History of suicide attempts in pediatric bipolar disorder: factors associated with increased risk
History of suicide attempts in pediatric bipolar disorder: factors associated with increased risk
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DOI：
10.1111/j.1399-5618.2005.00263.x
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发表时间：
2005-12-01
影响因子：
5.4
通讯作者：
Keller, M
中科院分区：
文献类型：
--
作者：
Goldstein, TR;Birmaher, B;Keller, M
背景资料：尽管有证据表明儿童双相情感障碍（BP）的发病率很高，但对这一人群中自杀行为的患病率和临床相关性知之甚少。目的：调查儿童和青少年BP患者自杀行为的患病率，并比较有自杀企图史的受试者与无自杀企图史的受试者在人口统计学、临床和家族危险因素方面的差异。受试者为405名7-17岁的儿童和青少年，他们符合DSM-IV的BPI（n = 236）或BPII（n = 29）标准，或通过学龄儿童情感障碍和精神分裂症计划表未另行说明的BP（BP NOS; n = 140）操作标准。作为一个多站点的纵向研究的儿科BP（双相青年的过程和结果）的一部分，人口统计学，临床和家族史变量进行了测量，在摄入量通过临床采访的主题和父母/guardian.Results：近三分之一的BP患者有自杀企图的一生史。与非尝试者相比，尝试者年龄更大，并且更有可能终生有混合发作、精神病特征和BPI病史。企图自杀者更可能有共病物质使用障碍、惊恐障碍、非自杀性自伤行为、自杀企图家族史、住院史以及身体和/或性虐待史的终生病史。多变量分析发现，以下是最强大的一套预测自杀企图：混合发作，精神病，住院治疗，自伤行为，恐慌症，和substance use disorder.Conclusions：这些研究结果表明，儿童和青少年与BP表现出较高的自杀行为率，更严重的功能BP疾病和合并症增加自杀企图的风险。多种临床因素出现区分自杀未遂者和非自杀未遂者。在评估和治疗儿童BP时应考虑这些临床因素。
Background: Despite evidence indicating high morbidity associated with pediatric bipolar disorder (BP), little is known about the prevalence and clinical correlates of suicidal behavior among this population.Objective: To investigate the prevalence of suicidal behavior among children and adolescents with BP, and to compare subjects with a history of suicide attempt to those without on demographic, clinical, and familial risk factors.Methods: Subjects were 405 children and adolescents aged 7-17 years, who fulfilled DSM-IV criteria for BPI (n = 236) or BPII (n = 29), or operationalized criteria for BP not otherwise specified (BP NOS; n = 140) via the Schedule for Affective Disorders and Schizophrenia for School-Aged Children. As part of a multi-site longitudinal study of pediatric BP (Course and Outcome of Bipolar Youth), demographic, clinical, and family history variables were measured at intake via clinical interview with the subject and a parent/guardian.Results: Nearly one-third of BP patients had a lifetime history of suicide attempt. Attempters, compared with non-attempters, were older, and more likely to have a lifetime history of mixed episodes, psychotic features, and BPI. Attempters were more likely to have a lifetime history of comorbid substance use disorder, panic disorder, non-suicidal self-injurious behavior, family history of suicide attempt, history of hospitalization, and history of physical and/or sexual abuse. Multivariate analysis found that the following were the most robust set of predictors for suicide attempt: mixed episodes, psychosis, hospitalization, self-injurious behavior, panic disorder, and substance use disorder.Conclusions: These findings indicate that children and adolescents with BP exhibit high rates of suicidal behavior, with more severe features of BP illness and comorbidity increasing the risk for suicide attempt. Multiple clinical factors emerged distinguishing suicide attempters from non-attempters. These clinical factors should be considered in both assessment and treatment of pediatric BP.