1 - (SYM 8) One-year Course of Suicidal Ideation and Attempts Among Adolescents with Bipolar Disorder Engaged in Treatment

Introduction: Individuals with early-onset bipolar disorder (BP) are at high risk for suicidal ideation (SI) and attempts (SA). Yet, little is known about the course SI and SA over time in this population, and particularly during treatment. We aimed to describe SI and SA course, with a specific focus on remission and recurrence, among adolescents carefully diagnosed with BP who were engaged in a one-year randomized psychosocial treatment study.

Methods:   The sample includes 100 adolescents (M age=16.1, 85% female sex assigned at birth, 74% White, 31% sexual minority) diagnosed with BP spectrum disorder via semi-structured interview who consented to participate in a 1-year randomized study of 2 psychosocial interventions (adjunct to medication management) at a psychiatric specialty clinic. Trained assessors naïve to treatment condition evaluated SI and SA at baseline and again quarterly throughout participation using the Adolescent Longitudinal Interval Follow-Up Evaluation (ALIFE). For the present analyses, we adopted DSM-V criteria for SI remission (8 consecutive weeks with no SI) and recurrence (SI/SA following period of remission). 

Results:   At intake, 54% of youth reported SI over the past 3 months (M weeks with SI=5). Over 1 year follow-up, youth spent an average of 6 weeks with SI. Of youth with any SI at intake, 91% reported at least 1 period of remission from SI, and 78% reported more than 1 (M remission length=9 weeks). Of youth who exhibited remission from SI over follow-up, 80% exhibited at least 1 recurrence.

With respect to SAs, 58% of youth reported at least 1 SA over the 3 months preceding intake. During the 1-year study, 33% reported at least 1 SA; among those who attempted, mean number of SAs over follow-up was four. Of youth with any SA at study intake, 45% reported at least 1 SA over follow-up, with a mean of 9 weeks between SAs.

Discussion: Adolescents with BP display high rates of SI and SA. Periods of remission from SI are common, and SI recurs at high rates over time. Although SAs are less common, among those who attempt, rates of re-attempt are high. These findings support the need for suicide prevention efforts in this population.