Goldstein Tina R, Birmaher Boris, Axelson David, Ryan Neal D, Strober Michael A, Gill Mary Kay, Valeri Sylvia, Chiappetta Laurel, Leonard Henrietta, Hunt Jeffrey, Bridge Jeffrey A, Brent David A, Keller Martin
Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Bipolar Disord. 2005 Dec;7(6):525-35. doi: 10.1111/j.1399-5618.2005.00263.x.
Despite evidence indicating high morbidity associated with pediatric bipolar disorder (BP), little is known about the prevalence and clinical correlates of suicidal behavior among this population.
To investigate the prevalence of suicidal behavior among children and adolescents with BP, and to compare subjects with a history of suicide attempt to those without on demographic, clinical, and familial risk factors.
Subjects were 405 children and adolescents aged 7-17 years, who fulfilled DSM-IV criteria for BPI (n = 236) or BPII (n = 29), or operationalized criteria for BP not otherwise specified (BP NOS; n = 140) via the Schedule for Affective Disorders and Schizophrenia for School-Aged Children. As part of a multi-site longitudinal study of pediatric BP (Course and Outcome of Bipolar Youth), demographic, clinical, and family history variables were measured at intake via clinical interview with the subject and a parent/guardian.
Nearly one-third of BP patients had a lifetime history of suicide attempt. Attempters, compared with non-attempters, were older, and more likely to have a lifetime history of mixed episodes, psychotic features, and BPI. Attempters were more likely to have a lifetime history of comorbid substance use disorder, panic disorder, non-suicidal self-injurious behavior, family history of suicide attempt, history of hospitalization, and history of physical and/or sexual abuse. Multivariate analysis found that the following were the most robust set of predictors for suicide attempt: mixed episodes, psychosis, hospitalization, self-injurious behavior, panic disorder, and substance use disorder.
These findings indicate that children and adolescents with BP exhibit high rates of suicidal behavior, with more severe features of BP illness and comorbidity increasing the risk for suicide attempt. Multiple clinical factors emerged distinguishing suicide attempters from non-attempters. These clinical factors should be considered in both assessment and treatment of pediatric BP.
尽管有证据表明儿童双相情感障碍（BP）的发病率很高，但对于该人群中自杀行为的患病率及临床相关因素却知之甚少。
调查患有双相情感障碍的儿童和青少年中自杀行为的患病率，并比较有自杀未遂史的受试者与无自杀未遂史的受试者在人口统计学、临床和家族风险因素方面的差异。
研究对象为405名年龄在7至17岁之间的儿童和青少年，他们符合双相情感障碍I型（BPI，n = 236）或双相情感障碍II型（BPII，n = 29）的DSM-IV标准，或通过学龄儿童情感障碍和精神分裂症检查表符合未另行规定的双相情感障碍（BP NOS，n = 140）的操作性标准。作为儿童双相情感障碍多中心纵向研究（双相情感障碍青少年的病程和结局）的一部分，在入组时通过对受试者及其父母/监护人进行临床访谈来测量人口统计学、临床和家族史变量。
近三分之一的双相情感障碍患者有过自杀未遂史。与未尝试自杀者相比，自杀未遂者年龄更大，更有可能有混合发作、精神病性特征和双相情感障碍I型的终生病史。自杀未遂者更有可能有共病物质使用障碍、惊恐障碍、非自杀性自伤行为、自杀未遂家族史、住院史以及身体和/或性虐待史。多变量分析发现，以下是自杀未遂最强有力的一组预测因素：混合发作、精神病、住院、自伤行为、惊恐障碍和物质使用障碍。
这些发现表明，患有双相情感障碍的儿童和青少年自杀行为发生率很高，双相情感障碍疾病的更严重特征和共病会增加自杀未遂的风险。出现了多个临床因素来区分自杀未遂者和未尝试自杀者。在儿童双相情感障碍的评估和治疗中均应考虑这些临床因素。
