Suicide Deaths in People With Bipolar Disorder: Characteristics and Treatments at Time of Death.

Objectives: This study aimed to compare suicide deaths in those with or without bipolar disorder (BD), taking into particular consideration the degree to which treatment at the time of death, according to toxicology data, reflects evidence-based pharmacotherapy.

Methods: Coroner data were coded for all verified suicide deaths in the City of Toronto, Canada (1998-2020). Suicide decedents with BD (n = 340) were compared to the non-BD group (n = 4948) on demographic, clinical, and suicide-related variables. In a subsample of decedents, the presence and/or lethality of medications or substances at the time of death was identified from toxicology data and compared between groups and across time (two 11.5 year epochs). Data were analyzed using univariate analyses.

Results: Several noteworthy demographic, clinical, and suicide-specific differences between BD and non-BD suicide groups emerged. Antidepressants (48.9%) and benzodiazepines (46.7%) were the most commonly present medications among people with BD, at a proportion similar to the non-BD group. There was a significant decrease in the presence of mood stabilizers across time (33.3% vs. 13.5%, p = 0.006), and lithium was present in only 5.8% of decedents with BD. Opioids (22.1%) and antipsychotics (22.1%) were the most common substances detected in lethal amounts in the BD group.

Conclusions: The findings of this study suggest that a substantial proportion of people with BD who die by suicide are not receiving first-line treatments at the time of death. While causality cannot be established, further exploration of pharmacotherapy at the time of death would ideally link to living controls to address issues of risk and lethality.