title: Predictors of prospectively examined suicide attempts among youth with bipolar disorder.
abstract: BACKGROUND
  Individuals with early onset of bipolar disorder are at high risk for suicide. Yet, no study to date has examined factors associated with prospective risk for suicide attempts among youth with bipolar disorder.
  
  
  OBJECTIVE
  To examine past, intake, and follow-up predictors of prospectively observed suicide attempts among youth with bipolar disorder.
  
  
  METHODS
  We interviewed subjects, on average, every 9 months over a mean of 5 years using the Longitudinal Interval Follow-up Evaluation.
  
  
  METHODS
  Outpatient and inpatient units at 3 university centers.
  
  
  METHODS
  A total of 413 youths (mean [SD] age, 12.6 [3.3] years) who received a diagnosis of bipolar I disorder (n=244), bipolar II disorder (n=28), or bipolar disorder not otherwise specified (n=141).
  
  
  METHODS
  Suicide attempt over prospective follow-up and past, intake, and follow-up predictors of suicide attempts.
  
  
  RESULTS
  Of the 413 youths with bipolar disorder, 76 (18%) made at least 1 suicide attempt within 5 years of study intake; of these, 31 (8% of the entire sample and 41% of attempters) made multiple attempts. Girls had higher rates of attempts than did boys, but rates were similar for bipolar subtypes. The most potent past and intake predictors of prospectively examined suicide attempts included severity of depressive episode at study intake and family history of depression. Follow-up data were aggregated over 8-week intervals; greater number of weeks spent with threshold depression, substance use disorder, and mixed mood symptoms and greater number of weeks spent receiving outpatient psychosocial services in the preceding 8-week period predicted greater likelihood of a suicide attempt.
  
  
  CONCLUSIONS
  Early-onset bipolar disorder is associated with high rates of suicide attempts. Factors such as intake depressive severity and family history of depression should be considered in the assessment of suicide risk among youth with bipolar disorder. Persistent depression, mixed presentations, and active substance use disorder signal imminent risk for suicidal behavior in this population.
authors: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pennsylvania 15213, USA. goldsteintr@upmc.edu
authors: Tina R
authors: TR
authors: Goldstein
authors: Wonho
authors: W
authors: Ha
authors: David A
authors: DA
authors: Axelson
authors: Benjamin I
authors: BI
authors: Goldstein
authors: Fangzi
authors: F
authors: Liao
authors: Mary Kay
authors: MK
authors: Gill
authors: Neal D
authors: ND
authors: Ryan
authors: Shirley
authors: S
authors: Yen
authors: Jeffrey
authors: J
authors: Hunt
authors: Heather
authors: H
authors: Hower
authors: Martin
authors: M
authors: Keller
authors: Michael
authors: M
authors: Strober
authors: Boris
authors: B
authors: Birmaher
mesh_terms: D000293:Adolescent; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010343:Patient Admission; D011446:Prospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013406:Suicide, Attempted / Q000517:prevention & control / Q000523:psychology* / Q000706:statistics & numerical data; D014481:United States