Attempted suicide in bipolar disorder: risk factors in a cohort of 6086 patients

PLoS One. 2014 Apr 4;9(4):e94097. doi: 10.1371/journal.pone.0094097. eCollection 2014.


Objective: Bipolar disorder is associated with high risk of self-harm and suicide. We wanted to investigate risk factors for attempted suicide in bipolar patients.

Method: This was a cohort study of 6086 bipolar patients (60% women) registered in the Swedish National Quality Register for Bipolar Disorder 2004-2011 and followed-up annually 2005-2012. Logistic regression was used to calculate adjusted odds ratios for fatal or non-fatal attempted suicide during follow-up.

Results: Recent affective episodes predicted attempted suicide during follow-up (men: odds ratio = 3.63, 95% CI = 1.76-7.51; women: odds ratio = 2.81, 95% CI = 1.78-4.44), as did previous suicide attempts (men: odds ratio = 3.93, 95% CI = 2.48-6.24; women: odds ratio = 4.24, 95% CI = 3.06-5.88) and recent psychiatric inpatient care (men: odds ratio = 3.57, 95% CI = 1.59-8,01; women: odds ratio = 2.68, 95% CI = 1.60-4.50). Further, those with many lifetime depressive episodes were more likely to attempt suicide. Comorbid substance use disorder was a predictor in men; many lifetime mixed episodes, early onset of mental disorder, personality disorder, and social problems related to the primary group were predictors in women.

Conclusion: The principal clinical implication of the present study is to pay attention to the risk of suicidal behaviour in bipolar patients with depressive features and more severe or unstable forms of the disorder.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bipolar Disorder / epidemiology*
  • Bipolar Disorder / psychology*
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Odds Ratio
  • Registries
  • Risk Factors
  • Sex Factors
  • Suicide, Attempted / psychology*
  • Sweden

Grants and funding

This work was supported by grants from the Stockholm City Council (Grant Number: 20120528) and Söderström-Königska Sjukhemmet Foundation (Grant Number: SLS-307101). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.