What is the risk of suicide when someone is diagnosed with bipolar disorder?

The overall mortality rate of bipolar disorder is two to three times higher than in the general population.  About 10% to 20% of bipolar individuals commit suicide, and upward to one-third admit to at least one suicide attempt.  The third with a history of suicide attempts have a number of additional risk factors.  These risk factors include a family history of drug abuse and suicide (or attempts), a greater personal history of early traumatic stressors such as sexual and physical abuse, more hospitalizations for depression, a course of increasing severity of mania, more Axis I, II, and III conditions, and more time ill overall.  Bipolar individuals with a history of suicide attempts experience more episodes of depression and react to them by having severe suicidal ideation.  They demonstrate behaviorally an overall higher level of lifetime aggression and a pattern of repeated suicide attempts.

In addition, mania decreases impulse control.  A person with mixed mania and depression is at an even higher risk of suicide attempts because he or she is generally irritable, dysphoric, anxious, energized, and behaviorally disinhibited.  A person with poor impulse control may be more apt to attempt suicide because the time interval between the thought and the act can be instantaneous.  Anyone with plans to kill him- or herslef, or who has made an attempt, requires emergency psychiatric evaluation.  In some situations, a family member finds out that someone has tried to kill himself or herself but does not take him or her to an emergency room because of assurances to the family member that t was a mistake and that he or she will be okay.  It is best, however, if a professional evaluates the situation to determine the most appropriate course of action.

Suicide is the most serious risk of bipolar disorder.  Clinicians assess suicide risk based on many factors, including the patient's current mental status, personal history, family history, use of substances, and more.  Suicidal thinking tends to fall on a continuum from morbid thoughts of death to passive thoughts of wishing to be dead to an actual plan to carry out the suicide, a continuum that is assessed by the clinician.  Clinicians will ask direct questions about suicidal thoughts.  Direct questions do not put ideas in a person's mind; rather, they invite the individual to speak openly about the issue.  Most patients want help and want to let someone know how they are feeling.  Also in this light, if you have reason to believe a family member is contemplating suicide, it is best to speak openly and frankly to that person about your concerns.  Doing so will not put new thoughts of suicide into the person's mind; instead, it will give an opportunity to help him or her get the treatment that may be needed.