Predictors of Prospectively Examined Suicide Attempts Among Youth With Bipolar Disorder

Abstract

Context Individuals with early onset of bipolar disorder are at high risk for suicide. Yet, no study to date has examined factors associated with prospective risk for suicide attempts among youth with bipolar disorder. Objective To examine past, intake, and follow-up predictors of prospectively observed suicide attempts among youth with bipolar disorder. Design We interviewed subjects, on average, every 9 months over a mean of 5 years using the Longitudinal Interval Follow-up Evaluation. Setting Outpatient and inpatient units at 3 university centers. Participants A total of 413 youths (mean [SD] age, 12.6 [3.3] years) who received a diagnosis of bipolar I disorder (n=244), bipolar II disorder (n=28), or bipolar disorder not otherwise specified (n=141). Main Outcome Measures Suicide attempt over prospective follow-up and past, intake, and follow-up predictors of suicide attempts. Results Of the 413 youths with bipolar disorder, 76 (18%) made at least 1 suicide attempt within 5 years of study intake; of these, 31 (8% of the entire sample and 41% of attempters) made multiple attempts. Girls had higher rates of attempts than did boys, but rates were similar for bipolar subtypes. The most potent past and intake predictors of prospectively examined suicide attempts included severity of depressive episode at study intake and family history of depression. Follow-up data were aggregated over 8-week intervals; greater number of weeks spent with threshold depression, substance use disorder, and mixed mood symptoms and greater number of weeks spent receiving outpatient psychosocial services in the preceding 8-week period predicted greater likelihood of a suicide attempt. Conclusions Early-onset bipolar disorder is associated with high rates of suicide attempts. Factors such as intake depressive severity and family history of depression should be considered in the assessment of suicide risk among youth with bipolar disorder. Persistent depression, mixed presentations, and active substance use disorder signal imminent risk for suicidal behavior in this population.

Clinical and genetic factors associated with suicide in mood disorder patients

“…Past suicide attempters were more likely to be current smokers, and this is also in line with other studies [8,98]. With regard to clinical characteristics that are associated with suicide, we found higher depression severity in the suicide attempters group, consistently with recent literature [13,20,28] that indicates symptoms like hopelessness and longer periods spent in depressed mood as substantial risk factors for suicidality. In fact, suicide attempts in BD are more likely to occur during depressive and mixed phases of the illness [30].…”

“…The main demographic feature involved in increasing risk of suicide attempts is the female gender, whereas males are more likely to have a completed suicide [9][10][11]. Clinical factors that increase the risk of suicide attempt include: early onset of disease [12], high severity of depressive episodes [13], longer period of undiagnosed and untreated illness [14] and discontinuation of antidepressants [15]. A considerable number of studies relate suicide attempts and completions to feelings of hopelessness and higher scores on subjective depression levels [16][17][18][19][20][21].…”

Bipolar disorders: is there an influence of seasonality or photoperiod?

“…[28][29][30] However, we found no significant difference between bipolar patients and those with other diagnoses, in contrast with the literature. 30,31 This might be explained by the different suicide risk rates of the psychiatric disorders included in the mixed control group.…”

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013

“…(232). Predictive variables included female gender, severity of depressive symptoms, familial history of depression, and lifetime history of exposure to antidepressants.…”