Can we reduce the cost of suicide in bipolar I?

But short of quickly finding long-term solutions, there is always another approach we can and should pursue in order to reduce escalating healthcare costs: preventing disease and better managing existing conditions. It’s not rocket science but sadly it isn’t always forefront in people’s minds; whilst we might be good at using the likes of sunscreen to help avoid skin cancer, for example, when it comes to less obvious but potentially equally effective preventative measures for certain conditions, we don’t always try hard enough.

High risk of suicide

A recent report that focuses on bipolar I disorder builds on this concept. World-leading experts identify that there is a lack of understanding of the more severe form of bipolar I (mania with depressive symptoms) and that consequently millions of people worldwide are not receiving timely and accurate diagnosis leaving them at a heightened risk of suicide.¹

During episodes of mania with depressive symptoms, patients are at their most vulnerable, with up to one out of two sufferers attempting suicide during these occurences.², They are also approximately three times more likely to be hospitalised than bipolar patients without mixed symptoms³ and the duration of these hospital stays are on average 40 per cent longer for those with mania with depressive symptoms.⁴ Most people (64 per cent) diagnosed with bipolar I disorder will suffer from at least one concurrent depressive symptom during an episode of mania.³

Professor Maurizio Pompili, Professor of Suicidology, Faculty of Medicine and Psychology of Sapienza University, Italy, who contributed to the report, said: "Suicide prevention among bipolar I patients could be improved through greater education and understanding of depressive symptoms during mania. Psychiatrists are too often afraid to raise the topic of suicidality with their patients, as they are fearful they may seed such an idea. This is sadly the opposite of what patients need; a combination of intervention and human support is vital. It is important that psychiatrists ask and understand why patients either want to attempt suicide or have attempted suicide; how can patients move forward when they haven’t understood why it happened in the first place?”

The report entitled “‘Paying the ultimate price’, highlights the urgent need for accurate treatment and diagnosis of bipolar I disorder in order to address the significant burden on society, patients and carers.

Cost of suicide

In Europe the cost of suicide per year can exceed €21.5 billion⁵, whilst in the USA figures are approximately $139 billion per annum⁶. The direct costs, such as caring for patients who have attempted suicide, are estimated at $6.45 billion a year in the USA alone. ⁷ Evidence reveals that 45 per cent of direct costs associated with suicide are attributable to hospitalisation,⁸ costing approximately $23,000 within the first year after a suicide attempt.²

The indirect costs associated with bipolar I disorder also have a huge impact on society, patients and carers. Almost one-fifth (16.5%) of indirect costs are incurred by lost productivity of family members and caregivers in the U.S.;⁹ and it is estimated that the indirect costs are 4 times higher than the direct costs.¹⁰

This report calls for an improvement in diagnosis and management of mania with depressive symptoms as well as greater support around the associated risk of suicide.

The road to better diagnosis

Observation and research leads to better understanding of diseases and we now understand that almost three-quarters (72%) of patients experiencing mania with depressive symptoms report symptoms of anxiety, irritability and agitation (AIA), compared to just 27% of patients without depressive symptoms.

Simple recognition that ‘AIA’ symptoms are hallmarks of this debilitating form of bipolar I disorder can enable healthcare professionals to accurately and timely diagnose these patients, thus potentially reducing hospital admissions, duration of stay, and most importantly avoiding the risk of suicidality.

With information like this, there really is no reason why we shouldn’t see the price of bipolar I start to fall.  Time to pull out the stops and prevent and avoid unnecessary suffering and costs.