Suicide in bipolar disorder in Finland

OBJECTIVE: The authors examined suicides of persons with bipolar disorder in aspects relevant to suicide prevention, including clinical features, treatment contacts, adequacy of treatment received, communication of suicidal intent, and suicide methods. METHODS: All suicide victims with DSM-III-R bipolar I disorder among all 1,397 suicides in Finland within a 12-month period were carefully studied using the psychological autopsy method and were compared to suicide victims with unipolar major depression. RESULTS: Thirty-one bipolar I victims were identified. Most suicides of persons with bipolar disorder occurred during a major depressive episode (79%), but in some cases it occurred during a mixed state (11%) or even during or immediately after remission of psychotic mania (11%). Men had a higher rate of comorbid alcoholism, a lesser mean age, and shorter treatment histories than women. Although 74% of the victims were receiving psychiatric care at the time of suicide, and 39% had even explicitly communicated their intent to health care personnel during the last 3 months, only 11% of those who were depressed had received adequate doses of antidepressants and none had received ECT. Only 32% of the bipolar patients were prescribed lithium. In comparison to unipolar depressed suicide victims, the bipolar victims had more divorces, longer treatment histories, and more frequent hospitalizations. CONCLUSIONS: Although late suicides were common among both male and female bipolar victims, suicide seemed to occur earlier among males. Most bipolar victims had had a recent psychiatric treatment contact, but few had received adequate treatment immediately before death. Suicide victims with unipolar and bipolar disorders differed in marital status and treatment history.