ISBD Task Force examines suicide predictors

By Eleanor McDermid, Senior medwireNews Reporter

The International Society for Bipolar Disorders (ISBD) Task Force on Suicide has published a meta-analysis of predictors of suicide attempts and deaths.

Writing in Bipolar Disorders, the Task Force notes that “considerable heterogeneity exists in the available literature, but as the number of studies is not very large, we included all studies with either epidemiological or clinical samples.”

The meta-analysis includes 44 studies, of which 34, with a total of 50,004 patients with bipolar disorder, reported on suicide attempts and 12, with 75,137 patients, reported on suicide deaths. Most were retrospective analyses.

“The largest studies included were usually prospective epidemiological samples, and the predominant concordance of results with smaller clinical samples should serve to strengthen the generalizability of our results”, note Ayal Schaffer (Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada) and study co-authors.

Overall, they found that 10 of 13 variables studied were significantly associated with suicide attempts, and two of four were associated with suicide deaths.

The factor most strongly associated with suicide attempts was having a current or recent depressive episode, increasing the risk almost sixfold. The next strongest predictor was having a comorbid cluster B or borderline personality disorder, which raised the risk 2.51-fold.

Other significant predictors were a depressive first-ever episode, comorbid anxiety disorder, any substance misuse, any illicit substance use, a first-degree family history of suicide, alcohol misuse and being female. In addition, the risk of a suicide attempt rose in line with younger age at bipolar onset.

Some of these predictors have been linked to suicide attempts in general, say Schaffer et al, whereas others are specific to patients with bipolar disorder.

Bipolar disorder subtype, cannabis use and history of psychosis were not significantly associated with suicide attempts.

The researchers found just two variables to be significantly associated with suicide death: male gender and a family history of suicide. However, they note that completed suicides have been little studied, compared with suicide attempts. “Suicide deaths are rarer and inherently more difficult to study, as evidenced by only four variables being sufficiently examined to allow for meta-analysis”, the team comments.

Schaffer and colleagues say their findings have “implications for future work on developing specific preventative programs and therapeutic interventions for people with [bipolar disorder].”

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