Department of Clinical Neuroscience/Psychology, Karolinska Institutet, Stockholm, Sweden.
Centre for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden.
JAMA Psychiatry. 2023 Aug 1;80(8):796-802. doi: 10.1001/jamapsychiatry.2023.1390.
The association of early diagnosis and management of bipolar disorder with adolescent suicide mortality (ASM) is unknown.
To assess regional associations between ASM and bipolar disorder diagnosis frequencies.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study investigated the association between annual regional ASM and bipolar disorder diagnosis rates in Swedish adolescents aged 15 to 19 years in January 1, 2008, through December 31, 2021. Aggregated data without exclusions reported at the regional level encompassed 585 suicide deaths, constituting 588 unique observations (ie, 21 regions, 14 years, 2 sexes).
Bipolar disorder diagnosis frequencies and lithium dispensation rates were designated as fixed-effects variables (interaction term in the case of males). An interaction term between psychiatric care affiliation rates and the proportion of psychiatric visits to inpatient and outpatient clinics constituted independent fixed-effects variables. Region and year comprised random intercept effect modifiers. Variables were population adjusted and corrected for heterogeneity in reporting standards.
The main outcomes were sex-stratified, regional, and annual ASM rates in adolescents aged 15 to 19 years per 100 000 inhabitants as analyzed using generalized linear mixed-effects models.
Female adolescents were diagnosed with bipolar disorder almost 3 times more often than male adolescents (mean [SD], 149.0 [19.6] vs 55.3 [6.1] per 100 000 inhabitants, respectively). Median regional prevalence rates of bipolar disorder varied over the national median by a factor of 0.46 to 2.61 and 0.00 to 1.82 in females and males, respectively. Bipolar disorder diagnosis rates were inversely associated with male ASM (β = -0.00429; SE, 0.002; 95% CI, -0.0081 to -0.0004; P = .03) independent of lithium treatment and psychiatric care affiliation rates. This association was replicated by β-binomial models of a dichotomized quartile 4 ASM variable (odds ratio, 0.630; 95% CI, 0.457-0.869; P = .005), and both models were robust after adjusting for annual regional diagnosis rates of major depressive disorder and schizophrenia. No such association was observed in females.
In this cross-sectional study, lower suicide death rates in adolescent males was robustly associated with regional diagnosis rates of bipolar disorder at an estimated magnitude of approximately 4.7% of the mean national suicide death rate. The associations could be due to treatment efficacy, early diagnosis and management, or other factors not accounted for.
双相障碍的早期诊断和管理与青少年自杀死亡率（ASM）之间的关联尚不清楚。
评估 ASM 与双相障碍诊断频率之间的区域相关性。
设计、地点和参与者：本横断面研究调查了 2008 年 1 月 1 日至 2021 年 12 月 31 日期间，瑞典 15 至 19 岁青少年的年度区域 ASM 与双相障碍诊断率之间的相关性。汇总数据没有排除在区域层面报告的数据，涵盖了 585 例自杀死亡，构成了 588 个独特观察值（即 21 个地区、14 年、2 性）。
双相障碍诊断频率和锂分配率被指定为固定效应变量（男性为交互项）。精神病护理隶属率与精神病门诊和住院门诊就诊比例之间的交互项构成了独立的固定效应变量。区域和年份构成随机截距效应修饰符。对变量进行了人口调整，并校正了报告标准的异质性。
主要结果是使用广义线性混合效应模型分析的 15 至 19 岁青少年每 10 万人中男女青少年的区域和年度 ASM 率。
女性青少年患双相障碍的诊断率几乎是男性青少年的 3 倍（分别为每 10 万人中有 149.0[19.6]和 55.3[6.1]）。双相障碍的区域中位流行率在全国中位数的基础上差异很大，女性为 0.46 至 2.61，男性为 0.00 至 1.82。双相障碍诊断率与男性 ASM 呈负相关（β=-0.00429；SE，0.002；95%CI，-0.0081 至-0.0004；P=0.03），独立于锂治疗和精神病护理隶属率。这种关联通过二项式模型的四分位数 4 ASM 变量得到了复制（比值比，0.630；95%CI，0.457-0.869；P=0.005），并且在调整了年度区域主要抑郁障碍和精神分裂症诊断率后，这两种模型都很稳健。在女性中未观察到这种关联。
在这项横断面研究中，男性青少年自杀死亡率较低与双相障碍的区域诊断率之间存在稳健的关联，其估计幅度约为全国平均自杀死亡率的 4.7%。这种关联可能是由于治疗效果、早期诊断和管理或其他未被考虑的因素所致。
