Children and adolescents who exhibit symptoms of bipolar disorder (BPD) are often diagnosed with other mental health conditions, such as attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and disruptive mood dysregulation disorder (DMDD), but these inaccurate diagnoses may increase subsequent suicide risk.
In addition to increasing risk of suicide, these inaccurate diagnoses often prevent young people from getting the focused care that can best address the root cause of their symptoms.
A recent study from Sweden suggests that early diagnoses of bipolar disorder may be a protective factor for adolescent boys. Though this is just one study, it offers a ray of hope for lowering the unfortunately high rate of suicide among people who have bipolar disorder.
The Scope of the Problem
According to the National Institute of Mental Health (NIMH), about 4.4% of adults in the United States will experience symptoms of bipolar disorder at some point in their lives, with this condition affecting women and men at about the same rate.
The 2020 U.S. census shows 258.3 million people aged 18 and over currently living in the United States. This means that an estimated 11.3 million adults currently have or will develop bipolar disorder.
Sadly, a considerable number of these people are at risk of ending their own lives.
An August 2019 review in the journal Medicina provided the following data about attempted and completed suicide among people who have bipolar disorder.
Suicide and Bipolar Disorder: Important Facts
- Experts estimate that the suicide rate among people with bipolar disorder is 10-30 times higher than among the general public.
- The prevalence of past-year suicidal ideation among people with bipolar disorder is estimated to be about 43%. Among the general public, research indicates 9% of people will have suicidal thoughts over the course of their entire lifetime.
- Close 60% of people with bipolar disorder will attempt to end their life at least once.
- Almost 20% of people with bipolar disorder die by suicide.
- Close to 14% of all suicide deaths involve people with bipolar disorder.
The team that conducted the August 2019 review also noted that people with bipolar disorder who attempt suicide are considerably more likely to end their lives than are those who don’t have this condition. One study, they reported, found that the ratio of attempted to completed suicides is 33:1 among the general public and 3:1 among people with BPD.
The authors of this review indicated that the following factors may be responsible for the high rate of suicidal thoughts and behaviors among people with bipolar disorder.
Suicide and Bipolar Disorder: Contributing Factors
- Suicidal and self-harming behaviors seem to be higher during the period immediately after hospital admission, and again immediately after discharge.
- People who have a history of multiple hospitalizations for bipolar disorder also have a higher risk of suicide.
- Individuals with BPD who experience rapid-cycling symptoms and predominant depressive polarity may be more likely to attempt suicide.
- Suicidal behaviors are much more common during major depressive episodes than during manic, hypomanic, or euthymic periods.
- Women with bipolar disorder are more likely to attempt suicide, while men who have this condition are more likely to complete the act and end their lives.
- A history of personal adversity, such as job loss, physical or sexual abuse, loss of a parent during childhood, or financial struggles have been linked with an increased likelihood of suicide among people with BPD.
- Among all people with bipolar disorder, suicidal behaviors are most common in two age groups: 35 and below and 75 and above.
The research team also reported that people who were diagnosed with bipolar disorder at an early age may have an elevated suicide risk. However, as we will discuss in the next section, at least one study suggests that early diagnosis may be a preventative factor, leading to a lower risk of suicide for some people.
Is Early Diagnosis the Answer?
In May 2023, the journal JAMA Psychiatry published a cross-sectional study of suicide deaths among Swedish adolescents aged 15-19. The team that conducted this study was led by Peter Andersson, MSc, and Adrian Desai Boströmm MD, PhD, both of whom are affiliated with the Karolinska Institute.
Features of this study included the following:
- The data for the study had been collected by the Swedish National Board of Health and Welfare between Jan. 1, 2008, and Dec. 31, 2021.
- The team reviewed information on all registered Swedish citizens who were in the 15-19 age range at some point during this 14-year period.
- The data sample included 8,033 cases of adolescents who had bipolar disorder and 585 young people who died by suicide.
“The majority of adults with bipolar disorder start having mood symptoms in their youth. But there is often a long delay between the onset of symptoms and correct diagnosis and treatment.” Andersson and Boströmm wrote in an article that was released the same day as the study. “So the question is whether this gap puts vulnerable young people at risk of suicide.”
The team’s assessment of the 14 years of data yielded the following findings.
Suicide and Bipolar Disorder: The Results
- Clinicians in Sweden diagnosed adolescent girls with bipolar disorder almost three times more frequently than adolescent boys.
- Regions in Sweden that had higher rates of bipolar disorder among adolescent males also had lower overall suicide rates among males. In these regions, the suicide rate was 4.7% lower than the national average.
- Rates of schizophrenia and depression were not associated with statistically significant differences in suicide rate.
- Treatment with lithium was linked to fewer suicide attempts and better functioning among young people with BPD.
The researchers did not cite any possible reasons for why the levels of bipolar diagnoses among girls did not impact the suicide rate.
However, they did acknowledge that diagnosing young people with bipolar disorder is controversial, and that many doctors may hesitate to provide such a diagnosis to an adolescent. Their research, they added, may prompt more clinicians to reconsider this hesitance.
“The picture of how to prevent suicide in young people is becoming increasingly clear,” Andersson and Boströmm wrote. “Not only have we shown that evidence-based treatment can help prevent suicide in young people, but now also that early diagnosis of bipolar disorder may play a role.”
Suicide Prevention Strategies
The study that we discussed in the previous section suggests that identifying a potential suicide risk factor (bipolar disorder) can reduce the likelihood that a person will end their own life. This is consistent with several other efforts that promote awareness and education as ways to reduce suicide.
In addition to bipolar disorder, several other mental and behavioral health concerns can put a person at elevated risk of suicide, including:
- Depression
- Eating disorders
- Schizophrenia
- Schizoaffective disorder
- Substance abuse and addiction
Suicide is also associated with history of untreated trauma. Risk increases for people with a history of childhood abuse, neglect, or assault. In addition, research associates bullying, harassment, isolation, and exposure to overwhelming stress with increased suicide risk. When people exposed to these external influences also have BPD or another mental health concern, risk of suicide escalates further.
Understanding potential risk factors can help you protect friends or other loved ones who may be at risk for suicidal thoughts or behaviors. You should also be aware of signs such as the following, which may indicate that someone is considering suicide.
Suicide Warning Signs
- Giving away valuable or otherwise important belongings
- Suddenly seeming to be at peace after struggling with intense depression or other difficult emotions
- Stating that they wish they had never been born, that the world would be a better place without them, or that they want to simply disappear
- Expressing a sense of hopelessness or helplessness
- Withdrawing from family and friends
- No longer participating in hobbies or other activities that used to be very important to them
- Acting as though they believe they are a burden to other people
It is not always possible to know if someone has been thinking about ending their life. But being aware of the possible risk factors and signs can put you in the best position to help.
988 Suicide & Crisis Lifeline
If you have been considering suicide, or you suspect that someone that you care about is in imminent danger of ending their own life, please summon help immediately. In the United States, you can contact the 988 Suicide & Crisis Lifeline by calling 988 or visiting https://988lifeline.org/.
Deaf and hard of hearing individuals can use their preferred TTY relay service or dial 711, then 988. The 988 Suicide & Crisis Lifeline also offers interpreters for more than 240 languages and dialects.
When you call, text, or use the chat feature on the 988 Suicide & Crisis Lifeline website, operators connect you with a trained professional in your area who can assess your needs and connect you with the right resources.
This free service is available 24 hours a day, seven days a week.
Gianna Melendez
Jodie Dahl, CpHT