Current Topic Review: The Role of Comorbid Substance Abuse in Suicide Risk for Bipolar Patients

Nancy Russ


May 20, 2003

In This Article

Bipolar Disorder and Suicide

A number of factors, including a history of prior serious attempts at suicide,[16,17] have been linked to patients with bipolar disorder who commit suicide.[18] Genetic predisposition also appears to contribute to suicide.[19,20,21,22] Bipolar disorder is associated with a high frequency of both completed suicides and suicide attempts. Twenty-five percent to 60% of all bipolar patients will have attempted suicide at least once in their lifetime, and 18.9% of deaths among bipolar patients are due to suicide.[4]

It has been proposed that psychiatric disorders are necessary triggers for suicidal acts, accompanied by factors that lower the threshold for acting on suicidal thoughts, such as impulsivity.[23,24]

In a recent study aimed at identifying clinical predictors of suicide attempts in subjects with bipolar disorder, Dalton and colleagues[25] studied 336 subjects with a diagnosis of bipolar I, bipolar II, or schizoaffective disorder (bipolar type) and examined predictors of suicide in attempters and nonattempters. They found that the lifetime rate of suicide attempts for the entire sample was 26.7%. Bipolar subjects with comorbid SUD had a 39.5% lifetime rate of attempted suicide, compared with a 23.8% lifetime rate for those without SUD. The researchers concluded that lifetime comorbid SUD was associated with a higher rate of suicide attempts in patients with bipolar disorder.

In an investigation of the association between suicide attempts and the predictive factors previously described in the literature, researchers followed 169 patients identified with bipolar I disorder.[26] More than one third (56) of the patients had a history of 1 or more suicide attempts. The rate of suicide attempts was much higher in patients with onset of bipolar disorder at or before the age of 25 years than in patients with onset after age 25 (25% vs 10%, respectively). Other factors related to suicide were drug abuse, family history of affective disorders, and severe depressive episodes. The patients who abused drugs had a history of more suicide attempts than those who did not.

Jamison[27,28] has concluded that bipolar illness puts young individuals at risk for the accumulation of a number of DSM-IV Axis I (including alcohol and substance abuse disorders) and Axis II comorbidities. She points out that at least 25% to 50% of patients with bipolar disorder also attempt suicide at least once and that, in general, little is known about the specific contributions of mood-altering treatments to minimizing mortality rates in persons with major mood disorders in general and bipolar depression in particular.


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