Rates of suicide and self-harm are higher in people with a mental disorder than in people without a mental disorder.

What is the evidence for suicide and self-harm in people with bipolar disorder?

Rates of suicide attempts in people with bipolar disorder

Moderate to high quality evidence finds the overall prevalence rate of suicide attempts is around 30% in people with bipolar disorder, with the yearly attempt incidence rate being around 4%. The overall suicide completion incidence rate is 237.0 per 100,000 person-years. This means there will be on average 237 suicides in 100,000 people with bipolar disorder over one year.

In children and adolescents with bipolar disorder

Moderate to high quality evidence suggests the risk of suicide attempts is higher in children and adolescents with bipolar disorder than in children and adolescents with major depression. Moderate quality evidence suggests suicide ideation is more prevalent than suicide attempts (~50% vs. ~25%). The only significant predictors of suicide attempts in children and adolescents were having bipolar I disorder rather than bipolar II disorder, and having a concurrent diagnosis of attention deficit hyperactivity disorder.

In adults with bipolar disorder

Moderate quality evidence suggests a large increased risk of suicide completion in psychiatric hospital patients who were assessed as being at high risk of suicide. A history of suicidal behaviour and depressive symptoms or affective disorder was included in the majority of the high-risk models.

Increased risk of suicide attempts was associated with; anxiety disorders or being female (both high quality evidence, small effects), concurrent cluster B personality disorders (moderate to high quality evidence, medium-sized effect), a history of child abuse (moderate to high quality evidence, small to medium-sized effect), a younger age at bipolar onset (<18yrs, moderate to high quality evidence, small effect), depressive polarity of first illness episode (moderate quality evidence, large effect), displaying risky decision making (moderate quality evidence, medium-sized effect), and depressive episode predominance, concurrent substance use disorders, and having a family history of suicide (all moderate quality evidence, small effects).

Increased risk of suicide completion was associated with; having a family history of suicide (moderate to high quality evidence, medium-sized effect), male gender (moderate quality evidence, small effect), or being incarcerated (moderate quality evidence, medium-sized effect).

November 2021

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The life expectancy of people with a mental illness may be reduced compared to the general population. The reasons are largely unclear, but may in part be related to lifestyle factors such as weight gain, smoking, unhealthy diet and low physical activity. Bipolar disorder may also be associated with increased suicide rates when compared to the general population.

What is the evidence regarding mortality rates in bipolar disorder?

Moderate to high quality evidence suggests a medium-sized effect of increased risk of all-cause mortality in people with the disorder compared to the general population.

There were large effects of increased risk of suicide or other violent deaths, medium-sized effects of increased risk of death from respiratory disease or infections, and small effects of increased risk of death from cardiovascular disease, circulatory disease or cancer.

November 2021

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Rates of suicide or self-harm are considerably higher in people with mental disorders compared to people without a mental disorder. There has been much research dedicated to determining potential risk factors for suicide, which may have clinically important applications for prevention. Many of the important risk factors for suicide in the general population can apply to people with mental disorders, including having depression and/or a history of previous suicide attempts.

What is the evidence for treatments for suicide and self-harm?

Moderate to high quality evidence suggests self-harm may be reduced with lithium treatment when compared to placebo or carbamazepine. Moderate quality evidence suggests there may be an association between increased levels of lithium in drinking water and reduced rates of suicide in the community.

There were no significant differences in rates of self-harm or suicide between people with bipolar disorder on lithium, lamotrigine, olanzapine, divalproex, or quetapine. There were also no differences between divalproex and placebo.

November 2021

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