title: Suicidal ideation and suicide attempts in children and adolescents with bipolar disorder: a systematic review of prevalence and incidence rates, correlates, and targeted interventions.
abstract: OBJECTIVE
  Pediatric bipolar disorder (PBD) is associated with poor outcomes, including suicidal ideation (SI) and suicide attempt (SA). However, frequencies and risk factors of SI/SA and targeted intervention trials for SI/SA in PBD have not been reviewed systematically.
  
  
  METHODS
  We conducted a systematic PubMed review, searching for articles reporting on prevalences/incidences, correlates and intervention studies targeting SI/SA in PBD. Weighted means were calculated, followed by an exploratory meta-regression of SI and SA correlates.
  
  
  RESULTS
  Fourteen studies (n = 1595), in which 52.1% of patients were male and the mean age was 14.4 years, reported data on SI/SA prevalence (N = 13, n = 1508) and/or correlates (N = 10, n = 1348) in PBD. Weighted mean prevalences were: past SI = 57.4%, past SA = 21.3%, current SI = 50.4%, and current SA = 25.5%; incidences (mean 42 months of follow-up) were: SI = 14.6% and SA = 14.7%. Regarding significant correlates, SI (N = 3) was associated with a higher percentage of Caucasian race, narrow (as opposed to broad) PBD phenotype, younger age, and higher quality of life than SA. Significant correlates of SA (N = 10) included female sex, older age, earlier illness onset, more severe/episodic PBD, mixed episodes, comorbid disorders, past self-injurious behavior/SI/SA, physical/sexual abuse, parental depression, family history of suicidality, and poor family functioning. Race, socioeconomic status, living situation, and life events were not clearly associated with SA. In a meta-regression analysis, bipolar I disorder and comorbid attention-deficit hyperactivity disorder were significantly associated with SA. Only one open label study targeting the reduction of SI/SA in PBD was identified.
  
  
  CONCLUSIONS
  SI and SA are very common but under-investigated in PBD. Exploration of predictors and protective factors is imperative for the establishment of effective preventive and intervention strategies, which are urgently needed.
authors.affiliation: The Zucker Hillside Hospital, Glen Oaks, NY 11004, USA.
authors.forename: Marta
authors.initials: M
authors.lastname: Hauser
authors.forename: Britta
authors.initials: B
authors.lastname: Galling
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
mesh_terms: D000293:Adolescent; D001714:Bipolar Disorder / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D002648:Child; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D015995:Prevalence; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data
keywords: adolescents; bipolar disorder; children; incidence; interventions; predictors; prevalence; risk factors; suicidal ideation; suicidality; suicide attempt