Self-poisoning suicide deaths in people with bipolar disorder: characterizing a subgroup and identifying treatment patterns.
OBJECTIVE
To characterize self-poisoning suicide deaths in BD compared to other suicide decedents.


METHODS
Extracted coroner data from all suicide deaths (n = 3319) in Toronto, Canada from 1998 to 2012. Analyses of demographics, clinical history, recent stressors, and suicide details were conducted in 5 subgroups of suicide decedents: BD self-poisoning, BD other methods, non-BD self-poisoning, non-BD other methods, and unipolar depression self-poisoning. Toxicology results for lethal and present substances were also compared between BD and non-BD self-poisoning subgroups as well as between BD and unipolar depression self-poisoning subgroups.


RESULTS
Among BD suicide decedents, self-poisoning was significantly associated with female sex, past suicide attempts, and comorbid substance abuse. In both the BD and non-BD self-poisoning groups, opioids were the most common class of lethal medication. For both groups, benzodiazepines and antidepressants were the most common medications present at time of death, and in 23% of the BD group, an antidepressant was present without a mood stabilizer or antipsychotic. Only 31% of the BD group had any mood stabilizer present, with carbamazepine being most common. No antidepressant, mood stabilizer, or antipsychotic was present in 15.5% of the BD group. Relative to unipolar depression self-poisoning group, the BD self-poisoning group evidenced higher proportion of previous suicide attempt(s) and psychiatry/ER visits in the previous week.


CONCLUSIONS
People with BD who die by suicide via self-poisoning comprise a distinct but understudied group. The predominant absence of guideline-concordant pharmacologic care comprises a crucial target for future policy and knowledge translation efforts.
Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room FG 52, Toronto, ON, M4N 3M5, Canada. ayal.schaffer@sunnybrook.ca.|Department of Psychiatry, University of Toronto, Toronto, Canada. ayal.schaffer@sunnybrook.ca.
Ayal
http://orcid.org/0000-0001-6220-5042
A
Schaffer
Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA.
Lauren M
LM
Weinstock
Department of Psychiatry, University of Toronto, Toronto, Canada.|Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada.
Mark
M
Sinyor
Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room FG 52, Toronto, ON, M4N 3M5, Canada.
Catherine
C
Reis
Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada.|Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Canada.
Benjamin I
BI
Goldstein
Department of Psychiatry, University of British Columbia, Vancouver, Canada.
Lakshmi N
LN
Yatham
Department of Psychiatry, University of Toronto, Toronto, Canada.|Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada.
Anthony J
AJ
Levitt
Bipolar disorder; Lethal medications; Overdose; Self-poisoning; Suicide death