Mood, Substance Use and Suicidality in Bipolar Adolescents: A Prospective Study

描述(申请人提供)：青少年自杀是一个重大的公共卫生问题，是全球青少年死亡的第二大原因。在所有青少年精神障碍中，双相情感障碍的自杀风险最大，其次是物质使用障碍。情绪障碍和物质使用障碍通常是同时发生的，而且这两种障碍的结合比单独使用任何一种障碍都会成倍增加青少年完全自杀的风险。不幸的是，有效的自杀预防努力仍然有限，特别是对有情绪障碍和药物使用的超高危青年群体。治疗研究中的这一空白可以通过以下发现来理解：来自不同领域的多种因素有助于自杀风险；这些因素仍然过于分散，而且被认为是预防干预的最佳目标。因此，该领域的专家呼吁对高危样本进行前瞻性、纵向研究，以系统地调查青少年自杀风险的具体机制。美国自杀学协会明确指出，有必要对药物使用的近端、动态和可改变因素进行研究--为高危人群提供有针对性的预防方法。 与公共卫生相关：青年自杀是一个重大的公共卫生问题，是全世界青年死亡的第二大原因。在所有精神障碍中，双相情感障碍具有最大的自杀风险，其次是物质使用障碍。情绪障碍和物质使用障碍通常是同时发生的，而且这两种障碍的结合比单独使用任何一种障碍都会成倍增加青少年完全自杀的风险。加强对这些相互关联的风险因素性质的了解，有可能为最高风险人群提供有针对性的自杀预防工作，从而减少与青少年自杀有关的发病率、死亡率和痛苦。

DESCRIPTION (provided by applicant): Youth suicide constitutes a major public health problem, ranking as the second leading cause of death for youth worldwide. Of all psychiatric disorders in youth, bipolar disorder imparts the greatest risk for suicide, followed by a substance use disorder. Mood disorder and substance use disorders commonly co-occur, and the combination increase the risk for completed suicide in adolescents exponentially over either disorder alone. Unfortunately, effective suicide prevention efforts, particularly for the ultra-high-risk population of youth with mood disorder and substance use, remain limited. This void in the treatment research may be understood by findings that a multitude of factors from a variety of domains contribute to suicidal risk; such factors remain too diffuse and multiply determined to be considered optimal targets for preventive interventions. Experts in the field have thus called for prospective, longitudinal studies in high-risk samples to systematically investigate specific mechanisms of suicide risk in adolescents. The American Association of Suicidology has specifically identified a need for research on proximal, dynamic and modifiable factors for substance use-to inform targeted preventive approaches for high-risk populations. PUBLIC HEALTH RELEVANCE: Youth suicide constitutes a major public health problem, ranking as the second leading cause of death for young people worldwide. Of all psychiatric disorders, bipolar disorder imparts the greatest risk for suicide, followed by a substance use disorder. Mood disorders and substance use disorders commonly co-occur, and the combination increases the risk for completed suicide in adolescents exponentially over either disorder alone. Improved understanding of the nature of these interrelated risk factors has the potential to inform targeted suicide prevention efforts for those at highest risk, thereby decreasing the morbidity, mortality and suffering associated with youth suicide.