Suicide Risk Assessment in Bipolar Disorder
Key Point
A history of previous suicide attempt is one of the strongest predictors of future suicide completion, particularly in patients with bipolar disorder. This patient's past overdose attempt represents a critical risk factor.
Risk Stratification in This Case
| Risk Factor | Significance | Present in This Patient? |
|---|
| History of previous attempt | Strongest predictor of future attempt | Yes |
| Current severe depression | High risk, especially in bipolar disorder | Yes |
| Detailed suicide plan (note) | Indicates intent and preparation | Yes |
| Psychomotor retardation | Associated with higher lethality | Yes |
| Male gender | 3–4× higher completion rate | Yes |
| Age 40–50 years | Peak risk period for males | Yes |
| Passive ideation only | Lower immediate risk than active intent | Yes |
| Social support (married) | Protective factor | Yes |
High-YieldNEET PG
The Columbia-Suicide Severity Rating Scale (C-SSRS) and SAD PERSONS scale both weight prior attempt history as a major risk factor. A prior attempt increases the risk of future completion by 5–10 fold.
Clinical Pearl
In bipolar disorder, the depressive phase carries the highest suicide risk—higher than in unipolar depression. Combined with a prior attempt, this patient requires immediate hospitalization and close monitoring.
Why This Patient Is High Risk
- 1.
Prior attempt (overdose) = demonstrated intent and method knowledge
- 2.
Current severe depression in bipolar disorder (highest-risk phase)
- 3.
Concrete planning (written note, giving away possessions)
- 4.
Demographic vulnerability (male, middle-aged)
- 5.
Anhedonia + psychomotor retardation = high lethality risk
Warning
Do not be reassured by his denial of "active intent at this moment." Passive ideation can rapidly escalate, and the presence of a detailed note indicates serious planning. The combination of prior attempt + current severe depression + concrete preparation = imminent risk.
Mnemonic — SAD PERSONS: Sex (male), Age (40–50), Depression, Previous attempt, Ethanol/substance use, Rational thinking loss, Social support loss, Organized plan, No spouse, Sickness (medical/psychiatric). This patient scores high on multiple domains.
