@article{ref1,
title="Attempted suicide in people with co-occurring bipolar and substance use disorders: systematic review and meta-analysis",
journal="Journal of affective disorders",
year="2014",
author="Carrà, Giuseppe and Bartoli, Francesco and Crocamo, Cristina and Brady, Kathleen T. and Clerici, Massimo",
volume="167C",
number="",
pages="125-135",
abstract="BACKGROUND: Both individuals with bipolar (BD) and those with alcohol (AUD) and other substance (SUD) use disorders are likely to attempt suicide. Comorbidity of BD and AUD/SUD may increase the likelihood of suicide attempts. We conducted a meta-analysis to estimate the association of comorbid AUD/SUD and suicide attempts in subjects with BD in the literature to date. <br><br>METHODS: Electronic databases through January 2013 were searched. Studies reporting rates of suicide attempts in people with co-occurring BD and AUD/SUD were retrieved. Comorbid AUD and SUD and suicide attempts rates as well as demographic, clinical, and methodological variables were extracted from each publication or obtained directly from its authors. <br><br>RESULTS: Twenty-nine of 222 studies assessed for eligibility met the inclusion criteria, comprising a total of 31,294 individuals with BD, of whom 6308 (20.1%) had documented suicide attempts. There were consistent findings across the studies included. As compared to controls, subjects with BD and comorbid AUD/SUD were more likely to attempt suicide. The cross-sectional association estimates showed random-effects pooled crude ORs of 1.96 (95% CI=1.56-2.47; p<0.01), 1.72 (95% CI=1.52-1.95; p<0.01), and 1.77 (95% CI=1.49-2.10; p<0.01), for combined AUD/SUD, AUD, and SUD. There was no publication bias and sensitivity analyses based on the highest quality studies confirmed core results. LIMITATIONS: The effects of the number and the type of suicide attempts could not be investigated due to insufficient information. <br><br>CONCLUSIONS: Comorbid AUD and SUD in individuals with BD are significantly associated with suicide attempts. Individuals with this comorbidity should be targeted for intensive suicide prevention efforts.<p /> <p>Language: en</p>",
language="en",
issn="0165-0327",
doi="10.1016/j.jad.2014.05.066",
url="http://dx.doi.org/10.1016/j.jad.2014.05.066"
}