Child and Adolescent Clinical Features Preceding Adult Suicide Attempts

Early clinical predictors and correlates of long-term morbidity in bipolar disorder

Objectives:

Identifying factors predictive of long-term morbidity should improve clinical planning limiting disability and mortality associated with bipolar disorder (BD).

Methods:

We analyzed factors associated with total, depressive and mania-related long-term morbidity and their ratio D/M, as %-time ill between a first-lifetime major affective episode and last follow-up of 207 BD subjects. Bivariate comparisons were followed by multivariable linear regression modeling.

Results:

Total % of months ill during follow-up was greater in 96 BD-II (40.2%) than 111 BD-I subjects (28.4%; P = 0.001). Time in depression averaged 26.1% in BD-II and 14.3% in BD-I, whereas mania-related morbidity was similar in both, averaging 13.9%. Their ratio D/M was 3.7-fold greater in BD-II than BD-I (5.74 vs. 1.96; P < 0.0001). Predictive factors independently associated with total %-time ill were: [a] BD-II diagnosis, [b] longer prodrome from antecedents to first affective episode, and [c] any psychiatric comorbidity. Associated with %-time depressed were: [a] BD-II diagnosis, [b] any antecedent psychiatric syndrome, [c] psychiatric comorbidity, and [d] agitated/psychotic depressive first affective episode. Associated with %-time in mania-like illness were: [a] fewer years ill and [b] (hypo)manic first affective episode. The long-term D/M morbidity ratio was associated with: [a] anxious temperament, [b] depressive first episode, and [c] BD-II diagnosis.

Conclusions:

Long-term depressive greatly exceeded mania-like morbidity in BD patients. BD-II subjects spent 42% more time ill overall, with a 3.7-times greater D/M morbidity ratio, than BD-I. More time depressed was predicted by agitated/psychotic initial depressive episodes, psychiatric comorbidity, and BD-II diagnosis. Longer prodrome and any antecedent psychiatric syndrome were respectively associated with total and depressive morbidity.

Personal values in adolescence and suicidality: a cross-sectional study based on a retrospective recall

BACKGROUND

This study retrospectively examined the association between personal values in adolescence and suicidality in a community-representative adult sample in Japan.

METHODS

Data were used from wave 1 (2010) and wave 3 (2017) of a Japanese Study on Stratification, Health, Income, and Neighborhood (J-SHINE) survey. Personal values at age 15 were retrospectively measured in 2017 in two ways: the original value priorities we made were based on the Schwartz theory of basic values; and the Japanese version of the Personal Values Questionnaire II (PVQ-II) was used to assess the degree of commitment to the values. Multivariate logistic regression analysis was used to estimate the association of personal values in adolescence with self-reported suicidal ideation, suicidal planning, and suicide attempt (both during a lifetime and in the most recent year), adjusting for socio-demographics, smoking, alcohol consumption, and economic status among 15 year olds.

RESULTS

Cherishing family and friends was significantly and negatively associated with suicidal ideation over a lifetime and in the most recent year. Commitment to values was also significantly and negatively associated with suicidal ideation in the most recent year.

CONCLUSIONS

Investigating the association between personal values and suicidality could make a significant contribution to the literature by offering a new approach to understanding and preventing suicide.