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Child Psychiatrist /Adult Psychiatrist

Suicide and Other Deaths From Unnatural Causes in Bipolar Disorder

Keypoint: Are individuals with bipolar disorder more likely to die from unnatural causes than the general population?


A poster at the 2024 American Psychiatric Association (APA) Annual Meeting discussed the results of a recent meta-analysis that investigated the risk of premature mortality, particularly due to unnatural causes like suicide, among individuals with bipolar disorder compared with the general population.

Bipolar Disorder

According to the poster’s researchers, there is an association between bipolar disorder and premature mortality. Individuals with bipolar disorder face heightened susceptibility to unnatural deaths, predominantly through suicide, alongside other unnatural causes such as homicide and accidents. The study discussed in the poster undertook a meta-analysis of current research findings concerning these unnatural causes, with a specific focus on suicide in bipolar disorder.

Following PRISMA guidelines, the study researchers retrieved relevant data from multiple databases including PubMed, Embase, Web of Science, and PsycINFO. A total of 25 studies on suicide and 17 studies on unnatural causes were included in the analysis, which encompassed 180,210 individuals with bipolar disorder for suicide and 349,744 individuals with bipolar disorder for unnatural causes.

The standardized mortality ratio (SMR) for suicide and unnatural causes was higher in individuals with bipolar disorder compared with the general population. Specifically, the relative risk (RR) for suicide was 11.69, with higher SMR observed in women (17.53) compared with men (14.02). Similarly, the SMR for unnatural causes was 7.29, with higher RR observed in females (9.33) compared with males (6.69). Meta-regression analysis showed no significant influence on results, and publication bias was not observed.

According to the researchers, the study emphasizes the urgent need for suicide prevention efforts, particularly among individuals with bipolar disorder, as suicide remains a leading cause of preventable death in this population. These findings also underscore the importance of addressing suicide risk factors at both the individual and the population levels through clinical interventions and public health policies.

“As supported by the data collected, in agreement with previous literature, bipolar disorder subjects presented elevated mortality from unnatural causes—suicide being the most concerning, as it is the leading cause of preventable death,” the researchers concluded. “Our findings lead to an understanding that an effort to prevent suicide is necessary mainly in high-risk bipolar disorder. Clinicians (individual level) and public health policies (populational level) should address risk factors for suicide.”

The poster was presented by Beny Lafer, MD, PhD, of the University of Toronto Department of Psychiatry, and Taís Biazus, MD, of the University of São Paulo Medical School Department and Institute of Psychiatry.

The suicide rate in the United States recently reached its highest peak since 1941.2 Are you interested in learning more about the latest research on suicide? See the Psychiatric Times® April cover stories on suicide in the context of various comorbidities and patient populations:

The suicide rate in the United States recently reached its highest peak since 1941. Here’s what you need to know.

Which therapeutic targets are likely to be relevant for reducing risk of suicide in TRD?

Although the practice of medicine can be immensely rewarding, it also can be extraordinarily stressful. Here’s how we can help prevent clinician suicide.

Note: This article originally appeared on Psychiatric Times®

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