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Suicidal ideation and suicide attempts in children and adolescents with bipolar disorder: a systematic review of prevalence and incidence rates, correlates, and targeted interventions
Author(s) -
Hauser Marta,
Galling Britta,
Correll Christoph U
Publication year - 2013
Publication title -
bipolar disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.285
H-Index - 129
eISSN - 1399-5618
pISSN - 1398-5647
DOI - 10.1111/bdi.12094
Subject(s) - suicidal ideation , bipolar disorder , suicide attempt , medicine , psychiatry , psychological intervention , bipolar i disorder , depression (economics) , poison control , family history , conduct disorder , clinical psychology , suicide prevention , mood , mania , environmental health , economics , macroeconomics
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 C aucasian 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.