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Suicide and attempted suicide in bipolar disorder: a systematic review of risk factors

Suicide and attempted suicide in bipolar disorder: a systematic review of risk factors
Suicide and attempted suicide in bipolar disorder: a systematic review of risk factors
Objective: To determine the main risk factors for suicide and nonfatal suicidal behavior in patients with bipolar disorder through a systematic review of the international literature.
Data Sources: Studies were identified through electronic searches of MEDLINE (1966-December 2003), EMBASE (1980-December 2003), PsycINFO (1872-November 2003), and Biological Abstracts (1985-December 2003) using index and free-text search terms for bipolar disorder, bipolar depression, manic depression, mania, and affective disorders; combined with terms for self-harm, self-injury, suicide, attempted suicide, automutilation, self-mutilation, self-poisoning, and self-cutting; and combined with terms for risk, case control, cohort, comparative, longitudinal, and follow-up studies. No language restrictions were applied to the search.
Study Selection: Included studies were cohort, case-control, and cross-sectional investigations of patients with bipolar disorder in which suicide (13 studies) or attempted suicide (23 studies) was reported as an outcome. The selected studies also used diagnostic tools including the DSM, International Classification of Diseases, and Research Diagnostic Criteria.
Data Synthesis: Meta-analysis of factors reported in more than 1 study identified the main risk factors for suicide as a previous suicide attempt and hopelessness. The main risk factors for nonfatal suicidal behavior included family history of suicide, early onset of bipolar disorder, extent of depressive symptoms, increasing severity of affective episodes, the presence of mixed affective states, rapid cycling, comorbid Axis I disorders, and abuse of alcohol or drugs.
Conclusions: Prevention of suicidal behavior in patients with bipolar disorder should include attention to these risk factors in assessment and treatment, including when deciding whether to initiate treatment aimed specifically at reducing suicide risk.
review, meta-analysis, risk factors
693-704
Hawton, K.H.
d2396921-7d5a-4b83-8023-6dd9fa97547c
Sutton, L.
d6c680a5-f535-4396-af7b-f06740a97902
Haw, C.
bf0196c6-aaca-4262-9d9b-611ee56640d0
Sinclair, J.M.A.
be3e54d5-c6da-4950-b0ba-3cb8cdcab13c
Harriss, L.
9b5196fe-aab6-4a12-b34d-5dbfd1e265cd
Hawton, K.H.
d2396921-7d5a-4b83-8023-6dd9fa97547c
Sutton, L.
d6c680a5-f535-4396-af7b-f06740a97902
Haw, C.
bf0196c6-aaca-4262-9d9b-611ee56640d0
Sinclair, J.M.A.
be3e54d5-c6da-4950-b0ba-3cb8cdcab13c
Harriss, L.
9b5196fe-aab6-4a12-b34d-5dbfd1e265cd

Hawton, K.H., Sutton, L., Haw, C., Sinclair, J.M.A. and Harriss, L. (2005) Suicide and attempted suicide in bipolar disorder: a systematic review of risk factors. The Journal of Clinical Psychiatry, 66 (6), 693-704.

Record type: Article

Abstract

Objective: To determine the main risk factors for suicide and nonfatal suicidal behavior in patients with bipolar disorder through a systematic review of the international literature.
Data Sources: Studies were identified through electronic searches of MEDLINE (1966-December 2003), EMBASE (1980-December 2003), PsycINFO (1872-November 2003), and Biological Abstracts (1985-December 2003) using index and free-text search terms for bipolar disorder, bipolar depression, manic depression, mania, and affective disorders; combined with terms for self-harm, self-injury, suicide, attempted suicide, automutilation, self-mutilation, self-poisoning, and self-cutting; and combined with terms for risk, case control, cohort, comparative, longitudinal, and follow-up studies. No language restrictions were applied to the search.
Study Selection: Included studies were cohort, case-control, and cross-sectional investigations of patients with bipolar disorder in which suicide (13 studies) or attempted suicide (23 studies) was reported as an outcome. The selected studies also used diagnostic tools including the DSM, International Classification of Diseases, and Research Diagnostic Criteria.
Data Synthesis: Meta-analysis of factors reported in more than 1 study identified the main risk factors for suicide as a previous suicide attempt and hopelessness. The main risk factors for nonfatal suicidal behavior included family history of suicide, early onset of bipolar disorder, extent of depressive symptoms, increasing severity of affective episodes, the presence of mixed affective states, rapid cycling, comorbid Axis I disorders, and abuse of alcohol or drugs.
Conclusions: Prevention of suicidal behavior in patients with bipolar disorder should include attention to these risk factors in assessment and treatment, including when deciding whether to initiate treatment aimed specifically at reducing suicide risk.

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More information

Published date: 2005
Keywords: review, meta-analysis, risk factors

Identifiers

Local EPrints ID: 62404
URI: http://eprints.soton.ac.uk/id/eprint/62404
PURE UUID: bb481e8f-77c5-4a33-b438-2efc59ced63a
ORCID for J.M.A. Sinclair: ORCID iD orcid.org/0000-0002-1905-2025

Catalogue record

Date deposited: 05 Sep 2008
Last modified: 23 Jul 2022 01:41

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Contributors

Author: K.H. Hawton
Author: L. Sutton
Author: C. Haw
Author: J.M.A. Sinclair ORCID iD
Author: L. Harriss

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