One of the biggest and most feared risks of bipolar disorder is the risk of suicide, which occurs at about 0.4% per year in women and men, more than 20 times higher compared to the general population.

In Europe, more lives are lost due to suicide every year

than die in car accidents!

According to the World Health Organisation (WHO) globally more than 700 000 people die due to suicide every year and there are many more people who attempt suicide (data from 2019). That is significantly more lives lost than on the roads in car accidents. But there are more suicide attempts, an estimated 20-30 times more, with women predominating. This is mainly due to the different methods (with higher rate of completed suicides) men choose to commit suicide compared to women.

When is the risk of suicide greatest in patients with bipolar disorder?

Suicide risk is highest for patients with bipolar affective disorder during depressive slumps or mixed episodes. Here it is important to take into account that at these times (also according to previous articles (“How does bipolar disorder look like?” “) the person’s thinking is distorted, more critical, pessimistic to tunnel vision with experiences of helplessness and hopelessness.This does not mean that every patient who is currently in a depressive episode must be having thoughts of suicide or even planning suicide. The occurrence of these thoughts is individual, as are other manifestations of depression or mania. It must be stressed that the depressive state has no other solution, quite the contrary. That is why it is necessary to know who you can turn to.  If you are experiencing bipolar disorder, other mental illness, or recurrent thoughts of suicide, or if you are experiencing such a situation in your immediate vicinity, contact a crisis line immediately.

Four forms of suicidal behaviour – or how to navigate?

This information is only indicative and the real risk must always be assessed by a professional, so if you are having thoughts of suicide or someone in your neighbourhood is talking about them, it is always a good idea to at least consult with a crisis line specialist or consult with a treating psychiatrist, psychologist or therapist.

First, it is important to review what forms suicidal behaviour can take:

• Suicidal thoughts – these are the first risk level, especially if they are recurrent even several times a week/day.
• Suicidal behaviours and tendencies – verbalising thoughts, more concrete planning, and sometimes non-verbal manifestations such as withdrawal into oneself, less interest in surroundings or hobbies, or sleep disturbances may be typical here.
• Suicide attempt – a suicide attempt that the person survived. Here it is always necessary to seek professional help (crisis lines, crisis centres, psychiatrist, psychologist, or directly contact the ambulance service (EU:122, US:911). Follow-up care and, for example, consideration of inpatient care (hospitalisation) to stabilise the condition are important. 
• Completed suicide – The individual dies as a result of the suicide attempt. Here, survivors need to be considered and again it may be appropriate to seek psychological help, which may be offered by crisis lines or centres. 

How to prevent or reduce the risk of suicide?

Rapid professional intervention proves to be effective – in the first place, according to our previous article, contacting crisis lines or crisis centres, where experts can help you stabilize the situation, delay the suicidal act or recommend you to call the emergency services (EU:112 /US:911). If you wish, the crisis interventionists can also call the ambulance service if you tell them where you are.

In addition, it is also advisable to contact a psychiatrist or treating therapist or psychologist if you are under their care and have access to these professionals. Psychologists or crisis intervention specialists can then direct you to further care.

The risk of suicide is huge for patients with Bipolar Disorder. Compared to the general population, it is up to 20 times greater. Whether you are experiencing suicidal thoughts or you see suicidal tendencies in anyone around you, the risk should not be underestimated. Seek professional help immediately. We hope this article has helped you at least a little to understand which direction to take.

Here we provide you with a list of crisis lines depending on the country in which they operate. 

UK: 

• Call 116 123 to talk to Samaritans, or email: jo@samaritans.org for a reply within 24 hours.
• If you are under 35 years you can call 0800 068 41 41 which is an suicide prevention hotline.
• Text “SHOUT” to 85258 to contact the Shout Crisis Text Line, or text “YM” if you’re under 19.
• If you’re under 19, you can also call 0800 1111 to talk to Childline. The number will not appear on your phone bill.
• Or find another crisis care here.

USA: 

• The national suicide prevention lifeline 1-800-273-8255.
• If you prefer written communication you can use a text line – text HOME to 741741 or a chat online.
• If you are a teenager you can use a Youthline 968-8491 or text TEEN2TEEN to 839863.

Canada: 

• If you or someone you know is thinking about suicide, call the Canada Suicide Prevention Service at 1-833-456-4566 (24/7).
• Or Call 1-855-242-3310 or connect to the online Hope for Wellness chat.
• If you are under 29 years Call 1-800-668-6868 or text CONNECT to 686868. You can also access support through Facebook Messenger – see the Kids Help Phone website.

Germany: 

• For a telephone crisis call 0800/ 1110111 or 0800/ 1110222.
• Or you can contact a specialised depression hotline –  0800 3344533.
• For children and young adults you can call 116 111 or use an online chat.

If you are looking for a crisis line in a different country, type the word “crisis line” into your internet browser and it will bring up crisis help sites that operate in your country. 

Sources:

• World Health Organisation (WHO).(2021, June, 17). Sucide. https://www.who.int/news-room/fact-sheets/detail/suicide
• Tondo, Leonardo, Gran Isacsson, a Ross J Baldessarini. „Suicidal Behaviour in Bipolar Disorder: Risk and Prevention”. CNS Drugs 17, č. 7 (2003): 491–511. https://doi.org/10.2165/00023210-200317070-00003.
• WHO: Suicidal behavior in Europe. The situation in the 1990 s. 1998.
• Koutek J. Jak rozpoznat a řešit suicidální riziko. Praha, Czechia: Interní Med. 2010;. 12(2): 109–110. https://solen.cz/pdfs/int/2010/02/12.pdf.
• Joiner, T.E. Myths about Suicide. Harvard University Press, 2010. https://books.google.cz/books?id=RSt4hnnKoWkC.
• Stone, D. M., & Crosby, A. E. (2014). Suicide Prevention. American journal of lifestyle medicine, 8(6), 404–420. https://doi.org/10.1177/1559827614551130
• World Health Organisation (WHO).(2021, June, 17). Sucide. https://www.who.int/news-room/fact-sheets/detail/suicide