Research Fellow Buse Beril Durdurak and Professor Steven Marwaha look at the increased risk of suicide for people who have Bipolar Disorder
Heston Blumenthal has recently announced that he has joined more than one million people in the UK who have been diagnosed with Bipolar Disorder. As the Michelin Starred chef begins his role as an ambassador for the charity Bipolar UK, recent media reports have also highlighted the concerning increased risk of suicide among people with the condition.
Bipolar disorder (BD) is a complex and highly variable condition, affecting approximately one in 150 adults worldwide according to the World Health Organization. Typically it is unrecognized and untreated for up to 10 years after onset, despite contact with health professionals.
One of the most pressing yet under-discussed aspects of BD is the significantly increased risk of suicide. Research consistently shows that individuals with BD are at a much higher risk of suicide compared to the general population, with estimates suggesting that up to 60% of persons with BD attempt suicide at some time over their life, and suicide fatalities occur in 5%–20% of adults with BD.
Despite this, public awareness and effective intervention strategies remain inadequate and this needs to change.
A significant barrier to effective suicide prevention in BD is the pervasive stigma surrounding both the disorder and suicide itself. Many individuals with BD face discrimination, which can discourage them from seeking help or disclosing suicidal thoughts.
Public figures speaking out about their experiences with BD can help shift the narrative. The recent discussions about Blumenthal’s experiences with BD have reignited conversations about mental health. While such disclosures can be instrumental in raising awareness, they must be accompanied by a broader societal effort to provide accurate information and improve access to mental health care. In England we know that experiences accessing care, and the provision of specific and effective treatments for the condition are sub-optimal.
Blumenthal’s story is a crucial reminder that BD is not just about mood swings. It is a serious condition that requires medical attention, psychological support, and social understanding. Public figures speaking openly about their diagnosis can help break down stigma, encouraging more individuals to seek help before their symptoms escalate to crisis levels. This is a one of the key focuses of the Bipolar UK, Bipolar Minds Matter policy report.
Suicide is unpredictable and it is unlikely that there is a single, simple pathway to fully understand this process, but if we can identify risk factors, it could be possible to intervening before it is too late.
Several factors may contribute to the elevated risk of suicide in BD patients, including a younger age of onset of illness, childhood trauma, longer periods spent in the depressive phase of illness increase the likelihood of suicidal behaviour in people with BD, and a family history of mood disorder.
There is also evidence regarding the role of genetic variation in suicidal behaviour in BD. Research shows that a total of 16 genes have also been shown to be differentially expressed in individuals with BD with a history of completed suicide attempt when compared with individuals with BD with no suicide attempt.
Lastly, diagnosis in BD often involves prolonged delays. This may involve inappropriate treatment and prolong suffering contributing to increased suicide rates.
Individuals with BD often also have anxiety disorders, substance use disorders, ADHD and personality disorders, all of which contribute to increased suicide risk. Substance use and ADHD, in particular are a major concern, as they can impair judgment and increase impulsivity, making suicidal actions more likely. Additionally, individuals with BD frequently struggle with sleep disturbances, which are increasingly recognized as a key risk factor for suicide.
Physical health conditions also intersect with suicide risk in BD. A growing body of evidence highlights the high prevalence of metabolic disorders, cardiovascular diseases, and chronic pain conditions in BD patients, which can exacerbate mental distress, lower quality of life and contribute to feelings of depression and hopelessness.
Research on treatments specifically aimed at suicide prevention remains highly limited, primarily due to clinical and ethical challenges. As a result, most trials tend to focus on assessing clinical efficacy rather than directly addressing suicide prevention.
Among potential treatments, one crucial area of focus is lithium, a mood stabilizer that has consistently been shown to reduce suicide risk in BD patients. Studies suggest that lithium not only stabilizes mood but may also have neuroprotective and anti-suicidal properties. However, concerns about side effects and the issues with long-term adherence could be limiting its use. Over the last few decades Lithium use in the UK and in Europe has declined despite the strong evidence for Lithium.
Adjunctive psychotherapy has also shown some promise in reducing suicidal ideation. Group based psychological interventions specifically designed for BD focussing coping strategies, managing emotional dysregulation, medication adherence and challenging negative thought patterns are known to reduce suicidality and re-admission to hospital.
Suicide prevention in BD requires a multi-faceted approach, integrating medical treatment, psychological support, and broader public health and social interventions. As research continues to shed light on the underlying mechanisms driving suicide risk in BD, it is imperative that public health efforts prioritize early detection, targeted treatments, and anti-stigma campaigns.
With greater awareness, better treatment options, and a commitment to breaking the silence surrounding BD and suicide, we can work towards a future where every individual with BD can receive the support they need.
Clinical Professorial Fellow
Steven Marwhaha is an academic Psychiatrist whose main interest is in early intervention and mood disorders, such as bi-polar disorder and depression.
