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

Papolos D, Hennen J, Cockerham MS

The Juvenile Bipolar Research Foundation, 550 Ridgewood Road, Maplewood, NJ 07040, USA.

BACKGROUND: It has recently been suggested that indicators of suicidality in youth may differ for different diagnostic groups []. 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.

Published 6 June 2005 in J Affect Disord, 86(2): 267-75.
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