Factors associated with parent-reported suicide threats by children and adolescents with community-diagnosed bipolar disorder

Abstract

Background It has recently been suggested that indicators of suicidality in youth may differ for different diagnostic groups [ Horesh, N., Orbach, I., Gothelf, D., Efrati, M., Apter, A., 2003. Comparison of the suicidal behavior of adolescent inpatients with borderline personality disorder and major depression, J. Nerv. Ment. Dis. 191, 582–588.]. Aggression, impulsivity and risk-taking behaviors may be strong indicators of suicidality in children and adolescents with symptoms of bipolar disorder. Methods Parents completed the Child Bipolar Questionnaire (CBQ) via a secure, Internet-based data acquisition system. In multivariate modeling analyses, with age and sex as covariates, CBQ items that were most closely correlated with parent-reported suicide threat were identified. The strength of this multifactor association was then examined among subjects reported to have a community diagnosis of bipolar disorder compared to those who did not. Results In order of strength of association, the CBQ items most closely correlated with parent-reported suicide threat were: hallucinations, cursing/foul language, low energy/withdrawal, imagery—gore/violence, destroys property, poor self-esteem, excessive risk-taking, and excessive anxiety/worry. Of these 8 CBQ items, 3 (low energy, poor self-esteem, and anxiety/worry) have a dysphoric orientation, but the items with the strongest associations are related to psychosis, aggression and impulsivity. The association of the 8 CBQ items with suicidal threats was found to be much stronger in subjects with a reported prior or current bipolar diagnosis, compared with all other subjects. Limitations Child report data is not available. Parent report data has not yet been validated by research diagnostic interview. Conclusions The presence of aggression and impulsivity are importantly related to suicidal threats independently of the risk associated with dysphoria in children and adolescents who have been assigned a diagnosis of bipolar disorder or exhibit some symptoms of the disorder. This may have implications for treatment with antidepressant medication when the diagnosis of bipolar disorder may be present.