Am J Psychiatry 1994; 151:1020-1024
Copyright © 1994 by American Psychiatric Association
Suicide in bipolar disorder in Finland
ET Isometsa, MM Henriksson, HM Aro and JK Lonnqvist
Department of Mental Health, National Public Health Institute, Helsinki, 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.
