ 3 studies with usable data were available were meta-analyzed using fixed or random-effects models for association with suicide attempts and suicide deaths. There was considerable heterogeneity in the methods employed by the included studies.

Results: Variables significantly associated with suicide attempts were: female gender, younger age at illness onset, depressive polarity of first illness episode, depressive polarity of current or most recent episode, comorbid anxiety disorder, any comorbid substance use disorder, alcohol use disorder, any illicit substance use, comorbid cluster B/borderline personality disorder, and first-degree family history of suicide. Suicide deaths were significantly associated with male gender and first-degree family history of suicide.

Conclusions: 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.

Keywords: bipolar disorder; meta-analysis; suicide.

Fig. 1.

Meta-analysis of suicide attempts among males and females with bipolar disorder. CI = confidence interval.

Fig. 2.

Meta-analysis of suicide attempts based on age of onset of bipolar disorder. SD = standard deviation; CI = confidence interval.

Fig. 3.

Meta-analysis of suicide attempts based on polarity of first episode of bipolar disorder. BD-I = bipolar I disorder; BD-II = bipolar II disorder; CI = confidence interval.

Fig. 4.

Meta-analysis of suicide attempts based on polarity of current or most recent episode of bipolar disorder. CI = confidence interval.

Fig. 5.

Meta-analysis of suicide attempts in bipolar disorder based on the presence of comorbid anxiety disorder. CI = confidence interval.

Fig. 6.

Meta-analysis of suicide attempts in bipolar disorder based on the presence of any substance use disorder. CI = confidence interval.

Fig. 7.

Meta-analyses of suicide attempts in bipolar disorder based on the presence of alcohol use disorder or any illicit substance use disorder. CI = confidence interval.

Fig. 7.

Meta-analyses of suicide attempts in bipolar disorder based on the presence of alcohol use disorder or any illicit substance use disorder. CI = confidence interval.

Fig. 8.

Meta-analysis of suicide attempts in bipolar disorder based on the presence of a comorbid cluster B/borderline personality disorder. CI = confidence interval.

Fig. 9.

Meta-analysis of suicide attempts in bipolar disorder based on the presence of a family history of suicide. CI = confidence interval.

Fig. 10.

Meta-analysis of suicide deaths among males and females with bipolar disorder. CI = confidence interval.

Fig. 11.

Meta-analysis of suicide deaths in bipolar disorder based on the presence of a family history of suicide. BD = bipolar disorder; CI = confidence interval.

Fig. 12.

List of variables that were or were not associated with suicide attempts or suicide deaths in people with bipolar disorder based on meta-analytic results. *Could not be ranked because a continuous measure of age of illness onset was used.