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Bipolar disorder associated with high rates of suicide in youth

Early-onset of bipolar disorder was associated with high rates of suicide attempts, data showed.

Tina R. Goldstein, PhD, assistant professor at the University of Pittsburgh School of Medicine, and colleagues interviewed 413 children and adolescents aged 7 to 17 years who had a primary diagnosis of bipolar I disorder (n=244), bipolar II disorder (n=28) or bipolar disorder not otherwise specified (n=141). All participants met DSM-IV criteria for bipolar disorder, and youths with schizophrenia, mental retardation, autism spectrum disorder or mood disorders secondary to substances, medications or medical illness were excluded from the study.

The researchers interviewed participants, on average, every 9 months over a mean total of 5 years, assessing symptoms and diagnoses with the Longitudinal Interval Follow-up evaluation.

Among the 413 participants with bipolar disorder, 18% made at least one suicide attempt within a mean of 5 years of study intake. Of those, 41% (8% of the entire sample) made multiple attempts, combining for a total of 163 suicide attempts in the entire sample to date. Ninety-four of the 163 suicide attempts (58%) were made when subjects reported they were taking prescribed psychotropic medication.

Controlling for sex, the researchers found that depressive severity (HR=1.03; 95% CI 1.01-1.06; P=.01) and family history of depression (HR=3.8; 95% CI, 1.19-12.6; P=.02) were significantly associated with an increased risk of a prospectively examined suicide attempt. More weeks spent in the preceding 8-week period with depression (HR=1.02; 95% CI, 1.01-1.03; P<.001), mixed symptoms (HR=1.01; 95% CI, 1.0-1.02; P=.05), substance use disorder (HR=1.01; 95% CI, 1.01-1.02; P<.001) and more weeks receiving outpatient psychosocial services (HR=1.01; 95% CI, 1.00-1.01; P=.02) predicted greater likelihood of a suicide attempt.

“These prospective data indicate pediatric bipolar disorder is associated with high rates of suicide attempts,” the researchers wrote. “These findings highlight the importance of suicide prevention strategies in youth with bipolar disorder, including frequent and thorough suicide risk assessment and safety planning. Clinicians treating youth with bipolar disorder should attend to intake depressive severity and to family history of depression when considering the prospective risk for suicidal behavior.”

Disclosure: See study for full list of financial disclosures.