Sexual abuse and suicide attempt in bipolar type I patients

Childhood-maltreatment subtypes in bipolar patients with suicidal behavior: systematic review and meta-analysis

Objective:

Patients with bipolar disorders have a high risk of suicidal behavior. Childhood maltreatment is a well-established risk factor for suicidal behavior. The objective of this study was to examine the association between childhood-maltreatment subtypes and vulnerability to suicide attempts in bipolar disorder using the Childhood Trauma Questionnaire (CTQ).

Methods:

A literature review was performed using the MEDLINE, Embase, and PsycINFO databases. Thirteen studies met the selection criteria. In the meta-analysis, the Childhood Trauma Questionnaire (CTQ) was used to assess a wide range of childhood maltreatment subtypes, which were analyzed by using a random-effects model to account for the likely variations of true effect sizes between the included studies.

Results:

In the systematic review, 13 studies met the selection criteria. The CTQ was selected for the meta-analysis to increase the homogeneity of assessment and to encompass a wide range of childhood-maltreatment subtypes. The data were analyzed using a random-effects model. Compared to bipolar non-attempters, bipolar suicide attempters had experienced childhood maltreatment with a significantly higher frequency and had higher total CTQ scores (Hedges’ g = -0.38, 95%CI -0.52 to -0.24, z = -5.27, p < 0.001) and CTQ sub-scores (sexual abuse: g = -0.39, 95%CI -0.52 to -0.26, z = -5.97; physical abuse: g = -0.26, 95%CI -0.39 to -0.13, z = -4.00; emotional abuse: g = -0.39, 95%CI -0.65 to -0.13, z = -2.97; physical neglect: g = -0.18, 95%CI -0.31 to -0.05, z = -2.79; emotional neglect: g = -0.27, 95%CI -0.43 to -0.11, z = -3.32).

Conclusions:

Childhood maltreatment, as assessed by the CTQ, may contribute to an increased risk of suicidal behavior among people with bipolar disorders. Recognizing maltreatment as an etiological risk factor is a crucial step toward furthering science-based preventive psychiatry.

Male and Female Physician Suicidality: A Systematic Review and Meta-analysis

IMPORTANCE

Population-based findings on physician suicide are of great relevance because this is an important and understudied topic.

OBJECTIVE

To evaluate male and female physician suicide risks compared with the general population from 1980 to date and test whether there is a reduction of SMR in cohorts after 1980 compared with before 1980 via a meta-analysis, modeling studies, and a systematic review emphasizing physician suicide risk factors.

DATA SOURCES

This study uses studies retrieved from PubMed, Scielo, PsycINFO, and Lilacs for human studies published by October 3, 2019, using the search term "(((suicide) OR (self-harm) OR (suicidality)) AND ((physicians) OR (doctors)))." Databases were also searched from countries listed in articles selected for review. Data were also extracted from an existing article by other authors to facilitate comparisons of the pre-1980 suicide rate with the post-1980 changes.

STUDY SELECTION

Original articles assessing male and/or female physician suicide were included; for the meta-analysis, only cohorts from 1980 to the present were included.

DATA EXTRACTION AND SYNTHESIS

The preregistered systematic review and meta-analysis followed Cochrane, PRISMA, and MOOSE guidelines. Data were extracted into standardized tables per a prespecified structured checklist, and quality scores were added. Heterogeneity was tested via Q test, I2, and τ2. For pooled effect estimates, we used random-effects models. The Begg and Egger tests, sensitivity analyses, and meta-regression were performed. Proportional mortality ratios were presented when SMR data could not be extracted.

MAIN OUTCOMES AND MEASURES

Suicide SMRs for male and female physicians from 1980 to the present and changes over time (before and after 1980).

RESULTS

Of 7877 search results, 32 articles were included in the systematic review and 9 articles and data sets in the meta-analysis. Meta-analysis showed a significantly higher suicide SMR in female physicians compared with women in general (1.46 [95% CI, 1.02-1.91]) and a significantly lower suicide SMR in male physicians compared with men in general (0.67 [95% CI, 0.55-0.79]). Male and female physician SMRs significantly decreased after 1980 vs before 1980 (male physicians: SMR, -0.84 [95% CI, -1.26 to -0.42]; P < .001; female physicians: SMR, -1.96 [95% CI, -3.09 to -0.84]; P = .002). No evidence of publication bias was found.

CONCLUSIONS AND RELEVANCE

In this study, suicide SMR was found to be high in female physicians and low in male physicians since 1980 but also to have decreased over time in both groups. Physician suicides are multifactorial, and further research into these factors is critical.

Childhood maltreatment is associated with attachment insecurities, dissociation and alexithymia in bipolar disorder

Child maltreatment is a public health issue that is a well-established risk factor for many psychological conditions, including bipolar disorder. The current study is one of the first to investigate associations among child maltreatment, dissociative symptomatology, alexithymia, anxiety, depression, and attachment insecurities. 40 patients with bipolar disorder-I and 40 healthy subjects matched for age, gender, and education participated in the study. The Dissociative Experiences Scale (DES), Somatoform Dissociation Questionnaire (SDQ), Childhood Trauma Questionnaire (CTQ-28), Toronto Alexithymia Scale (TAS-20), Depression Anxiety Stress Scale (DASS-21), and Experiences in Close Relationships-Revised (ECR-R) were completed by participants. In comparison to control participants, patients with bipolar disorder-I reported significantly more frequent abusive experiences in childhood, higher levels of attachment insecurities, more severe pathological and somatoform dissociation, as well as higher scores on measures of alexithymia, anxiety, depression and psychological stress. Reports of psychopathology among first-degree relatives (OR = 102.169, 95%IC = 4.596-2271.255; P < 0.01) and childhood emotional trauma (OR = 1.032; 95%CI = 0.782-1.363, P = 0.05) significantly contributed to bipolar disorder-I diagnosis. In contrast, absorption was negatively associated with bipolar illness (OR = 0.852; 95% CI = 0.747-0.973, P < 0.05). Our results showed significant associations between childhood trauma exposure and risk of bipolar disorder. Moreover, the results demonstrate that emotional abuse exposure predicts bipolar illness.

Gray matter brain volumes in childhood-maltreated patients with bipolar disorder type I: A voxel-based morphometric study

BACKGROUND

Childhood maltreatment (CM) may be related to clinical expression and outcome of bipolar disorder (BD). Several neuroimaging studies have detected brain morphological changes in specific neural networks of adults who suffered maltreatment in their childhood. We investigated alterations in gray matter volume (GMV) to determine a possible neuroanatomical basis of vulnerability in patients with CM having type I BD (BD-I).

METHODS

We assessed 39 euthymic DSM-IV BD-I patients with (n=20) and without (n=19) a history of CM and 20 healthy controls without maltreatment as defined by the Childhood Trauma Questionnaire (CTQ). Voxel-based morphometry (VBM) was used to compare GMV differences between patients and controls and perform linear correlations in overall BD group between GMV and CTQ scores.

RESULTS

BD-I patients had significant negative correlations between CTQ total score and GMV in the right dorsolateral prefrontal cortex (PFC) and the right thalamus; between physical abuse and GMV in the right dorsolateral PFC; between physical neglect and GMV in the thalamus bilaterally; and between emotional neglect and GMV in the right thalamus.

LIMITATIONS

Pharmacological treatment could have altered GMV findings. Results emerged only when using SVC approach. CTQ, a retrospective self-report, has the risk of potential recall bias. The cross-sectional design limits longitudinal and neurodevelopmental inferences.

CONCLUSIONS

The severity of self-reported CM in BD-I patients is associated with morphological changes in GMV of specific neural networks relevant to responses to stress and to modulate emotional behavior.