Hot Publication - Goldstein et al.

Predictors of Prospectively Examined Suicide Attempts among Youth with Bipolar Disorder
Goldstein TR, Ha W, Axelson DA, Goldstein BI, Liao F, Gill MK, Ryan ND, Yen S, Hunt J, Hower H, Keller M, Strober M, Birmaher B.
Archives of General Psychiatry, 2012 Nov;69(11):1113-22.

Individuals with bipolar disorder are at high risk for suicide, and those who experience onset of their illness during childhood are at even greater risk.  Yet, little is known about which youth with bipolar disorder are at highest risk for suicide, and when.  The ability to identify specific warning signs indicating that suicidal behavior may be imminent could help to inform our efforts to prevent suicide in this high-risk group. In a study published in the November 2012 issue of Archives of General Psychiatry, Drs. Tina Goldstein, Boris Birmaher, and colleagues in the Department of Psychiatry aimed to identify warning signs associated with suicidal behavior in a large sample of youth with bipolar disorder. 

The investigators conducted interviews with 413 youth diagnosed with bipolar disorder and their parents every 9 months over a period of 5 years.  Results showed that nearly 20% of the youth attempted suicide at least once during the 5 year period, and about 10% attempted suicide more than once.  Suicide attempters were more depressed at study intake, and also were more likely to have a family history of depression. For those youth who attempted suicide, the 2 month period prior to the suicide attempt was characterized by more persistent depression, mixed symptoms (i.e., co-occurring depressive and manic symptoms), and alcohol and drug abuse.  Suicide attempters were also receiving more out-patient mental health services in the weeks preceding their suicide attempt, possibly because they and others recognized that their condition was worsening.  Treatment providers and family members may therefore recognize that for youth with bipolar disorder, worsening mood symptoms and substance use may be warning signs of imminent suicidal behavior, and be proactive to ensure safety.


Tina Goldstein, PhD; Wonho Ha, PhD; David Axelson, MD; Fangzi Liao, MS; Mary Kay Gill, RN, MSN; Neal Ryan, MD; Boris Birmaher, MD (Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center)

Benjamin Goldstein, MD, PhD (Department of Child Psychiatry, University of Toronto Medical Center, Ontario, Canada)

Shirley Yen, PhD; Jeffrey Hunt, MD; Heather Hower, MSW; Martin Keller, MD (Warren Alpert Medical School of Brown University, Providence, Rhode Island)

Michael Strober, PhD (Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles)

The results of this study were published in the November 2012 issue of the Archives of General Psychiatry. Click here for a link to the abstract.