Bipolar disorder (BD) is a common and severe major psychiatric illness with an estimated worldwide lifetime prevalence of between 1% and 5% (Goodwin & Jamison, 1990). It is associated with a high risk of premature mortality in general and a high risk of suicide in particular (Goodwin & Jamison, 1990). It has been estimated that as many as 10% of BD patients die by suicide, and as many as 40% report having made suicide attempts (Lopez, et al., 2001; Leverich, et al., 2003; Dalton, et al., 2003). Evidence also suggests that suicidal behaviour in BD patients has a higher lethality than in the general population (Tondo, Isacsson, & Baldessarini, 2003).
A number of risk factors for suicide attempts in BD have been identified in previous research, but less is known about risk for completed suicide or how such risk factors link together to precipitate episodes of suicidal behaviour (Hawton, et al., 2005). Risk factors for attempted suicide and self-harm in BD include: a family history of suicide (Lopez, et al., 2001), earlier onset of BD (Oquendo, et al., 2000; Lopez, et al., 2001; Dalton, et al., 2003), comorbid anxiety disorder, and substance misuse (Hawton, et al., 2008). For completed suicide only male gender, a history of suicide attempt and expressed hopelessness have been shown to be consistent risk factors (Leverich, et al., 2003; Tondo, et al., 2003; Simon, et al., 2007). Evidence of factors that reduce or protect against suicidal behaviour in BD, such as specific medical treatment, also remains limited and largely inconclusive (Baldessarini, & Jamison, 1999; Angst, et al., 2002). However there is consistent evidence for the efficacy of Lithium in reducing suicidal behaviours (Tondo, Hennen, & Baldessarini, 2001).
This study seeks to fill the gaps in the current body of knowledge on risk factors for suicide in BD. Using existing datasets held by the National Confidential Inquiry and Manchester Self Harm Project which contain detailed information on a large number of BD patients, we hope to build a more comprehensive picture of demographic, illness, and clinical management risk factors and associations between them. Factors found to be important will be investigated further in a series of in depth interviews, with BD patients who have made medically serious suicide attempts and the relatives of BD patients who have died by suicide, to explore how risk factors are linked together in a suicidal process.
Main research questions
- To understand the risk of suicide in bipolar disorder
- To understand the demographic, clinical, and management-related risk factors for suicidal behaviour in bipolar disorder
- To understand how these risk factors link together in episodes of self-harm or suicide