Cognitive and family correlates of current suicidal ideation in children with bipolar disorder

Abstract

Background Suicidality among youth with bipolar disorder is an extreme, but largely unaddressed, public health problem. The current study examined the psychosocial characteristics differentiating youth with varying severities of suicidal ideation that may dictate targets for suicide prevention interventions. Methods Participants included 72 youth aged 7–13 (M = 9.19, SD = 1.61) with DSM-IV-TR bipolar I, II, or NOS and a parent/caregiver. Current suicidal ideation and correlates were assessed at intake, including: demographics and clinical factors (diagnosis, symptom severity, psychiatric comorbidity); child factors (cognitive risk and quality of life); and family factors (parenting stress, family cohesion, and family rigidity). Results Current ideation was prevalent in this young sample: 41% endorsed any ideation, and 31% endorsed active forms. Depression symptoms, quality of life, hopelessness, self-esteem, and family rigidity differentiated youth with increasing ideation severity. Separate logistic regressions examined all significant child- and family-level factors, controlling for demographic and clinical variables. Greater family rigidity and lower self-esteem remained significant predictors of current planful ideation. Diagnosis, index episode, comorbidity, and mania severity did not differentiate non-ideators from those with current ideation. Limitations Limitations include the small sample to examine low base-rate severe ideation, cross-sectional analyses and generalizability of findings beyond the outpatient clinical sample. Conclusions Findings underscore the importance of assessing and addressing suicidality in preadolescent youth with bipolar disorder, before youth progress to more severe suicidal behaviors. Results also highlight child self-esteem and family rigidity as key treatment targets to reduce suicide risk in pediatric bipolar disorder.

Evidence-Base Update for Parenting Stress Measures in Clinical Samples

“…In addition, parents of youth with clinically significant mental, emotional, and/or behavioral health issues may experience greater parenting demands and obligations compared to parents of youth without clinical issues (Mendenhall & Mount, 2011). It is perhaps not surprising, then, that parents of youth with clinically significant mental, emotional, and behavioral health issues (e.g., autism spectrum disorders [ASD], developmental delay, suicidal ideation, trichotillomania, bipolar spectrum disorders, attention deficit hyperactivity disorder [ADHD]) report higher levels of parenting stress than parents of youth without clinical issues (Hayes & Watson, 2013;Keuthen et al, 2013;Perez Algorta et al, 2018;Theule, Wiener, Tannock, & Jenkins, 2013;Weinstein, Van Meter, Katz, Peters, & West, 2015). This link between parenting stress and child adjustment elevates the relevance of parenting stress in the treatment of youth mental, emotional, and behavioral health issues.…”

Bipolarity and suicidal ideation in children and adolescents: a systematic review with meta-analysis

“…Based on the observation of previously presented data, it is possible to infer that the presence of BAD in children and adolescents is a risk factor for the use of psychoactive substances. They contribute to worsening of the mental disorder condition due to humor alteration, whether it is during intoxication or during the abstinence phase or even due to the decrease of treatment adhesion [19]. Table 2 includes the main risk factors for the development of suicidal ideation in the BD.…”

“…They contribute to worsening of the mental disorder condition due to humor alteration, whether it is during intoxication or during the abstinence phase or even due to the decrease of treatment adhesion [19]. Table 2 includes the main risk factors for the development of suicidal ideation in the BD.…”

Cognitive vulnerabilities and development of suicidal thinking in children of depressed mothers: A longitudinal investigation

“…First, HSC has been shown to exhibit lower internal consistency when utilized with nonclinical samples, compared to clinical samples (e.g., Prinstein et al, 2008;Spirito et al, 1988). Second, a comparison of the studies that utilized HSC in child versus adolescent samples reveals a generally lower internal consistency of the scale in children (e.g., Weinstein et al, 2015), compared to adolescents (e.g., Prinstein et al, 2008). Finally, a surprisingly large number of studies that have utilized HSC have not reported the internal consistency of the measure in their sample (e.g., Aglan et al, 2008;Hetrick et al, 2011;Yilmaz & Turkum, 2008).…”

“…Further, a recent study found that self-esteem was a unique predictor of SI in children with bipolar disorder (Weinstein et al, 2015). However, it is unclear whether children's self-perceived competence in social or academic domains, or their more global levels of perceived self-worth, prospectively predicts first onsets of SI.…”