Journal of Affective Disorders Reports · Published 2026-05-07 · DOI 10.1016/j.jadr.2026.101070
Background: There are few studies in bipolar disorder (BD) concerning differences between single and multiple suicide attempters. Most studies of suicide attempts (SA) in BD makes no difference between single and multiple suicide attempters. Methods: A long-term follow-up study (25 years) of 192 patients with BD (DSM IV) were recruited from lithium dispensaries. Patients with SA (n = 51) were divided into single and multiple suicide attempters. Results: Multiple suicide attempters were younger (p = 0.009), had younger age at their first SA (p = 0.017), more often performed SA before the age of 30 years (p = 0.044), had earlier age of onset (AOO) (p = 0.008), had more depressive episodes/year (p < 0.001), had more episodes per year (p = 0.042), showed poorer lithium compliance (p = 0.018), had more SA on lithium (p = 0.003), were treated earlier after their first hypomania or mania (p = 0.032) and more often belonging to generation III (p = 0.028), had their first hypomania or mania later after AOO (p = 0.035) and therefore were diagnosed later as a bipolar diagnose compared to single attempters. Conclusions: Our data confirm and emphasize that bipolar patients with multiple suicide attempts have a more severe form of BD. Clinicians should especially regard patients with a unipolar diagnose, early AOO and SA as a potential bipolar diagnose in the future. Therefore, mood stabilization with e.g. lithium treatment should be early taken into consideration for this patient group. If lithium is not considered the most adequate drug to use it is probable that another mood stabilizer agent could be used, although this is not investigated in the present study.
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