Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada.
Department of Pharmacology, University of Toronto, Toronto, ON, Canada.
Eur Child Adolesc Psychiatry. 2023 Jan;32(1):41-51. doi: 10.1007/s00787-021-01803-9. Epub 2021 May 24.
There is high risk of suicidality in bipolar disorder (BD), particularly in early onset cases. The literature regarding correlates and putative predictors of suicide attempts (SA), non-suicidal self-injury (NSSI) and suicidal ideation (SI) among youth with BD remains sparse. Participants included 197 adolescents with BD, divided into 4 groups: SA (with or without NSSI), NSSI (with or without SI), SI only, and comparison group (CG; no SA/NSSI/SI). Diagnoses, treatment, and suicidality measures were determined via semi-structured interviews, conducted between 2009 and 2017. Univariate analyses were followed by multinomial regression. Overall, 73.6% of participants had history of SA, NSSI, and/or SI. In comparison to CG, SA and NSSI were each associated with BD-II/-NOS (odds ratio [OR] = 15.99, p = 0.002; OR = 16.76, p = 0.003), female sex (OR = 6.89, p = 0.006; OR = 3.76, p = 0.02), and emotion dysregulation (OR = 1.10, p < 0.001; OR = 1.07, p = 0.004). NSSI and SI were each associated with most severe lifetime depression (OR = 1.10, p = 0.01; OR = 1.10, p = 0.01). SA and SI were associated with psychiatric hospitalization (OR = 19.45, p = 0.001; OR = 6.09, p = 0.03). SA was associated with poorer global functioning at most severe episode (OR = 0.88, p = 0.008). NSSI was associated with not living with both natural parents (OR = 0.22, p = 0.009). Study limitations include cross-sectional and retrospective design, stringent cut-offs for SA and NSSI, and recruitment from a tertiary clinical setting. Three quarters of adolescents with BD have had suicidality and/or self-injury. SA and NSSI were most similar to one another, and most different from CG, supporting the broader construct of self-harm. Future research should address the gap in knowledge regarding how sex differences and neurobiology are associated with the observed clinical differences.
双相障碍（BD）患者自杀风险高，尤其是发病早的患者。关于 BD 青少年自杀未遂（SA）、非自杀性自伤（NSSI）和自杀意念（SI）的相关因素和可能的预测因素的文献仍然很少。参与者包括 197 名患有 BD 的青少年，分为 4 组：SA（有或无 NSSI）、NSSI（有或无 SI）、SI 仅和对照组（CG；无 SA/NSSI/SI）。通过 2009 年至 2017 年进行的半结构化访谈确定诊断、治疗和自杀相关评估。进行单变量分析后，再进行多项回归分析。总体而言，73.6%的参与者有过 SA、NSSI 和/或 SI 病史。与 CG 相比，SA 和 NSSI 分别与 BD-II/-NOS（比值比[OR] = 15.99，p = 0.002；OR = 16.76，p = 0.003）、女性（OR = 6.89，p = 0.006；OR = 3.76，p = 0.02）和情绪调节障碍（OR = 1.10，p < 0.001；OR = 1.07，p = 0.004）相关。NSSI 和 SI 分别与最严重的终生抑郁相关（OR = 1.10，p = 0.01；OR = 1.10，p = 0.01）。SA 和 SI 与精神病院住院相关（OR = 19.45，p = 0.001；OR = 6.09，p = 0.03）。SA 与最严重发作时的总体功能较差相关（OR = 0.88，p = 0.008）。NSSI 与未与亲生父母同住相关（OR = 0.22，p = 0.009）。研究局限性包括横断面和回顾性设计、SA 和 NSSI 的严格截止值以及从三级临床环境招募。四分之三的 BD 青少年有过自杀或自伤行为。SA 和 NSSI 彼此之间最相似，与 CG 最不同，这支持了自我伤害这一更广泛的概念。未来的研究应该解决关于性别差异和神经生物学如何与观察到的临床差异相关的知识差距。
