Suicide Prevention & Bipolar Disorder: Identifying At-Risk Patients

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September 10 is World Suicide Prevention Day.
September 10 is World Suicide Prevention Day.

Sometimes the people who need to talk about suicide the most don't talk about it at all. Whether because of stigma, shame, or guilt, these individuals who need nothing more than to speak honestly may hesitate to do so – not just with their loved ones, but with their psychiatrist. For patients with bipolar disorder, this is an especially troubling proposition.

Patients with bipolar disorder are especially at risk for suicide. The numbers are sobering: 80% of patients have suicidal ideation,1 25% to 50% attempt suicide at least once,2 and 8% to 19% complete suicide.3

This World Suicide Prevention Day, we're spreading awareness by shining light on a population extremely vulnerable to suicide: patients diagnosed with bipolar disorder. Because some patients can't or won't open up, psychiatrists should always be on the lookout for certain risk factors:1, 3-6

  • Prior suicide attempt
  • Family history of suicide
  • Younger age at onset of illness
  • Substance use disorder
  • Feelings of hopelessness
  • Seeking access to pills or weapons
  • Recent life event
  • Irritability directed inward
  • Hostility
  • Depression
  • Comorbidity
  • Long duration of illness
  • Unemployment

What else can psychiatrists do to identify patients who might consider suicide? In 2016, Aruna Jha, PhD, LCSW, Research Assistant Professor, University of Illinois at Chicago, spoke with Psychiatry Advisor about this very subject.7 Jha laid out a few key points to consider:

  • Start by establishing trust with the patient. Psychiatrists must create a safe environment where patients trust them enough to share the depths of their pain. Jha states, a suicide assessment begins with “creating a safe place where patients trust you enough to share their struggles.” This is done by “demonstrating that you are okay with whatever they share and you are not afraid to talk about suicide.”
  • Harness your curiosity. “Curiosity is your best tool,” Jha claims. After building a trusting relationship, start getting into specifics to evaluate potential triggers. Specific questions lay the groundwork for psychoeducation. Suicidal thoughts “ebb and flow” and they “subside in time.” That's why she encourages patients to note thought patterns relating to suicidal impulses so they can choose not to give into those impulses.
  • Use assessment tools but don't rely on them too much. Jha warns not to administer assessment tools in a “mechanical manner” as doing so can make the patient uncomfortable. “Sit next to the patient and complete the form together,” she adds.
  • Don't be afraid to ask patients about suicide. Some clinicians fear that bringing up suicide might elicit the patient to act on their suicidal impulses. Yet, the truth is anything but. Bringing up suicide does not increase suicidal thoughts and can be very beneficial.8 Jha notes, “in my experience, patients do not feel the questions are intrusive, nor do they elicit new suicidal thoughts.”

Every patient is unique and there's no foolproof method for suicide prevention. But as Jha outlines, it's important to build trust and broach the subject.

Read more about the challenges psychiatrists face in treating patients with bipolar disorder.


References

  1. Valtonen H, Suominen K, Mantere O, et al. Suicidal ideation and attempts in bipolar I and II disorders. J Clin Psychiatry. 2005;66(11):1456-1462.
  2. Jamison KR. Suicide and bipolar disorder. J Clin Psychiatry. 2000;61(9):47-51.
  3. Latalova K, Kamaradova D, Prasko J. Suicide in bipolar disorder: a review. Psychiatria Danubina. 2014;26(2):108-114.
  4. Gonda X, Pompili M, Serafini G, et al. Suicidal behavior in bipolar disorder: epidemiology, characteristics and major risk factors. J Affect Dis. 2012;143:16-26.
  5. Umamaheswari V, Avasthi A, Grover S. Risk factors for suicidal ideations in patients with bipolar disorder. Bipolar Disord. 2014;16(6):642-651.
  6. Pompili M, Tondo L, Grispini A, et al. Suicide attempts in bipolar disorder patients. Clin Neuropsych. 2006;3(5):327-331.
  7. Yasgur BS. Is this patient suicidal? Tips for effective assessment. Psychiatry Advisor. August 17, 2016. Accessed September 6, 2018.
  8. Hammond C. Does discussing suicide make people feel more suicidal? BBC. January 13, 2014. Accessed September 6, 2018.
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