Suicide Risk in Bipolar Disorder During Treatment With Lithium and Divalproex

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Abstract
Bipolar disorder is a major public health problem, in any given year affecting approximately 1.3% to 1.5% of the US population.1 In addition to the personal anguish of affected individuals, bipolar disorder places substantial burdens on the health care, social welfare, and criminal justice systems and on families, caregivers, and employers. In the World Health Organization's Global Burden of Disease study, bipolar disorder ranked sixth among all medical disorders in years of life lost to death or disability.2 Suicide and suicide attempts are significant contributors to that premature mortality and disability. Estimates of the lifetime risk of suicide in patients with bipolar disorder range from 8% to 20%, 10 to 20 times that in the US general population.3-7 In a review of 31 studies including nearly 10 000 patients with recurrent affective disorder (primarily bipolar), the proportion of deaths attributable to suicide ranged from 9% to 60%, with a weighted mean of 18.9%.8 Thus, it is critical to determine if maintenance treatment is associated with a reduction in suicide attempts and suicide mortality in this high-risk group.