Citation

Keks NA, Hill C, Sundram S, Graham A, Bellingham K, Dean B, Opeskin K, Dorissa A, Copolov DL. Aust. N. Zeal. J. Psychiatry 2009; 43(6): 503-508.

Affiliation

Mental Health Research Institute of Victoria, Melbourne, Victoria, Australia. nicholas.keks@med.monash.edu.au

Copyright

(Copyright © 2009, Royal Australian and New Zealand College of Psychiatrists, Publisher SAGE Publishing)

DOI

10.1080/00048670902873680

PMID

19440881

Abstract

OBJECTIVE: The aim of the present study was to evaluate clinical factors relevant to suicide prevention (including treatment) in cases of bipolar suicide with available therapeutic histories. METHOD: Victorian Coroner's Office data enabled identification of suicides that occurred between March 1993 and December 2001. Cases involving sufficient clinical notes to enable diagnosis of DSM-IV bipolar disorder and review of treatment were de-identified and assessed by an expert clinical panel. RESULTS: From 3752 suicides, 35 eligible bipolar subjects (22 men, 13 women) aged 40.3 +/- 1.8 years were identified. Duration of illness was 11.9 +/- 1.1 years. A total of 86% had made at least one previous suicide attempt, and 83% were in the depressed phase of illness. A total of 63% manifested psychosis at some time during lifetime illness. Fourteen per cent were inpatients, and 26% suicided within 6 weeks of hospital discharge. The panel's retrospective risk assessment concluded that only 48% of cases could have been assessed as high risk. In the 4 weeks prior to suicide, treatment was rated as not reaching benchmark standards in 60% of cases. Electroconvulsive therapy had been given to 11%, lithium to 43% (but definitely therapeutic in only 11%), 31% had never been treated with lithium, and psychosocial interventions did not reach adequate standards in 57% during the previous year. CONCLUSIONS: In the majority of bipolar suicide cases in the present case series the subjects did not receive treatment at or above a benchmark standard, often due to illness and situational factors, but also possibly due to inadequate clinical interventions. Strategies to improve treatment may reduce suicide in bipolar disorder.

Language: en