Search

OBJECTIVE: Youth with bipolar disorder (BD) are at high risk for deliberate self-harm (DSH) and suicide. However, research regarding factors associated with DSH, a key suicide risk factor, among youth with BD is limited. In a population-based sample of youth with BD, we therefore investigated associations between demographic, clinical, and service utilization factors and DSH incidence and compared suicide, unintentional injury, and all-cause mortality to the general population. METHOD: We analyzed a retrospective cohort of youth aged 5 to 19 years with a new BD episode between 2010 and 2017 (n = 25,244) using Ohio Medicaid claims and death certificate data. Cox proportional hazards models examined associations between different factors and DSH. Mortality rates were compared to the general population using standardized mortality ratios. RESULTS: During follow-up, 1,517 (6.0%) youth had at least one DSH event. Older index age, female sex, comorbid psychiatric/medical conditions, prior DSH/suicidal ideation, and prior ER mental healthcare were associated with increased DSH risk. Prior DSH was most strongly associated with increased DSH risk for 3 months after a new BD episode. Being non-Hispanic Black (vs. White, non-Hispanic) and prior psychiatric hospitalization were associated with decreased DSH hazard. DSH risk was highest for 3 months after a new BD episode. Suicide, unintentional injury, and all-cause mortality rates were elevated in youth with BD. LIMITATIONS: May not generalize to other states or non-Medicaid populations; claims data cannot distinguish suicidal intent of self-harm CONCLUSION: Early intervention following a new BD episode, particularly among high-risk groups, is key to prevent DSH.

Background As recruitment and retention are often challenging in randomized controlled trials (RCTs), this study sought to identify predictors of participation (i.e., trial enrollment). Method These analyses identified predictors of enrollment among 119 youth, ages 7–14, with a primary mood disorder, who screened eligible for the Omega-3 and Therapy pilot studies; 95 (79.8%) actually participated in the treatment. Results Youth who received some form of travel assistance (16.0%) almost uniformly enrolled in the treatment portion of the RCT. Youth who lived further away from the study site (p = .047) or whose primary caregiver never married (p = .01) were less likely to enroll. Of note, socioeconomic status (SES) variables (parent education and child insurance status) did not significantly predict enrollment, suggesting that study incentives or accommodations may have adequately addressed barriers commonly associated with SES. Limitations Due to the fairly high trial enrollment rate (approximately 80%), there likely was limited power to detect some differences between groups. Generalizability may be limited to youth with a primary mood disorder diagnosis. Conclusions Despite retaining a large proportion of the youth who screened eligible, participant self-selection is a limitation of any RCT. A silent inclusion criterion of any RCT is willingness to be randomized.

Bipolar disorder-not otherwise specified (BD-NOS) is an imprecise, heterogeneous diagnosis that is unstable in youth. This study reports rates of conversion from BD-NOS to BD-I or II in children aged 8-12, and investigates the impact of family history of bipolar disorder and depression on conversion.As part of the Multi-Family Psychoeducational Psychotherapy (MF-PEP) study, 27 children (6-12 years of age) diagnosed with BD-NOS at baseline were reassessed every 6 months over an 18-month period. Family history of bipolar disorder and depression was assessed at baseline.One-third of the sample converted from BD-NOS to BD-I or II over 18-months. Having a first-degree relative with symptoms of bipolar disorder and having a loaded pedigree for diagnosis of depression each were associated with conversion from BD-NOS to BD-I or II (odds ratio range: 1.09-3.14; relative risk range: 1.06-2.34).This study had very low power (range: 10-45) given the small sample size, precluding statistical significance of non-parametric Fisher's Exact test findings.This study replicates the previous finding of a high rate of conversion from BD-NOS to BD-I or II among youth, and suggests conversion is related to symptoms of bipolar disorder or depression diagnoses in the family history. Additional research is warranted in a larger sample with a longer follow-up period.

Background A web-based survey was developed to explore the effect of pharmacological and non-pharmacological interventions for sleep difficulties associated with Early-Onset Bipolar Spectrum Disorders (EBSD). Method Four hundred ninety four parents of 4–12 year-olds, identified by parents as being diagnosed with EBSD, provided information about which professionals were consulted regarding their child's EBSD-sleep problems and pharmacological and non-pharmacological interventions that helped or worsened sleep. Results Most parents reported consulting at least one medical, mental health, and/or school professional regarding their child's sleep problems. Psychiatrists and other physicians were most often consulted. The majority of parents reported several medications/supplements as helpful, most commonly, atypical antipsychotics (54.4%). Over half identified various pharmacological agents that worsened sleep, most commonly, stimulants (35.0%). Most parents also reported several non-pharmacological interventions that aided sleep problems, most frequently, a sleep routine. Over two-thirds reported a variety of non-pharmacological interventions that worsened sleep, most notably, punishment (34.8%). Limitations The sample was non-random consisting of self-selected and web-savvy parents who self-identified their children as having EBSD and provided only parent derived data. Conclusions Although exploratory and despite limitations, this is the first survey to report data on both pharmacological and non-pharmacological treatments for EBSD-sleep problems. It highlights clinical interventions that may improve or worsen EBSD-sleep and provides directions for future research.

Transgenerational association of bipolar spectrum disorder (BPSD) and attention deficit/hyperactivity disorder (ADHD) has been reported, but inconclusively.Children ages 6-12 were systematically recruited at first outpatient visit at 9 clinics at four universities and reliably diagnosed; 621 had elevated symptoms of mania (12 on the Parent General Behavior Inventory 10-Item Mania Scale); 86 had scores below 12. We analyzed baseline data to test a familial association hypothesis: compared to children with neither BPSD nor ADHD, those with either BPSD or ADHD would have parents with higher rates of both bipolar and ADHD symptoms, and parents of comorbid children would have even higher rates of both.Of 707 children, 421 had ADHD without BPSD, 45 BPSD without ADHD, 117 comorbid ADHD+BPSD, and 124 neither. The rate of parental manic symptoms was similar for the comorbid and BPSD-alone groups, significantly greater than for ADHD alone and "neither" groups, which had similar rates. ADHD symptoms in parents of children with BPSD alone were significantly less frequent than in parents of children with ADHD (alone or comorbid), and no greater than for children with neither diagnosis. Family history of manic symptoms, but not ADHD symptoms, was associated with parent-rated child manic-symptom severity over and above child diagnosis.The sample was not epidemiologic, parent symptoms were based on family history questions, and alpha was 0.05 despite multiple tests.These results do not support familial linkage of BPSD and ADHD; they are compatible with heritability of each disorder separately with coincidental overlap.

Background This study examined depressive symptoms in bereaved children and adolescents two months after the death of a parent. Methods Participants were 325 children and adolescents bereaved of a parent approximately two months prior to the study. They were compared to 129 non-bereaved community controls and 110 non-bereaved depressed controls. Participants and their parents were interviewed regarding the child's depressive symptoms. Possible moderating factors for depression in bereaved children were examined. Results 25% of the bereaved participants experienced a major depressive episode (MDE) compared to 1% of the community controls. An additional 24% of the bereaved participants experienced a sub-syndromal depressive episode, defined as 3 or 4 depressive symptoms, compared to 4% of the community controls. Factors correlated with occurrence of MDE in the bereaved children in exploratory analyses were (1) history of MDE in the child and (2) history of alcoholism in a parent. Guilt/worthlessness, psychomotor disturbance, and low energy in the context of an MDE predicted membership in the depressed control group over the bereaved group. Limitations The relationship between an MDE in the bereaved child and parent history of alcoholism is exploratory, as the p-value for this correlation was greater than the α adjusted for multiple comparisons. The bereaved child's history of MDE was based on the child's and parent's memories of depressive symptoms. Conclusions The death of a parent is a risk factor for depressive symptoms and depressive episodes in children and adolescents two months after the death.

Family psychiatric histories of 63 inpatient children with major depressive disorder (MDD) and 63 matched inpatient psychiatric controls were compared. MDD, anxiety disorders, somatization disorder and antisocial personality disorder (ASP) were significantly more common (P < 0.05) in the family histories of MDD probands. When family histories of depressed/anxious (D/A) versus depressed/behavior disordered (D/B) children were compared, the D/B group had more alcohol abuse (P < 0.05) and antisocial personality disorder (P < 0.08) than the D/A group. This report supports findings from earlier studies and suggests mood and anxiety disorders are increased in families of children with MDD.

Occurrence of learning disabilities was determined in 30 inpatient children aged 6-12 with major depressive disorder (MDD). Learning disabilities (LD) occurred seven times more often compared to community base rates (33% v 4.7%). While rates of comorbid diagnoses, severity of depression, and children's and parents' reports (DICA-C, DICA-P) did not differ between groups, teachers' reports (TRS, TRF) indicated increased classroom problems and poorer adaptive functioning in MDD/LD subjects (P < 0.0001).

Sensitivity, specificity, and diagnostic confidence of the Children's Depression Inventory (CDI) and the dexamethasone suppression test (DST) in assessing childhood depression were determined. Parent and child forms of the CDI and plasma cortisol levels at 8 a.m. and 4 p.m. were used. Three groups of prepubertal children were sampled: (1) 63 depressed inpatients, (2) 14 non-depressed inpatient psychiatric controls, and (3) 21 normal community sample controls. Results suggest that scores greater than or equal to 15 on the CDI obtained from either parent or child provide a good screening instrument (sensitivity = 89%). If the DST is administered to all children with elevated CDI scores, diagnostic confidence is 97.5%. Cautions and recommendations for use of the CDI and DST are made.

Prior to the introduction of lithium, mania was underdiagnosed in the U.S.A. Almost 50% of adults who met DSM-III criteria for mania had previously been diagnosed to have schizophrenia. To determine if mania had similarly been underdiagnosed in prepubertal children, 157 cases of 'severely disturbed' children described in the literature were reviewed. Approximately one-half (16/33) of the children diagnosed in this study as manic according to DSM-III had originally received another diagnosis. These results indicate that mania should be considered in the differential diagnosis of psychotic children, particularly those with affective symptoms.