Bipolar disorder has long been associated with increased risks for suicidality; though factors associated with dying by suicide remain obscure. Here, we retrospectively examine the associations between the different phases of bipolar illness and other common comorbidities with death by suicide in the 120 days following each discharge for Swedes first admitted as inpatients for bipolar disorder during the years 2000-2014. Data on admissions and suicide deaths were extracted from the Swedish National Patient Register and the Cause of Death Register, respectively. ICD-10 diagnostic codes were used to define the phases: depressive, manic, mixed, and other; and the comorbidities: specific substance use disorders, attention deficit hyperactivity disorder, and personality disorders. Extended Cox regressions were employed to model the time to death by suicide as a function of the bipolar phases, comorbidities, and other important control variables. Our analysis included 60,643 admissions by 22,402 patients over an observation time of 15,187 person-years. Overall, 213 (35.7%) of all suicides occurred within 120 days of discharge. Upon adjustment and compared to the depressive phases, manic phases were significantly associated with a far lower hazard of dying by suicide (HR 0.34, 95% CI: 0.21–0.56, p < 0.001), though mixed phases were not (HR 0.92, 95% CI: 0.48–1.73, p = 0.957). With regard to comorbidity, only sedative use disorder remained significantly associated with dying by suicide upon adjustment (HR 2.08, 95% CI: 1.41–3.06, p = 0.001). Vigilant monitoring of patients post discharge and of prescription practices are recommended.

躁郁症长期以来与自杀风险增加有关。尽管与自杀死亡相关的因素仍然不清楚。在这里，我们回顾性研究了2000-2014年间首次入院为躁郁症住院患者的瑞典人每次出院后120天内，躁郁症不同阶段与其他常见合并症与自杀死亡之间的关联。关于入院和自杀死亡的数据分别来自瑞典国家病人登记簿和死亡原因登记簿。ICD-10诊断代码用于定义阶段：抑郁，躁狂，混合和其他阶段；合并症：特定物质使用障碍，注意力缺陷多动障碍和人格障碍。采用扩展的Cox回归来模拟自杀死亡的时间，该时间是双相期，合并症和其他重要控制变量的函数。我们的分析包括22,402名患者的60,643例入院，观察时间为15,187人年。总体而言，所有自杀中有213起（35.7％）在出院120天内发生。经过调整并与抑郁期相比，躁狂期与自杀死亡的风险显着相关（HR 0.34，95％CI：0.21-0.56，p <0.001），而混合相则没有（HR 0.92，95） ％CI：0.48–1.73，p = 0.957）。关于合并症，只有镇静剂使用障碍与调整后自杀死亡显着相关（HR 2.08，95％CI：1.41-3.06，p = 0.001）。