Table 1.
Summary of main factors associateda with suicide attempts and suicide deaths in BD.
| Variables | Increased likelihood of suicide attempts in BD | Increased likelihood of suicide deaths in BD |
|---|---|---|
| Sociodemographics | ||
| Sex | Female | Male |
| Females have higher SMR | ||
| Age | Younger | No clear effect |
| Older age—higher lethality attempts | Older age—higher ratio of deaths/attempts | |
| Race | Minorities—specific to youth only | |
| Marital status | Single, divorced, single parents | |
| Religious affiliation | Discordant results | |
|
| ||
| Characteristics of BD | ||
| Age of illness onset | Younger age | |
| Duration of illness | Discordant results | |
| Polarity of first episode | Depression | |
| Mixed symptoms | ||
| Mania—more violent attempts | ||
| Predominant polarity | Depressive | |
| Polarity of current episode | Depressive episodes | Depressive episodes |
| Mixed states | Mixed states | |
| Manic states with psychotic features | ||
| Other mood episode characteristics | Mixed features | Hopelessness |
| Greater number and severity of episodes/rapid cycling | Psychomotor agitation | |
| Anxiety | ||
| Atypical features | ||
| Suicidal ideation | ||
| Psychosis at any time | Discordant results | No effect |
| BD subtype | No clear effect | No clear effect |
|
| ||
| Comorbidities | ||
| Psychiatric comorbidity | Substance use disorder | Substance use disorder—no clear effect |
| Cigarette smoking | Anxiety disorder | |
| Coffee intake | ||
| Anxiety disorder | ||
| Obesity or high BMI | ||
| Eating disorder | ||
| Personality disorders and characteristics | Personality disorders—including borderline or cluster B PD in particular | |
| Aggression or irritability | ||
| Impulsivity (discordant results) | ||
|
| ||
| Other clinical variables | ||
| First-degree family history | Mood disorders | Mood disorders |
| BD | BD | |
| Suicide | Suicide | |
| Prior suicide attempts | Presence | Presence |
| Early life trauma | Childhood abuse | |
| Higher early life stress | ||
| Psychosocial precipitants | Interpersonal problems | Present within a week prior to death |
| Occupational problems | ||
| Bereavement | ||
| Sexual dysfunction | Presence | |
SMR: standardized mortality ratio; BD: bipolar disorder; BMI: body mass index; PD: personality disorder.
Discordant results were identified if studies produced opposite results for a particular variable.
a
Based on findings in at least one study. The data quality to support the findings varies to a considerable degree. See text of manuscript for full descriptions.