Summary: Researchers report that regions in Sweden with higher rates of bipolar disorder diagnoses among adolescents have lower suicide rates for teenage boys. The finding points to the potential value of earlier detection and more active psychiatric care in preventing suicides.
The study observed that suicide rates for males aged 15–19 were nearly 5% lower in Swedish regions with the highest population-adjusted rates of bipolar diagnosis compared with regions reporting the fewest such diagnoses. The results suggest that more accurate, timely diagnosis and consistent treatment of bipolar disorder could contribute to reducing adolescent suicide.
Key Facts:
- Bipolar disorder most often appears between ages 12 and 25 and carries a comparatively high risk of suicide.
- The researchers found a clear association: regions with more bipolar diagnoses (adjusted for population) tended to have lower suicide rates among adolescent boys.
- Improving recognition and treatment of bipolar disorder in young people could be an effective strategy to reduce suicide deaths in teenage males in Sweden.
Source: Karolinska Institute
Bipolar disorder accounts for roughly five percent of suicides among young people, and prior research indicates there is often a long gap between illness onset and correct diagnosis and treatment.
A team at Karolinska Institutet analyzed regional health registries across Sweden and found fewer suicides among boys in areas where clinicians diagnose bipolar disorder more frequently. Their results, published in JAMA Psychiatry, underline how earlier and more proactive mental health care might reduce adolescent suicide mortality.
Peter Andersson, the study’s first author and a doctoral student at the Department of Clinical Neuroscience at Karolinska Institutet, explains that bipolar disorder that begins early in life tends to be particularly distressing and is strongly linked to suicide risk. The condition typically emerges between ages 12 and 25 and is characterised by repeated episodes of mania and depression. Previous studies have shown diagnostic delays can extend up to six years, and comparisons with national prevalence estimates suggest bipolar disorder is under-diagnosed among 15–19-year-olds in Sweden.
Large regional differences
Using registry data from all 21 Swedish regions from 2008 through 2021, the researchers examined regional variation in the number of adolescents aged 15–19 diagnosed with bipolar disorder and compared these figures, adjusted for population, with confirmed suicide deaths for males and females.
Across the study period there were 585 confirmed suicide deaths in this age group. The data revealed substantial regional variation in the percentage of young people diagnosed with bipolar disorder. Importantly, the study found that higher rates of population-adjusted bipolar diagnoses were associated with lower suicide rates among adolescent boys.
Adrian E. Desai Boström, corresponding author and child and adolescent psychiatry resident in Stockholm, notes that suicide rates among boys were nearly five percent lower in regions making the most bipolar diagnoses compared with regions making the fewest. The authors suggest that better detection and management of bipolar disorder could plausibly reduce suicides among teenage males in Sweden.
Risks of misdiagnosis and treatment patterns
Complementary analyses showed the inverse link between bipolar diagnosis frequency and male suicide rates remained even after accounting for regional differences in overall psychiatric care use and rates of depression or schizophrenia diagnoses. In other words, the association was not explained simply by more psychiatric visits overall or by differing rates of other psychiatric diagnoses.
Interestingly, prescriptions for lithium as a mood stabilizer decreased overall where bipolar diagnoses increased, yet more boys in those regions received lithium at least once. The authors suggest this pattern could reflect clinicians initiating lithium treatment and then switching patients to other mood stabilizers for clinical reasons.
The researchers also caution that incorrect or inadequate treatment could potentially raise suicide risk. For example, some young people may be transferred from psychiatric care to social services under provisions for child and disability care, which could disrupt appropriate psychiatric follow-up. In addition, bipolar disorder is sometimes mistaken for unipolar depression, delaying the targeted treatments suitable for bipolar illness.
Earlier work by the team, published in Nature Communications, identified major regional differences in access to advanced psychiatric treatments for children and adolescents in Sweden. The researchers plan further studies to examine how advanced treatments affect outcomes for young people with bipolar disorder and other severe psychiatric conditions.
This study was a collaborative effort involving researchers at Karolinska Institutet, Uppsala University, Umeå University, Lund University, Region Halland, and Region Stockholm, and was funded by the Swedish Research Council. One co-author, Jussi Jokinen, disclosed participation on an advisory committee for Janssen regarding esketamine use in depression; no other conflicts were reported.
About this mental health research news
Author: Peter Andersson
Source: Karolinska Institute
Contact: Peter Andersson – Karolinska Institute
Image: The image is credited to Neuroscience News
Original Research: Open access.
“Association of Bipolar Disorder Diagnosis With Suicide Mortality Rates in Adolescents in Sweden” by Peter Andersson et al. JAMA Psychiatry
Abstract
Association of Bipolar Disorder Diagnosis With Suicide Mortality Rates in Adolescents in Sweden
Importance
The impact of earlier diagnosis and management of bipolar disorder on adolescent suicide mortality has not been well established.
Objective
To evaluate regional associations between adolescent suicide mortality (ASM) and local rates of bipolar disorder diagnoses.
Design, Setting, and Participants
This cross-sectional analysis used aggregated registry data from all 21 regions of Sweden for the period January 1, 2008, through December 31, 2021. The dataset covered adolescents aged 15 to 19 years and included 585 suicide deaths, yielding 588 observations across regions, years, and sexes.
Exposures
Population-adjusted bipolar diagnosis frequencies and lithium dispensation rates were treated as fixed-effects variables. The models also included an interaction between psychiatric care affiliation rates and the share of psychiatric visits occurring in inpatient versus outpatient settings. Region and year were included as random intercepts. Variables were adjusted for population size and reporting differences between regions.
Main Outcomes and Measures
The primary outcome was sex-stratified, regional, annual ASM per 100,000 inhabitants among 15–19-year-olds, analyzed with generalized linear mixed-effects models.
Results
Female adolescents received bipolar diagnoses nearly three times more often than males (mean [SD], 149.0 [19.6] vs 55.3 [6.1] per 100,000 inhabitants). Median regional bipolar prevalence varied considerably around the national median. Higher regional bipolar diagnosis rates were inversely associated with male ASM (β = −0.00429; SE, 0.002; 95% CI, −0.0081 to −0.0004; P = .03), independently of lithium use and psychiatric care affiliation rates. Results were supported by β-binomial models and remained robust after adjusting for regional rates of major depressive disorder and schizophrenia. No similar association was seen in females.
Conclusions and Relevance
In this national cross-sectional study, regions that diagnosed bipolar disorder more frequently had lower suicide death rates among adolescent males—an effect size estimated at approximately 4.7% of the mean national suicide rate. These associations may reflect benefits of early diagnosis and treatment, treatment effectiveness, or other unmeasured regional factors.