Potential Research Problem

Bipolar disorders (BDs) are one of the psychiatric illnesses that are quite prevalent in the
world today. Studies show that 1-5% of the world population have a chronic disease trajectory
and have a high risk of increased premature deaths (Dome et al., 2019). Suicide has been proven
to be a key contributor to the decreased life expectancy among patients with bipolar disorders.
Bipolar disorder has a depression-predominant course that is often associated with a long
duration of untreated bipolar. Bipolar depression is thus associated with higher risks of suicidal
behavior. The relationship between psychiatric disorders and suicide has been an issue of
importance among many researchers and mental health practitioners. According to Pompili et al.
(2018), more than 75% of suicide attempters and suicide completers have major depressive
disorders (mostly untreated) at the time they attempt the suicide act.
Further, people with major depressive disorder (MDD) and type 1 and type II bipolar, as
well as those with major affective disorders (MAD), are highly vulnerable to suicide (Pompili et
al., 2018). The male gender has been found to have a high risk for lethal suicides while their
female counterparts face a high-risk factor for attempts. Suicidality as a result of depression
among bipolar patients is more frequent among patients who are single parents, unmarried,
divorced, or live in isolation from their social circles (Ferro, 2016). Apart from gender, another
sociodemographic factor is age. Bipolar patients above the age of 75 years and those under 35
years are at an elevated risk for engaging in suicide or suicide-related behaviors compared to
their counterparts in other age brackets (Dome et al., 2019). Bipolar depression is related to
higher risks for suicide, and the risk varies among subjects of different age brackets.

3
The problem to be addressed by this study is the high prevalence of suicide risk among
bipolar patients below the age of 35 and above the age of 75 who are depressed ((Dome et al.,
2019). Age is a key sociodemographic risk factor in suicide associated with bipolar depression.
Existing studies show that pharmacotherapy is a key predictor of suicidality risk ((Jamison,
2019). After controlling other variables such as depression severity, anxiety, and diagnosis,
pharmacotherapy has been found to cause an increased risk for suicide. In 2004, U.S Food and
Drugs Administration (FDA) offered an advisory on the worsening situation relating to
suicidality and treatment of depression among bipolar patients using antidepressants (Dome et
al., 2019). The advisory pointed to an existing relationship between antidepressants and suicide
and suicide thoughts in patients of bipolar being treated for depression.
Existing literature, however, shows that antidepressants are not directly associated with
increased suicide risk. Despite this, there are incidences when it is obligatory for physicians not
to administer antidepressants to treat bipolar depression (Dome et al., 2019). There exists
evidence showing that administering antidepressants may cause patients with depression to
experience mania or even increased irritability which is a condition associated with an increased
risk for suicidality (Ferro, 2016). Conversely, when manic individuals, especially those that are
high-voltage, slow down and experience switches in their moods, they face an elevated risk for
suicide. Aggression and impulsivity levels are essential factors for both the timing as well as the
risk of suicidality. They may help in accounting for the disparity in the effectiveness of certain
components such as lithium in reducing the risk that bipolar patients may face for suicide.
researchers agree that the correct dosage for mood-stabilizers is a key determinant for whether a
person develops a high suicide risk or not (Jamison, 2019).

4
Persons with bipolar depression have been said to show increased cognitive loss that has
often been associated with age. Studies have suggested that increased cortisol activity when
persons with bipolar go through episodes of depression may experience cumulative
excitotoxicity in the amygdala and associated brain regions that are linked with loss in cognitive
activity (O’Rourke et al., 2017). However, no consensus has been reached. In a recent study,
Sajatovic et al. (2017) have opposed the idea that cognition is a likely mistake that should be
reevaluated in older bipolar patients who experience depressive episodes.
The current body of literature does not adequately explain the age-related variation in the
risk levels for suicide among depressed bipolar patients (Valtonen et al., 2017). Understanding
suicidal thinking among bipolar patients within different age groups is important in advancing
treatment. It is also important in determining whether some interventions are more important in
certain age groups and not in others, as well as possible causes for such disparities. Published
studies show that younger age, a history of suicide within a patient’s family, suicidal ideation,
poor social support, and hopelessness are some of the risk factors for suicide attempts among
depressed bipolar patients (Jamison, 2019).
As most bipolar patients experience major depressive or mixed mood episodes, they face
an increased risk to think of, plan or even attempt suicide. The suffering from a major depressive
disorder in itself explains suicide risks among bipolar patients. Age, social support, severity as
well as the duration of the disorder are also factors that strengthen the argument on the elevated
suicide risk among bipolar patients (Isometsä, 2016). Childhood neglect and abuse or such
related personal histories may leave neuroendocrinological scars that may make a patient
vulnerable to suicide (Valtonen et al., 2017). however, traits and illnesses such as bipolar
depression only predispose a person to attempt or complete suicide. Further studies are important

5
to help understand how mood states, bipolar depression, and age are intertwined and how these
expose a patient to increased suicide risks.
Young age at onset and young age of patients is a high risk for attempted suicide. Other
studies show that advanced age, mainly patients above 75 years, face an increased risk for a
suicide attempt. While bipolar depression affects patients across different ages, and suicide may
occur among patients of any of these ages, there is a high prevalence of suicide rates amongst
younger patients below the age of 35 and older patients among the age of 75 (Jamison, 2019).
Social isolation, mainly common in old age, maybe a risk factor for suicide among depressed
bipolar patients above 75 years. Socially, these patients are isolated from their family members.
Most family members have left to pursue their dreams and interests, leaving their old parents
behind. If these parents are bipolar, the social isolation may expose them to extreme and frequent
depressive episodes, consequently elevating their suicidality risk. People below the age of 35
may feel that the disorder is affecting their lives and denying them an opportunity to fully
experience life just like their otherwise healthy individuals (Jamison, 2019). Such factors should
be looked at and their association or lack thereof established in relation to suicide and the
manifestation of bipolar.

6

References

Dome, P., Rihmer, Z., & Gonda, X. (2019). Suicide risk in bipolar disorder: a brief
review. Medicina, 55(8), 403.
Ferro, M. A. (2016). Major depressive disorder, suicidal behaviour, bipolar disorder, and
generalised anxiety disorder among emerging adults with and without chronic health
conditions. Epidemiology and psychiatric sciences, 25(5), 462-474.
Isometsä, E. (2016). Suicidal behaviour in mood disorders—who, when, and why?. The
Canadian Journal of Psychiatry, 59(3), 120-130.
Jamison, K. R. (2019). Suicide and bipolar disorder. The Science of Mental Health, 115-119.
O’Rourke, N., Heisel, M. J., Canham, S. L., Sixsmith, A., & BADAS Study Team. (2017).
Predictors of suicide ideation among older adults with bipolar disorder. PLoS
one, 12(11), e0187632.
Pompili, M., Innamorati, M., Raja, M., Falcone, I., Ducci, G., Angeletti, G., … & De Pisa, E.
(2018). Suicide risk in depression and bipolar disorder: Do impulsiveness-aggressiveness
and pharmacotherapy predict suicidal intent?. Neuropsychiatric disease and
treatment, 4(1), 247.
Sajatovic, M., Strejilevich, S. A., Gildengers, A. G., Dols, A., Al Jurdi, R. K., Forester, B. P., …
& Shulman, K. I. (2017). A report on older‐age bipolar disorder from the International
Society for Bipolar Disorders Task Force. Bipolar disorders, 17(7), 689-704.

7
Valtonen, H. M., Suominen, K., Mantere, O., Leppämäki, S., Arvilommi, P., & Isometsä, E.
(2017). Suicidal behaviour during different phases of bipolar disorder. Journal of
affective disorders, 97(1-3), 101-107.