138 Bipolar and Related Disorders
Suicide Risk
Suicide risk is high in bipolar II disorder. Approximately one-third of individuals with bi-
polar II disorder report a lifetime history of suicide attempt. The prev alence rates of life-
time attempted suicide in bipolar II and bipola r I disorder appear to be similar (32.4% and
36.3%, respectively). However, the lethality of attempts, as defined by a lower ratio of at-
tempts to completed suicides, may be higher in individuals with bipolar II disorder com-
pared with individuals with bipolar I disorder. There may be an association between
genetic markers and increased risk for suicidal behavior in individuals with bipolar dis-
order, including a 6.5-fold higher risk of su icide among first-degree relatives of bipolar II
probands compared with those with bipolar I disorder. 
Functional Consequences  of Bipolar II Disorder
Although many in dividuals with bipolar II disorder return to a fully functional level be-
tween mood episodes, at least 15% continue to have some in ter-episode dysfunction, and
20% transition directly into another mood episode without inter-ep isode recovery. Func-
tional recovery lags substantially behind recovery from symptoms of bipolar II disorder,
especially in regard to occupational recovery , resulting in lower socioeconomic status de-
spite equivalent levels of education with the general population. Individuals with bipolar
II disorder perform more  poorly than healthy individuals on cognitive tests and, with the
exception of memory and semantic fluency, ha ve similar cognitive impairment as do in-
dividuals with bipolar I disord er. Cognitive impairments associ ated with bipolar II disor-
der may contribute to vocational difficulti es. Prolonged unemployment in individuals
with bipolar disorder is associated with more episodes of depression, older age, increased