title: Attempted suicide in people with co-occurring bipolar and substance use disorders: systematic review and meta-analysis.
abstract: BACKGROUND
  Both individuals with bipolar (BD) and those with alcohol (AUD) and other substance (SUD) use disorders are likely to attempt suicide. Comorbidity of BD and AUD/SUD may increase the likelihood of suicide attempts. We conducted a meta-analysis to estimate the association of comorbid AUD/SUD and suicide attempts in subjects with BD in the literature to date.
  
  
  METHODS
  Electronic databases through January 2013 were searched. Studies reporting rates of suicide attempts in people with co-occurring BD and AUD/SUD were retrieved. Comorbid AUD and SUD and suicide attempts rates as well as demographic, clinical, and methodological variables were extracted from each publication or obtained directly from its authors.
  
  
  RESULTS
  Twenty-nine of 222 studies assessed for eligibility met the inclusion criteria, comprising a total of 31,294 individuals with BD, of whom 6308 (20.1%) had documented suicide attempts. There were consistent findings across the studies included. As compared to controls, subjects with BD and comorbid AUD/SUD were more likely to attempt suicide. The cross-sectional association estimates showed random-effects pooled crude ORs of 1.96 (95% CI=1.56-2.47; p<0.01), 1.72 (95% CI=1.52-1.95; p<0.01), and 1.77 (95% CI=1.49-2.10; p<0.01), for combined AUD/SUD, AUD, and SUD. There was no publication bias and sensitivity analyses based on the highest quality studies confirmed core results.
  
  
  CONCLUSIONS
  The effects of the number and the type of suicide attempts could not be investigated due to insufficient information.
  
  
  CONCLUSIONS
  Comorbid AUD and SUD in individuals with BD are significantly associated with suicide attempts. Individuals with this comorbidity should be targeted for intensive suicide prevention efforts.
authors: Division of Psychiatry, University College London, London, UK.
authors: Giuseppe
authors: G
authors: Carrà
authors: Department of Surgery and Interdisciplinary Medicine, University of Milano Bicocca, Via Cadore 48, Monza (MB), Italy. Electronic address: f.bartoli@campus.unimib.it.
authors: Francesco
authors: F
authors: Bartoli
authors: Department of Surgery and Interdisciplinary Medicine, University of Milano Bicocca, Via Cadore 48, Monza (MB), Italy.
authors: Cristina
authors: C
authors: Crocamo
authors: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina,Charleston, SC, USA.
authors: Kathleen T
authors: KT
authors: Brady
authors: Department of Surgery and Interdisciplinary Medicine, University of Milano Bicocca, Via Cadore 48, Monza (MB), Italy.
authors: Massimo
authors: M
authors: Clerici
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D006801:Humans; D008297:Male; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D013406:Suicide, Attempted / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data
keywords: Addiction; Alcohol use disorder; Bipolar Disorder; Meta-analysis; Substance use disorder; Suicide