title: A review of factors associated with greater likelihood of suicide attempts and suicide deaths in bipolar disorder: Part II of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder.
abstract: OBJECTIVE
  Many factors influence the likelihood of suicide attempts or deaths in persons with bipolar disorder. One key aim of the International Society for Bipolar Disorders Task Force on Suicide was to summarize the available literature on the presence and magnitude of effect of these factors.
  
  
  METHODS
  A systematic review of studies published from 1 January 1980 to 30 May 2014 identified using keywords 'bipolar disorder' and 'suicide attempts or suicide'. This specific paper examined all reports on factors putatively associated with suicide attempts or suicide deaths in bipolar disorder samples. Factors were subcategorized into: (1) sociodemographics, (2) clinical characteristics of bipolar disorder, (3) comorbidities, and (4) other clinical variables.
  
  
  RESULTS
  We identified 141 studies that examined how 20 specific factors influenced the likelihood of suicide attempts or deaths. While the level of evidence and degree of confluence varied across factors, there was at least one study that found an effect for each of the following factors: sex, age, race, marital status, religious affiliation, age of illness onset, duration of illness, bipolar disorder subtype, polarity of first episode, polarity of current/recent episode, predominant polarity, mood episode characteristics, psychosis, psychiatric comorbidity, personality characteristics, sexual dysfunction, first-degree family history of suicide or mood disorders, past suicide attempts, early life trauma, and psychosocial precipitants.
  
  
  CONCLUSIONS
  There is a wealth of data on factors that influence the likelihood of suicide attempts and suicide deaths in people with bipolar disorder. Given the heterogeneity of study samples and designs, further research is needed to replicate and determine the magnitude of effect of most of these factors. This approach can ultimately lead to enhanced risk stratification for patients with bipolar disorder.
authors.affiliation: Task Force on Suicide, The International Society for Bipolar Disorders (ISBD), Pittsburgh, PA, USA; Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada ayal.schaffer@sunnybrook.ca.
authors.forename: Ayal
authors.initials: A
authors.lastname: Schaffer
authors.affiliation: Department of Psychiatry, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Erkki T
authors.initials: ET
authors.lastname: Isometsä
authors.affiliation: Department of Adult Psychiatry, Sainte Marguerite Hospital, Marseille, France; University of Aix-Marseille II, Marseille, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Azorin
authors.affiliation: Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioural Sciences, Duke University, Durham, NC, USA.
authors.forename: Frederick
authors.initials: F
authors.lastname: Cassidy
authors.affiliation: Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Tina
authors.initials: T
authors.lastname: Goldstein
authors.affiliation: Department of Clinical and Theoretical Mental Health, and Department of Psychiatry and Psychotherapy, Semmelweis Medical University, Budapest, Hungary.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Rihmer
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Sinyor
authors.affiliation: Lucio Bini Center, Cagliari, Italy; Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Tondo
authors.affiliation: Section of Psychiatric Epidemiology, and Mood Disorders Unit, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
authors.forename: Doris H
authors.initials: DH
authors.lastname: Moreno
authors.affiliation: Research and Academic Affairs, Department of Psychiatry, McGill University, Montréal, QC, Canada; McGill Group for Suicide Studies, Montréal, QC, Canada; Depressive Disorders Program, Douglas Institute, Montréal, QC, Canada; Departments of Psychiatry, Human Genetics, and Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Turecki
authors.affiliation: Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Reis
authors.affiliation: Psychiatric Center Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Lars Vedel
authors.initials: LV
authors.lastname: Kessing
authors.affiliation: Mood Disorders Clinic and Affective Neuroscience Laboratory, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Korea Association for Suicide Prevention, Seoul, Republic of Korea.
authors.forename: Kyooseob
authors.initials: K
authors.lastname: Ha
authors.affiliation: Laboratory of Biological Psychiatry, The Felsenstein Medical Research Center, Petah Tikva, Israel; Research Unit, Geha Mental Health Center, Petah Tikva, Israel; Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Weizman
authors.affiliation: Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA.
authors.forename: Annette
authors.initials: A
authors.lastname: Beautrais
authors.affiliation: Section of Psychosomatic Medicine, Department of Psychiatry, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yuan-Hwa
authors.initials: YH
authors.lastname: Chou
authors.affiliation: Laboratory of Clinical and Translational Studies, National Institute of Alcohol Abuse and Alcoholism, Bethesda, MD, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Diazgranados
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Levitt
authors.affiliation: Experimental Therapeutics & Pathophysiology Branch, Division Intramural Research Programs, National Institute of Mental Health, Bethesda, MD, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Zarate
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Yatham
mesh_terms: D026683:Advisory Committees; D001714:Bipolar Disorder / Q000523:psychology*; D015897:Comorbidity; D006801:Humans; D012307:Risk Factors; D013406:Suicide, Attempted / Q000706:statistics & numerical data*
keywords: Bipolar disorder; suicide; suicide attempts