Fatal suicidal behavior in Bipolar II patients after their first hospitalization

Bipolar disorder, especially Bipolar II disorder, is a mental disorder with high risk of fatal suicide behavior (FSB). The aim of this study was determine rate and risk factors of FSB in a cohort of Bipolar II patients followed after their first hospitalization.

We recruited all Bipolar II patients according DSM-IV criteria who were hospitalized for first time in our Psychiatric unit between 1996 and 2016 (N=59). We collected clinical variables during their first hospitalization and identified all patients with FSB during follow-up until 31st December 2020. We compared baseline variables between Bipolar II patients with FSB and the ones without FSB.

The average age at FSB was 45.5 years old and there was a 2-year gap on average between the first psychiatric hospitalization and completed suicide. FSB was characterized by a violent act (83% of cases). When we compared Bipolar II patients who died by suicide with who died by other causes or they are alive, only a history of previous violent suicide attempt (p<0.05) was detected as a risk factor significantly associated with FSB. 10% of Bipolar II inpatients died by suicide, all of them in the first five years after the first hospitalization and usually by a violent method.

Bipolar II disorder has a high rate of completed suicide. History of a previous violent suicide attempt is a predictor of completed suicide.