Two factors predict suicide in teens with bipolar disorder



ORLANDO – History of self-harm and suicidal ideation are two strong indicators that a teen with bipolar disorder might attempt suicide, according to an unpublished Canadian study presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Identifying such clinical features is important as they can help with intervention and prevention of suicide among teens with bipolar disorder, the researchers wrote.

Dr. Benjamin Goldstein

Previous studies have shown that adults with bipolar disorder (BD) are at a higher risk of completing suicide – as many as 25%-50% of them make at least one suicide attempt in their lifetime, and up to 20% complete the attempt.

Meanwhile, studies of pediatric patients have shown a lifetime suicide attempt rate of 20%-50%. Yet there is limited research on teens, Dr. Benjamin I. Goldstein of Sunnybrook Health Sciences Centre, Toronto, and his colleagues wrote in their poster.

A 2013 systemic review of suicidal ideation and suicide attempts by children and teenagers with bipolar disorder showed that the issue is underinvestigated. "Exploration of predictors and protective factors is imperative for the establishment of effective preventive and intervention strategies, which are urgently needed," researchers at Zucker Hillside Hospital, Glen Oaks, N.Y., wrote (Bipolar Disord. 2013;15:507-23).

Dr. Goldstein and his colleagues studied 72 teenagers aged 13-19 years who had bipolar I disorder, bipolar II disorder, or bipolar disorder not otherwise specified.

The 20% of patients who reported having attempted suicide were significantly more likely to be female and to have lower socioeconomic status, more self-harm behavior, suicide ideation, a lifetime history of conduct disorder, bulimia nervosa, lifetime lamotrigine use, and a family history of suicide attempts. That’s compared with teens who did not attempt a suicide.

The multivariate analyses showed that history of self-injurious behavior and family history of suicide attempts was strongly associated with suicide attempts. And when comparing the findings from previous studies and the current study, the researchers found that they all shared history of self-injurious behavior and suicidal ideation.

The analyses had limited power to detect small effect sizes, and "the cross-sectional methodology precludes conclusions regarding the directionality of the observed associations," Dr. Goldstein and his colleagues wrote.

They added that future studies should examine whether the characteristics found in the study can be incorporated in assessment and treatment of youth with bipolar disorder to help reduce the risk of suicide in this high-risk population.

Dr. Goldstein is a consultant for Bristol-Myers Squibb and has received honoraria from Purdue Pharma.

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