Background and Objectives: Every year, suicide accounts for approximately one million preventable deaths worldwide. Suicidal behavior is complex and multi-determined with risk factors identified in multiple domains including clinical, genetic, environmental, behavioral, neurophysiological, and neurocognitive. Modeling causal pathways that integrate these factors may assist in better identification of high-risk individuals would allow for effective preventive intervention. Methods: Published literature in the English language was reviewed to identify evidence supporting a multi-dimensional model of putative causal pathways for suicidal behavior. Results: There is evidence that clinical, neurochemical, neuroendocrine, neurocognitive, and neurophysiological contributory factors may be useful as intermediate phenotypes in describing putative causal pathways from genetics and early-life adversity to suicidal acts. Conclusions: Determining the causes of suicidal behavior involves integrating risk factors from multiple domains.

OBJETIVO: O artigo revisa as evidências relacionadas aos principais fatores de risco associados ao comportamento suicida no transtorno bipolar. MÉTODO: Revisão de artigos da literatura em transtorno bipolar, tentativa de suicídio e ideação suicida. RESULTADOS: O transtorno bipolar está fortemente associado à presença de ideação suicida e a tentativas de suicídio. Em amostras clínicas, entre 14% e 59% dos pacientes apresentam ideação suicida e entre 25% e 56% têm pelo menos uma tentativa de suicídio ao longo da vida. Aproximadamente 15% a 19% dos pacientes com transtorno afetivo bipolar morrem por suicídio. As causas do comportamento suicida são múltiplas e complexas. Alguns preditores de comportamento suicida vêm sendo demonstrados consistentemente na literatura, tais como estado de humor atual, gravidade da depressão, ansiedade, agressividade, hostilidade, presença de comorbidades com outros transtornos do eixo I e eixo II, presença de estados mistos ao longo do curso da doença e história de abuso físico ou sexual. CONCLUSÃO: O transtorno bipolar é o transtorno psiquiátrico com maior risco ao longo da vida para tentativas de suicídio e suicídio completo. Sendo assim é importante para o clínico identificar os principais fatores de risco para comportamento suicida visando a escolha das melhores estratégias para lidar com esse comportamento complexo.

OBJECTIVE: This article reviews the evidence for the major risk factors associated with suicidal behavior in bipolar disorder. METHOD: Review of the literature studies on bipolar disorder, suicidal behavior and suicidal ideation. RESULTS: Bipolar disorder is strongly associated with suicide ideation and suicide attempts. In clinical samples between 14-59% of the patients have suicide ideation and 25-56% present at least one suicide attempt during lifetime. Approximately 15% to 19% of patients with bipolar disorder die from suicide. The causes of suicidal behavior are multiple and complex. Some strong predictors of suicidal behavior have emerged in the literature such as current mood state, severity of depression, anxiety, aggressiveness, hostility, hopelessness, comorbidity with others Axis I and Axis II disorders, lifetime history of mixed states, and history of physical or sexual abuse. CONCLUSION: Bipolar disorder is the psychiatric condition associated with highest lifetime risk for suicide attempts and suicide completion. Thus it is important to clinicians to understand the major risk factors for suicidal behavior in order to choose better strategies to deal with this complex behavior.