Article

Predictors of Prospectively Examined Suicide Attempts Among Youth With Bipolar Disorder

Archives of general psychiatry (Impact Factor: 14.48). 07/2012; 69(11):1-10. DOI: 10.1001/archgenpsychiatry.2012.650
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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.

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Available from: Heather Hower, Sep 24, 2014
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    • "Predictor variables were selected using a priori knowledge. Notably, the majority of clinical variables selected were related to psychiatric comorbidities (Almeida et al., 2012; Bhui et al., 2012; Blackmore et al., 2008; Blanco et al., 2012; Bostwick and Pankratz, 2000; Bottlender et al., 2000; De Araújo et al., 2015; Foley et al., 2006; Galfalvy et al., 2006; Goes et al., 2012; Goldstein et al., 2012; Gonzalez-Pinto et al., 2006; Holma et al., 2014; Isometsä et al., 2014; Johnson et al., 1991; Katz et al., 2011; Lenze et al., 2000; Morina et al., 2013; Neves et al., 2009; Oquendo et al., 2010; Schaffer et al., 2014a, 2014b; Simon et al., 2004; Soloff et al., 2000; Stein, 2006; Torres et al., 2011; Webb et al., 2014), given the recent findings that effects of mental disorders on the risk of suicide attempt were exerted almost exclusively through a general psychopathology factor representing the shared effect across all mental disorders (Hoertel et al., 2015). As a result, we implemented a set of algorithms that are able to integrate the information from multiple variables to subsequently identify an individual patient's probability or risk of being a suicide attempter. "
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    ABSTRACT: Objective: A growing body of evidence has put forward clinical risk factors associated with patients with mood disorders that attempt suicide. However, what is not known is how to integrate clinical variables into a clinically useful tool in order to estimate the probability of an individual patient attempting suicide. Method: A total of 144 patients with mood disorders were included. Clinical variables associated with suicide attempts among patients with mood disorders and demographic variables were used to 'train' a machine learning algorithm. The resulting algorithm was utilized in identifying novel or 'unseen' individual subjects as either suicide attempters or non-attempters. Three machine learning algorithms were implemented and evaluated. Results: All algorithms distinguished individual suicide attempters from non-attempters with prediction accuracy ranging between 65% and 72% (p<0.05). In particular, the relevance vector machine (RVM) algorithm correctly predicted 103 out of 144 subjects translating into 72% accuracy (72.1% sensitivity and 71.3% specificity) and an area under the curve of 0.77 (p<0.0001). The most relevant predictor variables in distinguishing attempters from non-attempters included previous hospitalizations for depression, a history of psychosis, cocaine dependence and post-traumatic stress disorder (PTSD) comorbidity. Conclusion: Risk for suicide attempt among patients with mood disorders can be estimated at an individual subject level by incorporating both demographic and clinical variables. Future studies should examine the performance of this model in other populations and its subsequent utility in facilitating selection of interventions to prevent suicide.
    Full-text · Article · Mar 2016 · Journal of Affective Disorders
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    • "The 10 year prevalence of suicide attempts in patients with major depression (26.5%) found in this study is higher than the lifetime prevalence of around 16% in people with MDD reported in clinic-based studies in some high-income countries [38]. However, the finding on bipolar disorder is comparable with other reports where up to 29% of patients with bipolar disorder are estimated to attempt suicide at least once in their life-time [39], with one study reporting a five year prevalence of 18% [40]. A European longitudinal study of bipolar disorder patients reported lifetime prevalence of suicide attempt of 29.9%, which is comparable to this study finding and that the risk for suicide attempt increases with increased duration of illness [17]. "
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    ABSTRACT: Background People with severe mental disorders (SMD) are at higher risk of suicide. However, research into suicide attempts and completed suicide in people with SMD in low- and middle-income countries is mostly limited to patients attending psychiatric facilities where selection bias is likely to be high. Methods A population-based cohort of 919 people with SMD from rural Ethiopia (who received standardized clinician diagnoses of schizophrenia (n = 358) major depressive disorder (n = 216) and bipolar I disorder (n = 345)) were followed up annually for an average of 10 years. The Longitudinal Interval Follow-up Evaluation chart was administered by psychiatrists and used to evaluate systematically suicidal behavior and risk factors, which may be amenable to intervention. Results Over the follow-up period, the cumulative risk of suicide attempt was 26.3% for major depression, 23.8% for bipolar I disorder and 13.1% for schizophrenia, (p < 0.001). The overall incidence of completed suicide was 200.2/100,000 person-years (CI = 120.6, 312.5). Hanging was the most frequent method used (71.5%) for both attempters and completers. Most people who completed suicide were successful on the first attempt (84.2%), but the case-fatality rate for suicide attempt was 9.7%. In the adjusted logistic regression model, being currently married (Adjusted OR) =2.17, 95% CI = 1.21, 3.91), and having a diagnosis of bipolar I disorder (Adjusted OR = 2.59, 95% CI = 1.57, 4.26) or major depression (Adjusted OR = 2.71, 95% CI = 1.60, 4.58) were associated significantly with increased risk of suicide attempts. Conclusion In this sample of people with SMD from a rural setting, the rate of suicide was high. Initiatives to integrate mental health service into primary care need to focus on limiting access to suicide methods in people with SMD in addition to expanding access to mental health care.
    Full-text · Article · May 2014 · BMC Psychiatry
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    • "Indeed, in one recent cross-sectional epidemiological study, adolescent suicidal thoughts and behavior were strongly associated with substance abuse and dependence (Nock et al., 2013). Support for this association in adolescents has also been reported in several longitudinal studies (Goldston et al., 2009; Goldstein et al., 2012; Rasic et al., 2013), and this relation has been observed to strengthen during the transition from late adolescence to early adulthood (Goldston et al., 2009). Indeed, the pronounced increase in adolescent suicide observed from 1960 to the 1980s has been attributed by some to the corresponding increase in substance use in this age group over this same time period (Institute of Medicine, 2002). "
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    ABSTRACT: Objective: Based on the interpersonal theory of suicide, pain habituation that occurs with injection substance use may raise risk for a suicide attempt. The current study tested whether injection substance use, relative to painless routes of substance administration, was related to greater risk for suicide attempts. We also assessed whether this risk was specific to suicide attempts and not suicidal ideation or suicide plans. Methods: Data on 2095 substance-using adolescents aged 12-17 who endorsed clinically significant depression symptoms and answered questions on suicidal thoughts and behavior were drawn from the 2004-2011 National Survey on Drug Use and Health, a nationally representative household survey. Logistic regression analyses were conducted to assess the associations between injection substance use and suicidal ideation, plans, and attempts. Results: Injection substance use was associated with suicide attempts (OR = 3.02, 95% CI = 1.75-5.23) but not ideation or plans. These findings were not accounted for by sex, age, race/ethnicity, family income, abuse and dependence symptoms, and depression symptoms. Among ideators, injection substance use was associated with suicide attempts (OR = 2.92, 95% CI = 1.58-5.06), but not plans. Among suicide planners, injection substance use was associated with suicide attempts (OR = 5.16, 95% CI = 1.88-14.17). Conclusion: Consistent with the interpersonal theory of suicide, adolescent injection drug use was associated with specific risk for suicide attempts but not ideation or planning. Hence, consideration of the manner in which adolescents use substances is important in evaluating suicide risk in this population.
    Full-text · Article · May 2014 · Journal of Psychiatric Research
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