Page 46 - e-book CPG - Bipolar Disorder

CLINICAL PRACTICE GUIDELINES MANAGEMENT OF BIPOLAR DISORDER (2ND ED.)

9.1. Risk and Protective Factors
9.1. Risk and Protective Factors

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The risk factors for suicide in BD in adults are: 6
The risk factors for suicide in BD in adults are:
 sociodemographic
 sociodemographic
o younger age
o younger age
o male
o male
o unemployed
o unemployed
o disabled
o disabled
 symptomatology
 symptomatology
o suicidal ideation
o suicidal ideation
o rapid cycling
o rapid cycling
o psychotic symptoms
o psychotic symptoms
o depressive phase
o depressive phase
o hopelessness
o hopelessness
o mixed state
o mixed state
 clinical characteristics
 clinical characteristics
o early onset of mood disorder
o early onset of mood disorder
o previous suicide attempts
o previous suicide attempts
o multiple hospitalisations
o multiple hospitalisations
o early sexual abuse
o early sexual abuse
o stressful life events
o stressful life events
o lack of confidant
o lack of confidant
o family history of suicide
o family history of suicide
 co-morbidity
 co-morbidity
o anxiety disorder
o anxiety disorder
o Cluster B personality (antisocial/borderline/histrionic/narcissistic personality disorder)
o Cluster B personality (antisocial/borderline/histrionic/narcissistic personality disorder)
o substance misuse
o substance misuse
 treatment
 treatment
o duration of treatment (<5 years)
o duration of treatment (<5 years)

A systematic review of 14 observational studies on children and adolescents (<18 years of
A systematic review of 14 observational studies on children and adolescents (<18 years of
age) with BD showed that the risk factors for suicide attempt were: 134, level II-2
134, level II-2
age) with BD showed that the risk factors for suicide attempt were:
 early illness onset
 early illness onset
 severe illness characteristics e.g. psychosis, hospitalisation, hopelessness etc
 severe illness characteristics e.g. psychosis, hospitalisation, hopelessness etc
 mixed episode
 mixed episode
 co-morbid disorders e.g. ADHD, substance use disorder, panic disorder, oppositional
 co-morbid disorders e.g. ADHD, substance use disorder, panic disorder, oppositional
defiant disorder
defiant disorder
 past self-injurious behaviour
 past self-injurious behaviour
 past suicide ideation/suicide attempt
 past suicide ideation/suicide attempt
 past physical/sexual abuse
 past physical/sexual abuse
 parental depression
 parental depression
 family history of suicidality
 family history of suicidality
 poor family functioning
 poor family functioning

Evidence for protective factors in suicidal behaviour in BD is limited. A small cross-sectional
Evidence for protective factors in suicidal behaviour in BD is limited. A small cross-sectional
study on euthymic adult outpatients with BD found that personal religious activities (e.g.
study on euthymic adult outpatients with BD found that personal religious activities (e.g.
meditation, prayers and religious studies) and religious integration in daily living exerted a
meditation, prayers and religious studies) and religious integration in daily living exerted a
protective effect against suicide attempts. 136, level III
136, level III
protective effect against suicide attempts.

9.2. Effective and Safe Intervention
9.2. Effective and Safe Intervention

Suicidal behaviour in BD has to be managed in a person-centered collaborative approach
Suicidal behaviour in BD has to be managed in a person-centered collaborative approach
requiring both clinical and community-based strategies. 132, level III
132, level III
requiring both clinical and community-based strategies.

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