Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA 15213, USA.
Bipolar Disord. 2010 Feb;12(1):1-9. doi: 10.1111/j.1399-5618.2009.00786.x.
The prevalence of suicide attempts (SA) in bipolar II disorder (BPII), particularly in comparison to the prevalence in bipolar I disorder (BPI), is an understudied and controversial issue with mixed results. To date, there has been no comprehensive review of the published prevalence data for attempted suicide in BPII.
We conducted a literature review and meta-analysis of published reports that specified the proportion of individuals with BPII in their presentation of SA data. Systematic searching yielded 24 reports providing rates of SA in BPII and 21 reports including rates of SA in both BPI and BPII. We estimated the prevalence of SA in BPII by combining data across reports of similar designs. To compare rates of SA in BPII and BPI, we calculated a pooled odds ratio (OR) and 95% confidence interval (CI) with random-effect meta-analytic techniques with retrospective data from 15 reports that detailed rates of SA in both BPI and BPII.
Among the 24 reports with any BPII data, 32.4% (356/1099) of individuals retrospectively reported a lifetime history of SA, 19.8% (93/469) prospectively reported attempted suicide, and 20.5% (55/268) of index attempters were diagnosed with BPII. In 15 retrospective studies suitable for meta-analysis, the prevalence of attempted suicide in BPII and BPI was not significantly different: 32.4% and 36.3%, respectively (OR = 1.21, 95% CI: 0.98-1.48, p = 0.07).
The contribution of BPII to suicidal behavior is considerable. Our findings suggest that there is no significant effect of bipolar subtype on rate of SA. Our findings are particularly alarming in concert with other evidence, including (i) the well-documented predictive role of SA for completed suicide and (ii) the evidence suggesting that individuals with BPII use significantly more violent and lethal methods than do individuals with BPI. To reduce suicide-related morbidity and mortality, routine clinical care for BPII must include ongoing risk assessment and interventions targeted at risk factors.
双相情感障碍 II 型（BPII）自杀未遂（SA）的发生率，特别是与双相情感障碍 I 型（BPI）相比，是一个研究不足且存在争议的问题，结果不一。迄今为止，尚无关于 BPII 自杀未遂已发表流行率数据的综合综述。
我们对已发表的报告进行了文献回顾和荟萃分析，这些报告专门规定了 SA 数据中 BPII 患者的比例。系统搜索产生了 24 份报告，提供了 BPII 中 SA 的发生率，以及 21 份报告，包括了 BPI 和 BPII 中 SA 的发生率。我们通过合并来自具有相似设计报告的数据来估计 BPII 中 SA 的流行率。为了比较 BPII 和 BPI 中 SA 的发生率，我们使用随机效应荟萃分析技术，根据 15 份详细报告了 BPI 和 BPII 中 SA 发生率的回顾性数据，计算了一个合并的优势比（OR）和 95%置信区间（CI）。
在有任何 BPII 数据的 24 份报告中，32.4%（356/1099）的个体回顾性报告了一生中发生过自杀未遂，19.8%（93/469）前瞻性报告了自杀未遂，20.5%（55/268）的索引尝试者被诊断为 BPII。在 15 项适合荟萃分析的回顾性研究中，BPII 和 BPI 中自杀未遂的发生率没有显著差异：分别为 32.4%和 36.3%（OR=1.21，95%CI：0.98-1.48，p=0.07）。
BPII 对自杀行为的贡献是相当大的。我们的发现表明，双相情感障碍亚型对自杀未遂率没有显著影响。我们的发现与其他证据，包括（i）自杀未遂对自杀完成的预测作用的充分记录，以及（ii）证据表明 BPII 患者比 BPI 患者使用的暴力和致命方法显著更多，这一发现尤其令人震惊。为了降低与自杀相关的发病率和死亡率，BPII 的常规临床护理必须包括持续的风险评估和针对危险因素的干预措施。
