Suicidal behavior in bipolar disorder: Epidemiology, characteristics and major risk factors

Background: Suicide is one of the leading causes of death and a major public health problem worldwide, and the majority of suicide attempters and completers suffer from some major affective disorder at the time of their death, which, in the majority of cases is unrecognized, under- or misdiagnosed and untreated. Methods: Based on a systematic literature search, the authors give a detailed and critical overview of established risk factors of suicide in bipolar disorder. Results: Among affective disorders, bipolar disorder carries the highest risk of suicide, yet not all bipolar patients commit or even attempt suicide during their illness. While the general suicide risk factors also apply for bipolar disorders, there are several disease-specific risk factors as well which should be taken into account when evaluating suicide risk in case of patients. Conclusion: It is crucial to identify suicide risk factors in bipolar disorder to be able to differentiate those patients within this already increased-risk illness group who are at especially high risk and therefore to allow for better prediction and prevention of suicidal acts. (C) 2012 Elsevier B.V. All rights reserved.