• adolescence;
  • bipolar disorder;
  • expressed emotion;
  • family-focused therapy;
  • psychosocial treatment;
  • suicide

Objectives:  Bipolar patients are at high risk for suicidal ideation and attempts. Suicidal behavior is correlated with poor family communication and/or high levels of intrafamilial conflict, particularly among adolescent bipolar patients. This article describes the application of family-focused therapy (FFT) as an adjunct to pharmacotherapy in the management of suicidal ideation and behavior among bipolar patients.

Methods:  We describe the empirical basis of FFT in studies of adult and adolescent patients. We then describe the manner by which the three modules of FFT – psychoeducation, communication skills training and problem solving – are adapted to address the clinical issues presented by suicidal bipolar adults or adolescents and their families.

Results:  Key objectives of the treatment are to help the family recognize that suicidal behavior is a part of the pathophysiology of bipolar disorder but that it is also to some extent under environmental control. Thus, the family is in a unique position to develop and help assure the success of a suicide prevention contract. A case study of an adolescent with suicidal behavior is presented.

Conclusions:  Future research should include a focus on: (i) cross-cultural issues in suicide and bipolar disorder; and (ii) the adaptation of interventions shown to be effective in reducing suicidal behaviors in non-bipolar populations.