Suicidal ideation (SI) is significantly higher for youth with pediatric bipolar disorder (PBD), yet clinical correlates of suicidality remain poorly understood in this population. The current study investigates how change in risk factors for SI relate to change in SI intensity over a 6-month period of treatment.
Method:
Children ages 9 to 13 (N = 71; 41% female; 54% Caucasian; Mean age = 9.17) engaged in one of two psychotherapy treatment conditions and completed assessments of SI risk factors and psychopathology symptoms at baseline (pre-treatment), 4 and 8 weeks (during treatment), 12 weeks (post-treatment), and 39 weeks (follow-up assessment at 6 months post-treatment). Children also completed assessments of SI intensity at baseline, post-treatment (12 weeks), and 6 months post-treatment.
Results:
Mixed-effects regression models indicate that increases in health-related quality of life in the family, mobilization of the family to acquire/accept help for PBD, and child self-concept were associated with decreased SI intensity over time.
Conclusions:
Findings highlight the importance of family and child level factors in influencing longitudinal change in SI intensity in youth with PBD. Clinical implications and future directions are discussed.
AlgortaG. P.YoungstromE. A.FrazierT. W.FreemanA. J.FindlingR. L.YoungstromJ. K. (2011). Suicidality in pediatric bipolar disorder: Predictor or outcome of family processes and mixed mood presentation?Bipolar Disorders, 13(1), 76–86. https://doi.org/10.1111/j.1399-5618.2010.00886.x
2.
APA. (1994). DSM-IV diagnostic and statistical manual of mental disorders (4th ed.). American Psychiatric Association.
3.
BeckA. T.SteerR. A.BallR.RanieriW. F. (1996). Comparison of Beck depression inventories -IA and -II in psychiatric outpatients. Journal of Personality Assessment, 67(3), 588–597. https://doi.org/10.1207/s15327752jpa6703_13
BouchJ.MarshallJ. J. (2003). Suicide – Risk Assessment and Management Manual (S–RAMM). Research Edition. Dinas Powys, Vale of Glamorgan: Cognitive Centre Foundation.
7.
CalearA. L.ChristensenH.FreemanA.FentonK.Busby GrantJ.van SpijkerB.DonkerT. (2016). A systematic review of psychosocial suicide prevention interventions for youth. European Child and Adolescent Psychiatry, 25(5), 467–482. https://doi.org/10.1007/s00787-015-0783-4
8.
CohenJ. A.MannarinoA. P. (2008). Trauma-focused cognitive behavioural therapy for children and parents. Child and Adolescent Mental Health, 13(4), 158–162.
9.
CompasB. E.ForehandR.KellerG.ChampionJ. E.RakowA.ReeslundK. L.MckeeL.FearJ. M.CollettiC. J. M.HardcastleE.MerchantM. J.RobertsL.PottsJ.GaraiE.CofeltN.RolandE.SterbaS. K.ColeD. A. (2009). Randomized controlled trial of a family cognitive-behavioral preventive intervention for children of depressed parents. Journal of Consulting and Clinical Psychology, 77(6), 1007–1020. https://doi.org/10.1037/a0016930
10.
ConnersC. K.MarchJ. S. (1994). Conners-March developmental questionnaire (CMDQ). Toronto: MultiHealth Systems Inc.
11.
CzyzE. K.HorwitzA. G.YeguezC. E.Ewell FosterC. J.KingC. A. (2018). Parental self-efficacy to support teens during a suicidal crisis and future adolescent emergency department visits and suicide attempts. Journal of Clinical Child and Adolescent Psychology, 47, S384–S396. https://doi.org/10.1080/15374416.2017.1342546
12.
FristadM. A.VerducciJ. S.WaltersK.YoungM. E. (2009). Impact of multifamily psychoeducational psychotherapy in treating children aged 8 to 12 years with mood disorders. Archives of General Psychiatry, 66(9), 1013–1021. https://doi.org/10.1001/archgenpsychiatry.2009.112
13.
GellerB.WilliamsM.ZimermanB.FrazierJ. (1996). Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS). St. Louis, Washington University.
14.
GoldsteinT. R.AxelsonD. A.BirmaherB.BrentD. A. (2007). Dialectical behavior therapy for adolescents with bipolar disorder: A 1-year open trial. Journal of the American Academy of Child and Adolescent Psychiatry, 46(7), 820–830. https://doi.org/10.1097/chi.0b013e31805c1613
15.
GoldsteinT. R.Fersch-PodratR. K.RiveraM.AxelsonD. A.MerrankoJ.YuH.BrentD. A.BirmaherB. (2015). Dialectical behavior therapy for adolescents with bipolar disorder: Results from a pilot randomized trial. Journal of Child and Adolescent Psychopharmacology, 25(2), 140–149. https://doi.org/10.1089/cap.2013.0145
16.
GoldsteinT. R.HaW.AxelsonD. A.GoldsteinB. I.LiaoF.GillM. K.RyanN. D.YenS.HuntJ.HowerH.KellerM.SroberM.BirmaherB. (2012). Predictors of prospectively examined suicide attempts among youth with bipolar disorder. Archives of General Psychiatry, 69(11), 1113–1122. https://doi.org/10.1001/archgenpsychiatry.2012.650
17.
HammertonG.ZammitS.ThaparA.CollishawS. (2016). Explaining risk for suicidal ideation in adolescent offspring of mothers with depression. Psychological Medicine, 46(2), 265–275. https://doi.org/10.1017/S0033291715001671
18.
HauserM.GallingB.CorrellC. U. (2013). Suicidal ideation and suicide attempts in children and adolescents with bipolar disorder: A systematic review of prevalence and incidence rates, correlates, and targeted interventions. Bipolar Disorders, 15, 507–523. https://doi.org/10.1111/bdi.12094
19.
HouckC. D.HadleyW.BarkerD.BrownL. K.HancockE.AlmyB. (2016). An emotion regulation intervention to reduce risk behaviors among at-risk early adolescents. Prevention Science, 17(1), 71–82. https://doi.org/10.1007/s11121-015-0597-0
20.
ImY.OhW. O.SukM. (2017). Risk factors for suicide ideation among adolescents: Five-year National data analysis. Archives of Psychiatric Nursing, 31, 282–286. https://doi.org/10.1016/j.apnu.2017.01.001
21.
JaserS. S.WhittemoreR.AmbrosinoJ. M.LindemannE.GreyM. (2008). Mediators of depressive symptoms in children with type 1 diabetes and their mothers. Journal of Pediatric Psychology, 33, 509–519. https://doi.org/10.1093/jpepsy/jsm104
22.
KaufmanA. S.KaufmanN. L. (2004). Kaufman brief intelligence test (2nd ed.). American Guidance Services.
23.
KircanskiK.PerisT. S.PiacentiniJ. C. (2011). Cognitive-behavioral therapy for obsessive–compulsive disorder in children and adolescents. Child and Adolescent Psychiatric Clinics of North America, 20, 239–254. https://doi.org/10.1016/j.chc.2011.01.014
24.
KuhlbergJ. A.PeñaJ. B.ZayasL. H. (2010). Familism, parent-adolescent conflict, self-esteem, internalizing behaviors and suicide attempts among adolescent Latinas. Child Psychiatry and Human Development, 41, 425–440. https://doi.org/10.1007/s10578-010-0179-0
25.
LairdN. M.WareJ. H. (1982). Random-effects models for longitudinal data. Biometrics, 38(4), 963. https://doi.org/10.2307/2529876
HeruA. M.RyanC.E. (2004). Burden, reward and family functioning of caregivers for relatives with mood disorders: 1-Year follow-up. Journal of Affective Disorders, 83(2–3), 221–225. https://doi.org/10.1016/j.jad.2004.04.013
28.
MachellK. A.RallisB. A.Esposito-SmythersC. (2016). Family environment as a moderator of the association between anxiety and suicidal ideation. Journal of Anxiety Disorders, 40, 1–7. https://doi.org/10.1016/j.janxdis.2016.03.002
29.
McCubbinH. I.McCubbinM. A.PattersonJ. M.CaubleA. E.WilsonL. R.WarwickW. (1983). CHIP. Coping health inventory for parents: An assessment of parental coping patterns in the care of the chronically ill child. Journal of Marriage and the Family, 45(2), 359. https://doi.org/10.2307/351514
30.
McCubbinH. I.OlsonD. H.LarsenA. (1987). Family Crisis-Oriented Personal Evaluation Scales (FCOPES) 1981. Brunner Mazel Publ.
31.
McCubbinH.I.ThompsonA. I. (1991). Family assessment inventories for research and practice. University of Wisconsin-Madison, Center for Excellence in Family Studies.
32.
NockM. K.GreenJ. G.HwangI.McLaughlinK. A.SampsonN. A.ZaslavskyA. M.KesslerR. C. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: Results from the national comorbidity survey replication adolescent supplement. JAMA Psychiatry, 70(3), 300–310. https://doi.org/10.1001/2013.jamapsychiatry.55
33.
PavuluriM. N.HenryD. B.DevineniB.CarbrayJ. A.BirmaherB. (2006). Child mania rating scale: Development, reliability, and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 45(5), 550–560. https://doi.org/10.1097/01.chi.0000205700.40700.50
34.
PelkonenM.MarttunenM. (2003). Child and adolescent suicide: Epidemiology, risk factors, and approaches to prevention. Pediatric Drugs, 5, 243–265. https://doi.org/10.2165/00128072-200305040-00004
35.
PinedaJ.DaddsM. R. (2013). Family intervention for adolescents with suicidal behavior: A randomized controlled trial and mediation analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 52(8), 851–862. https://doi.org/10.1016/j.jaac.2013.05.015
36.
PosnerK.BrownG. K.StanleyB.BrentD. A.YershovaK. V.OquendoM. A.CurrierG. WMelvinG. A.GreenhillL.ShenS.MannJ. J. (2011). The Columbia-suicide severity rating scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266–1277. https://doi.org/10.1176/appi.ajp.2011.10111704
37.
PoznanskiE. O.GrossmanJ. A.BuchsbaumY.BanegasM.FreemanL.GibbonsR. (1984). Preliminarystudies of the reliability and validity of the children’s depression rating scale. Journal of the American Academy of Child Psychiatry, 23(2), 191–197.
38.
Ravens-SiebererU.BullingerM. (1998). Assessing health-related quality of life in chronically ill children with the German KINDL: First psychometric and content analytical results. Quality of Life Research, 7(5), 399–407. https://doi.org/10.1023/A:1008853819715
39.
Ridge AndersonA.KeyesG. M.JobesD. A. (2016). Understanding and treating suicidal risk in young children. Practice Innovations, 168, 1266–1277. https://doi.org/10.1037/pri0000018
40.
SarkarM.ByrneP.PowerL.FitzpatrickC.AnglimM.BoylanC.MorganS. (2010). Are suicidal phenomena in children different to suicidal phenomena in adolescents? A six-year review. Child and Adolescent Mental Health, 15, 197–203. https://doi.org/10.1111/j.1475-3588.2010.00567.x
41.
SchnyderU.EhlersA.ElbertT.FoaE. B.GersonsB. P.ResickP. A.ShapiroF.CloitreM. (2015). Psychotherapies for PTSD: What do they have in common?European Journal of Psychotraumatology, 6(1), 28186.
42.
ShpigelM. S.DiamondG. M.DiamondG. S. (2012). Changes in parenting behaviors, attachment, depressive symptoms, and suicidal ideation in attachment-based family therapy for depressive and suicidal adolescents. Journal of Marital and Family Therapy, 38(Suppl.1), 271–283. https://doi.org/10.1111/j.1752-0606.2012.00295.x
SpiritoA.StantonC.DonaldsonD.BoergersJ. (2002). Treatment-as-usual for adolescent suicide attempters: Implications for the choice of comparison groups in psychotherapy research. Journal of Clinical Child and Adolescent Psychology, 31(1), 41–47. https://doi.org/10.1207/S15374424JCCP3101_06
45.
SteerR. A.BrownG. K.BeckA. T.SandersonW. C. (2001). Mean Beck Depression Inventory-II scores by severity of major depressive episode. Psychological Reports, 88(3Part 2), 1075–1076. https://doi.org/10.2466/pr0.2001.88.3c.1075
46.
StoneD. M.LuoF.LippyC.McIntoshW. L. (2015). The role of social connectedness and sexual orientation in the prevention of youth suicide ideation and attempts among sexually active adolescents. Suicide and Life-Threatening Behavior, 45, 415–430. https://doi.org/10.1111/sltb.12139
WeinsteinS. M.CruzR. A.IsaiaA. R.PetersA. T.WestA. E. (2018). Child- and family-focused cognitive behavioral therapy for pediatric bipolar disorder: Applications for suicide prevention. Suicide and Life-Threatening Behavior, 48(6), 797–811. https://doi.org/10.1111/sltb.12416
49.
WeinsteinS. M.Van MeterA.KatzA. C.PetersA. T.WestA. E. (2015). Cognitive and family correlates of current suicidal ideation in children with bipolar disorder. Journal of Affective Disorders, 173, 15–21. https://doi.org/10.1016/j.jad.2014.10.058
50.
WeinsteinS. M.WestA. E.PavuluriM. (2013). Psychosocial intervention for pediatric bipolar disorder: Current and future directions. Expert Review of Neurotherapeutics, 13, 843–850. https://doi.org/10.1586/14737175.2013.811985
51.
WestA. E.JacobsR. H.WesterholmR.LeeA.CarbrayJ.HeidenreichJ.PavuluriM. N. (2009). Child and family-focused cognitive-behavioral therapy for pediatric bipolar disorder: Pilot study of group treatment format. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 18(3), 239–245.
52.
WestA. E.WeinsteinS. M.CelioC. I.HenryD.PavuluriM. N. (2011). Co-morbid disruptive behavior disorder and aggression predict functional outcomes and differential response to risperidone versus divalproex in pharmacotherapy for pediatric bipolar disorder. Journal of Child and Adolescent Psychopharmacology, 21(6), 545–553. https://doi.org/10.1089/cap.2010.0140
53.
WestA. E.WeinsteinS. M.PetersA. T.KatzA. C.HenryD. B.CruzR. A.PavuluriM. N. (2014). Child- and family-focused cognitive-behavioral therapy for pediatric bipolar disorder: A randomized clinical trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53(11), 1168–1178.e1. https://doi.org/10.1016/j.jaac.2014.08.013
54.
WildL. G.FlisherA. J.LombardC. (2004). Suicidal ideation and attempts in adolescents: Associations with depression and six domains of self-esteem. Journal of Adolescence, 27(6), 611–624. https://doi.org/10.1016/j.adolescence.2004.03.001
55.
WolffJ. C.DavisS.LiuR. T.ChaC. B.CheekS. M.NestorB. A.FrazierE. A.SchafferM. M.SpiritoA. (2018). Trajectories of suicidal ideation among adolescents following psychiatric hospitalization. Journal of Abnormal Child Psychology, 46(2), 355–363. https://doi.org/10.1007/s10802-017-0293-6
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
