title: Suicide attempts in bipolar disorders: comprehensive review of 101 reports.
abstract: OBJECTIVE
  Assess reported risk of suicide attempts by patients with bipolar disorder (BD).
  
  
  METHODS
  Systematic searching yielded 101 reports from 22 countries (79 937 subjects). We analyzed for risk (%) and incidence rates (%/year) of attempts, comparing sex and diagnostic types, including by meta-analysis.
  
  
  RESULTS
  Attempt risk averaged 31.1% [CI: 27.9-34.3] of subjects, or 4.24 [3.78-4.70]%/year. In BD-I (43 studies) and BD-II subjects (30 studies), risks (29.9%, 31.4%) and incidence rates (4.01, 4.11%/year) were similar and not different by meta-analysis. Among women vs. men, risks (33.7% vs. 25.5%) and incidence (4.50 vs. 3.21%/year) were greater (also supported by meta-analysis: RR = 1.35 [CI: 1.25-1.45], P < 0.0001). Neither measure was related to reporting year, % women/study, or to onset or current age. Risks were greater with longer exposure, whereas incidence rates decreased with longer time at risk, possibly through 'dilution' by longer exposure.
  
  
  CONCLUSIONS
  This systematic update of international experience underscores high risks of suicide attempts among patients with BD (BD-I = BD-II; women > men). Future studies should routinely include exposure times and incidence rates by diagnostic type and sex for those who attempt suicide or not.
authors.affiliation: International Consortium for Bipolar & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA.|Department of Psychiatry, Harvard Medical School, Boston, MA, USA.|Lucio Bini Mood Disorder Centers, Cagliari and, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Tondo
authors.affiliation: International Consortium for Bipolar & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA.|NESMOS, Sant'Andrea Medical Center, La Sapienza University of Rome, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Pompili
authors.affiliation: International Consortium for Bipolar & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA.|NESMOS, Sant'Andrea Medical Center, La Sapienza University of Rome, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Forte
authors.affiliation: International Consortium for Bipolar & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA.|Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Baldessarini
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*
keywords: attempt; bipolar disorder; onset age; rates; suicide