Suicidal ideation and suicide attempts in children and adolescents with bipolar disorder: a systematic review of prevalence and incidence rates, correlates, and targeted interventions

Authors

  • Marta Hauser,

    1. The Zucker Hillside Hospital, Glen Oaks, NY, USA
    2. The Feinstein Institute for Medical Research, Manhasset, NY, USA
    3. Hofstra North Shore LIJ School of Medicine, Hempstead, NY, USA
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  • Britta Galling,

    1. Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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  • Christoph U Correll

    Corresponding author
    1. The Feinstein Institute for Medical Research, Manhasset, NY, USA
    2. Hofstra North Shore LIJ School of Medicine, Hempstead, NY, USA
    3. Albert Einstein College of Medicine, Bronx, NY, USA
    • The Zucker Hillside Hospital, Glen Oaks, NY, USA
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Corresponding author:

Christoph U. Correll, M.D.

Division of Psychiatry Research

The Zucker Hillside Hospital

75-59 263rd Street

Glen Oaks, NY 11004

USA

Fax: 718-343-1659

E-mail: ccorrell@lij.edu

Abstract

Objective

Pediatric bipolar disorder (PBD) is associated with poor outcomes, including suicidal ideation (SI) and suicide attempt (SA). However, frequencies and risk factors of SI/SA and targeted intervention trials for SI/SA in PBD have not been reviewed systematically.

Methods

We conducted a systematic PubMed review, searching for articles reporting on prevalences/incidences, correlates and intervention studies targeting SI/SA in PBD. Weighted means were calculated, followed by an exploratory meta-regression of SI and SA correlates.

Results

Fourteen studies (n = 1595), in which 52.1% of patients were male and the mean age was 14.4 years, reported data on SI/SA prevalence (N = 13, n = 1508) and/or correlates (N = 10, n = 1348) in PBD. Weighted mean prevalences were: past SI = 57.4%, past SA = 21.3%, current SI = 50.4%, and current SA = 25.5%; incidences (mean 42 months of follow-up) were: SI = 14.6% and SA = 14.7%. Regarding significant correlates, SI (N = 3) was associated with a higher percentage of Caucasian race, narrow (as opposed to broad) PBD phenotype, younger age, and higher quality of life than SA. Significant correlates of SA (N = 10) included female sex, older age, earlier illness onset, more severe/episodic PBD, mixed episodes, comorbid disorders, past self-injurious behavior/SI/SA, physical/sexual abuse, parental depression, family history of suicidality, and poor family functioning. Race, socioeconomic status, living situation, and life events were not clearly associated with SA. In a meta-regression analysis, bipolar I disorder and comorbid attention-deficit hyperactivity disorder were significantly associated with SA. Only one open label study targeting the reduction of SI/SA in PBD was identified.

Conclusions

SI and SA are very common but under-investigated in PBD. Exploration of predictors and protective factors is imperative for the establishment of effective preventive and intervention strategies, which are urgently needed.

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