Abstract
ObjectiveTo characterize self-poisoning suicide deaths in BD compared to other suicide decedents.MethodsExtracted 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.ResultsAmong 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.ConclusionPeople 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.
Highlights
Suicide is one of the most common causes of death for people with bipolar disorder (BD) (Angst et al 2005; Høyer et al 2000; Ösby et al 2001; Pompili et al 2013a)
Self-poisoning accounted for 25–30% of deaths in the three largest studies that reported on BD suicide methods (Chen et al 2009; Hunt et al 2006; Ösby et al 2001) and 17–53% in the smaller studies (Angst et al 2005; Clements et al 2013; Crump et al 2013; Harris and Barraclough 1997; Høyer et al 2000; Ilgen et al 2010; Karch et al 2006; Kessing et al 2005; Pompili et al 2013a; Schaffer et al 2014; Takizawa 2012); there is a paucity of data focusing on characterizing this subgroup of suicide deaths in BD
In a small Finnish study examining 11 people with BD who died by self-poisoning suicide, lethal ingestion of an antipsychotic occurred in 45% of cases, followed by 18% with each of a tricyclic antidepressant, lithium, or combination of benzodiazepines (Isomets and Henriksson 1994)
Summary
Suicide is one of the most common causes of death for people with bipolar disorder (BD) (Angst et al 2005; Høyer et al 2000; Ösby et al 2001; Pompili et al 2013a). Self-poisoning accounted for 25–30% of deaths in the three largest studies that reported on BD suicide methods (Chen et al 2009; Hunt et al 2006; Ösby et al 2001) and 17–53% in the smaller studies (Angst et al 2005; Clements et al 2013; Crump et al 2013; Harris and Barraclough 1997; Høyer et al 2000; Ilgen et al 2010; Karch et al 2006; Kessing et al 2005; Pompili et al 2013a; Schaffer et al 2014; Takizawa 2012); there is a paucity of data focusing on characterizing this subgroup of suicide deaths in BD. In a small Finnish study examining 11 people with BD who died by self-poisoning suicide, lethal ingestion of an antipsychotic occurred in 45% of cases, followed by 18% with each of a tricyclic antidepressant, lithium, or combination of benzodiazepines (Isomets and Henriksson 1994)
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