Epidemiology, traits and risk factors of suicide in bipolar disorder

1. Epidemiology, traits and risk factors of suicide in bipolar disorder Xénia Gonda1 (PhD), Emőke Borbély-Ipkovich2 (Student, Ma/Msc), Péter Döme1 (PhD), Tímea Duleba1(PhD), Zoltán Rihmer1(PhD) 1Department of Clinical and Theoretical Mental Health, Semmelweis University, Budapest, Hungary 2Department of Clinical and Theoretical Mental Health, Semmelweis University, Budapest, Hungary 3Department of Pharmacodynamics, Faculty of Pharmacology Semmelweis University, Budapest, Hungary 4The Neuropsychopharmacology and Neurochemistry Research Group, National Academy of Sciences, Budapest, Hungary 5Institute of Psychology, University of Szeged, Szeged, Hungary

2. Introduction • Objective Suicidal behaviour is one of the most severe health problems worldwide and it has a complex and multicausal background. The majority of suicide attempts and terminated suicides are committed by psychiatric patients and within this illness group, patents with bipolar disorder are at an especially high risk. As a charachteristic of the desease, the longer it remains untreated, the higher is the prevalence of suicide acts, consequently it is crucial to understand its special traits and to predict or prevent its onset. The present review aims to overview the specific risk factors associated with bipolar disorders. • Methods Based on a systematic literature research, the authors give a detailed and critical overview of established risk factors of suicide in bipolar disorder.

3. Results 1. • The prevalence of terminated suicides is the highest among psychiatric patients with bipolar disorder, but not all of them commit suicide (Cassidy et al. 2011)  It is crucial to identify its typical risk factors. • 3 cathegories according to their predictive value (e.g Rihmer, 1996) Psychiatric Psychosocial Demographic (primary) (secondary) (tertiary)

4. Results 2. • Prevalence of suicide in affective disorders: • higher risk among unipolar and bipolar patients (I + II) (e.g Cassidy et. al, 2011) • no differences were found between the subtypes of affective disorder (e.g Tondo et. al, 2007) • Risk factors: • familiar factors, distal and proximal environmental adverse events, loss of medical and social support, higher number of axis I and II comorbidities, serious course of bipolar illness, a history of physical and sexual abuse, substance abuse, aggression, number and severity of depressive episodes, suicide ideation and early onset of disease (e.g Hawton et. al, 2005). • dysphoric mania, mixed depressive episodes as well as rapid cycling course (e.g Benazzi, 2003, Bottlender et. al, 2000, Rihmer and Akiskal, 2006) • Methodological problems: • few of the studies are prospective andresults are not robust enough  Apparently, the more suicide risk facors are present, the higher is the risk of suicidal behaviour (Abreau et. al, 2009.

5. Discussion • Conclusion Many study findings identify the risk factors of suicidal behaviour in bipolar disorder, which are partly overlapping the general suicide risk factors. In addition to these, however, unique risk factors show up which can help identify patients at the highest risk. Furthermore, the effective diagnosis and treatment of bipolar disorders plays a crucial role in the prevention of suicide. • Keywords: bipolar disorder, risk factors, epidemiology

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