Comparing suicide completion rates in bipolar I versus bipolar II disorder: A systematic review and meta-analysis

Donovan A Dev; Gia Han Le; Angela T H Kwan; Sabrina Wong; Akhilan Arulmozhi; Felicia Ceban; Kayla M Teopiz; Shakila Meshkat; Joshua D Rosenblat; Hernan F Guillen-Burgos; Taeho Greg Rhee; Roger C Ho; Bing Cao; Giacomo d'Andrea; Isak Sundberg; Roger S McIntyre

doi:10.1016/j.jad.2024.06.045

Comparing suicide completion rates in bipolar I versus bipolar II disorder: A systematic review and meta-analysis

J Affect Disord. 2024 Sep 15:361:480-488. doi: 10.1016/j.jad.2024.06.045. Epub 2024 Jun 18.

Authors

Donovan A Dev¹, Gia Han Le², Angela T H Kwan³, Sabrina Wong⁴, Akhilan Arulmozhi⁵, Felicia Ceban⁶, Kayla M Teopiz⁷, Shakila Meshkat⁸, Joshua D Rosenblat⁹, Hernan F Guillen-Burgos¹⁰, Taeho Greg Rhee¹¹, Roger C Ho¹², Bing Cao¹³, Giacomo d'Andrea¹⁴, Isak Sundberg¹⁵, Roger S McIntyre¹⁶

Affiliations

¹ Brain and Cognition Discovery Foundation, Toronto, ON, Canada; School of Medicine, University College Dublin, Dublin, Ireland; Department of Neuroscience Imaging and Clinical Sciences, University G d'Annunzio, Chieti, Italy. Electronic address: [email protected].
² Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. Electronic address: [email protected].
³ Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. Electronic address: [email protected].
⁴ Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada. Electronic address: [email protected].
⁵ Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
⁶ Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada. Electronic address: [email protected].
⁷ Brain and Cognition Discovery Foundation, Toronto, ON, Canada. Electronic address: [email protected].
⁸ Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
⁹ Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada. Electronic address: [email protected].
¹⁰ Center for Clinical and Translational Research, Universidad Simón Bolívar, Barranquilla, Colombia; Center for Clinical and Translational Research, Faculty of Medicine, Universidad El Bosque, Bogotá D.C., Colombia; Department of Psychiatry and Mental Health, Pontificia Universidad Javeriana, Bogotá D.C., Colombia.. Electronic address: [email protected].
¹¹ Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA. Electronic address: [email protected].
¹² Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 117599, Singapore.; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore. Electronic address: [email protected].
¹³ Key Laboratory of Cognition and Personality (SWU), Faculty of Psychology, Ministry of Education, Southwest University, Chongqing 400715, PR China. Electronic address: [email protected].
¹⁴ Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
¹⁵ Department of Neuroscience Psychiatry, Uppsala University Hospital, Uppsala, Sweden. Electronic address: [email protected].
¹⁶ Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; School of Medicine, University College Dublin, Dublin, Ireland; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada. Electronic address: [email protected].

PMID: 38901691
DOI: 10.1016/j.jad.2024.06.045

Abstract

Background: Bipolar disorder (BD) has a high disease burden and the highest mortality risk in BD comes from suicide. Bipolar disorder type II (BD-II) has been described as a milder form of bipolar disorder; however, extant literature is inconsistent with this description and instead describe illness burden and notably suicidality comparable to persons with bipolar I disorder (BD-I). Towards quantifying the hazard of BD-II, herein we aim via systematic review and meta-analysis to evaluate the rates of completed suicide in BD-I and BD-II.

Method: We conducted a literature search on PubMed, OVID (Embase, Medline) and PsychINFO databases from inception to June 30th, 2023, according to PRISMA guidelines. Articles were selected based on the predetermined eligibility criteria. A meta-analysis was performed, comparing the risk of completed suicide between individuals diagnosed with BD-I to BD-II.

Results: Four out of eight studies reported higher suicide completion rates in persons living with BD-II when compared to persons living with BD-I; however, two of the studies reported non-significance. Two studies reported significantly higher suicide completion rates for BD-I than BD-II. The pooled odds ratio of BD-II suicide rates to BD-I was 1.00 [95 % CI = 0.75, 1.34].

Limitations: The overarching limitation is the small number of studies and heterogeneity of studies that report on suicide completion in BD-I and BD-II.

Conclusion: Our study underscores the severity of BD-II, with a risk for suicide not dissimilar from BD-I. The greater propensity to depression, comorbidity and rapid-cycling course reported in BD-II are contributing factors to the significant mortality hazard in BD-II.

Keywords: Bipolar I disorder; Bipolar II disorder; Mood disorder; Mortality risk; Risk factor; Suicide.

Publication types

Comparative Study
Meta-Analysis
Systematic Review

MeSH terms

Bipolar Disorder* / mortality
Bipolar Disorder* / psychology
Humans
Suicide, Completed* / statistics & numerical data