the amount of time they spend ill and a decrease in mood episodes. along with medication, other forms of therapy have been shown to be beneficial for bp-ii patients. a treatment called a "well-being plan" serves several purposes: it informs the patients, protects them from future episodes, teaches them to add value to their life, and works toward building a strong sense of self to fend off depression and reduce the desire to succumb to the seductive hypomanic highs. the plan has to aim high. otherwise, patients will relapse into depression. a large part of this plan involves the patient being very aware of warning signs and stress triggers so that they take an active role in their recovery and prevention of relapse. mortality several studies have shown that the risk of suicide is slightly higher in patients who have bp-ii than those with bp-i. in results of a summary of several lifetime study experiments, it was found that 32.4% of bp-ii patients experienced suicidal ideation or suicide attempts compared to 36% in bp-i patients. bipolar disorders, in general, are the third leading cause of death in 15- to 24-year-olds. bp-ii patients were also found to employ more lethal means and have more complete suicides overall. bp-ii patients have several risk factors that increase their risk of suicide. the illness is very recurrent and results in severe disabilities, interpersonal relationship problems, barriers to academic, financial, and vocational goals, and a loss of social standing in their community, all of which increase the likelihood of suicide. mixed symptoms and rapid-cycling, both very common in bp-ii, are also associated with an increased risk of suicide. the tendency for bp-ii to be misdiagnosed and treated ineffectively, or not at all in some cases, leads to an increased risk. as a result of the high suicide risk for this group, reducing the risk and preventing attempts remains a main part of the treatment; a combination of self-monitoring, close supervision by a therapist, and faithful adherence to their medication regimen will help to reduce the risk and prevent the likelihood of suicide. suicide is a common endpoint for many patients with severe psychiatric illness. the mood disorders (depression and bipolar) are by far the most common psychiatric conditions associated with suicide. at least 25% to 50% of patients with bipolar disorder also attempt suicide at least once. aside from lithium—which is the most demonstrably effective treatment against suicide—little is known about contributions of specific mood-altering treatments to minimizing mortality rates in persons with either major mood disorders or bipolar depression specifically. suicide is usually a manifestation of severe psychiatric distress that is often associated with a diagnosable and treatable form of depression or other mental illness. in a clinical setting, an assessment of suicidal risk must precede any attempt to treat psychiatric illness. epidemiology the global estimated lifetime prevalence of bipolar disorder among adults range from 1 to 3 percent. the annual incidence is estimated to vary from 0.3 to 1.2 percent worldwide. according to the world mental health survey initiative, the lifetime prevalence of bp-ii was found to be 0.4%, with a 12-month prevalence of 0.3%. other meta-analyses have found lifetime prevalence of bp-ii up to 1.57%. in the united states, the estimated lifetime prevalence of bp-ii was found to be 1.1%, with a 12-month prevalence of 0.8%. the mean age of onset for bp-ii was 20 years. thus far, there have been no studies that have conclusively demonstrated that an unequal distribution of bipolar disorders across sex and ethnicity exists. a vast majority of studies and meta-analysis do not differentiate between bp-i and bp-ii, and current epidemiology data may not accurately describe true prevalence and incidence. in addition, bp-ii is underdiagnosed in practice, and it is easy to miss milder forms of the condition. history in 19th century psychiatry, mania covered a broad range of intensity, and hypomania was equated by some to concepts of 'partial insanity' or monomania. a more specific usage was advanced by the german neuro-psychiatrist emanuel ernst mendel in 1881, who wrote "i recommend (taking under consideration the word used by hippocrates) to name those types of mania that show a less severe phenomenological picture, 'hypomania'". narrower operational definitions of hypomania were developed from the 1960s/1970s. the first diagnostic distinction to be made between manic-depression involving mania and involving hypomania came from carl gustav jung in 1903. in his paper, jung introduced the non-psychotic version of the illness with the statement, "i would like to publish a number of cases whose peculiarity consists in chronic hypomanic behavior" where "it is not a question of real mania at all but of a hypomanic state which cannot be regarded as psychotic." jung illustrated the hypomanic variation with five case histories, each involving hypomanic behavior, occasional bouts of depression, and mixed mood states, which involved personal and interpersonal upheaval for each patient. in 1975, jung's original distinction between mania and hypomania gained support. fieve and dunner published an article recognizing that only individuals in a manic state require hospitalization. it was proposed that the presentation of either the one state or the other differentiates two distinct diseases; the proposition was initially met with skepticism. however, studies since confirm that bp-ii is a phenomenologically distinct disorder. empirical evidence, combined with treatment considerations, led the dsm-iv mood disorders work group to add bp-ii as its own entity in the 1994 publication. only one other mood disorder was added to this edition, indicating the conservative nature of the dsm-iv work group. in may 2013, the dsm-5 was released. two revisions to the existing bp-ii criteria are anticipated. the first expected change will reduce the required duration of a hypomanic state from four to two days. the second change will allow hypomania to be diagnosed without the manifestation of elevated mood; that is, increased energy/activity will be sufficient. the rationale behind the latter revision is that some individuals with bp-ii manifest only visible changes in energy. without presenting elevated mood, these individuals are commonly misdiagnosed with major depressive disorder. consequently, they receive prescriptions for antidepressants, which unaccompanied by mood stabilizers, may induce rapid cycling or mixed states. society and culture heath black revealed in his autobiography, black, that he has been diagnosed with bp-ii. maria bamford has been diagnosed with bp-ii. geoff bullock, singer-songwriter, was diagnosed with bp-ii. mariah carey was diagnosed with bp-ii in 2001. in 2018, publicly revealed and actively seeking treatment in the form of therapy and medication. charmaine dragun, former australian journalist/newsreader. inquest concluded she had bp-ii. joe gilgun has been diagnosed with bp-ii. shane hmiel has been diagnosed with bp-ii. jesse jackson jr. has been diagnosed with bp-ii. thomas eagleton received a diagnosis of bp-ii from dr. frederick k. goodwin. carrie fisher had been diagnosed with bp-ii. demi lovato has been diagnosed with bp-ii. evan perry, subject of the documentary boy interrupted, was diagnosed with bp-ii. richard rossi, filmmaker, musician, and maverick minister was diagnosed with bp-ii. rumer has been diagnosed with bp-ii. catherine zeta-jones received treatment for bp-ii after dealing with the stress of her husband's throat cancer. according to her publicist, zeta-jones made a decision to check into a mental health facility for a brief stay.