Suicidal ideation and attempts in unipolar versus bipolar depression: analysis of 131,740 adolescent inpatients nationwide

Sleep disturbance and suicidal ideation among youth with depression

BACKGROUND

Sleep disturbance may exacerbate the risk of suicide among youth with depression, but whether this association is independent of psychopathology requires further study.

METHODS

This cross-sectional study included 576 youths (13-25 years old) recruited from January 2022 to May 2023. The patients were first divided into two groups by the presence of suicidal ideation according to the Columbia-Suicide Severity Scale (C-SSRS). Sleep quality was assessed by the Athens Insomnia Scale (AIS) and mental health with the Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA). Logistic regression was conducted to analyze the association between sleep disturbance and suicidal ideation, adjusted for depressive symptoms severity.

RESULTS

The suicidal ideation group exhibited more severe sleep disturbances, anxiety symptoms, and depressive symptoms than the non-suicidal ideation group. Pearson correlation showed that sleep disturbance (AIS) was significantly correlated with the severity of anxiety symptoms, depressive symptoms, and suicidal ideation. Logistic regression analysis revealed that the AIS factor "daytime dysfunction" (β = 0.145; OR = 1.156, 95 % CI: 1.02, 1.309; p = 0.023) was significantly associated with suicidal ideation after adjusting for demographic characteristics and depressive symptoms severity.

LIMITATIONS

Due to the cross-sectional nature of the data, no causal inference can be made regarding the observed associations between sleep disturbance and suicidal ideation.

CONCLUSION

Sleep disturbance, particularly in the realm of daytime dysfunction, is associated with increased suicidal ideation among depressed youth. Clinicians need to assess and manage sleep disturbance in the context of suicidal ideation for young depression patients.

The impact of mindfulness therapy combined with mentalization-based family therapy on suicidal ideation in adolescents with depressive disorder: randomized intervention study

BACKGROUND

Adolescents with depression who engage in non-suicidal self harming behaviors are more likely to adopt negative coping strategies when faced with negative events. Therefore, these patients should be introduced to positive coping strategies. Evidences have showed that mindfulness-based interventions can positively impact the psychology of patients with mental disorders. This study was to explore the impact of a combination of mindfulness therapy and mentalization-based family therapy (MBFT) on suicidal ideation in adolescents with depressive disorder.

METHODS

Eighty adolescent patients with depression and suicidal ideation admitted to our hospital from September 2021 to February 2022 were selected as subjects. They were divided into a control group and a study group using the random number table method, with each group comprising 40 subjects. The control group received MBFT, whereas the study group received both mindfulness therapy and MBFT. The psychological status and suicidal ideations of the two groups were compared before and after the intervention.

RESULTS

The psychological health scores of both groups of patients were lower after the intervention, with the scores of the study group being lower than those of the control group (P < 0.05). The scores on the suicidal ideation scales for both groups were lower after intervention, and the study group scored lower than the control group (P < 0.05). The absolute values of the differences in psychological health scale scores and suicidal ideation scale scores before and after the intervention were higher in the study group than in the control group (P < 0.05).

CONCLUSION

The combination of mindfulness therapy and MBFT can improve the psychological condition of adolescents with depression, reduce their suicidal ideations, and help them develop a healthy and positive outlook toward life, making this method worthy of clinical recommendation.

Childhood Clinical Features Preceding the Onset of Bipolar Versus Major Depressive Disorders During Adolescence

OBJECTIVE

To identify childhood psychopathological features that predict the onset of adolescent Bipolar (BD) versus Unipolar Major Depressive Disorder (UD) during adolescence.

METHOD

We analyzed clinical data from 495 juveniles diagnosed with DSM-5 UD (n = 359), and BD (n = 136), using bivariate analysis and multivariate logistic regression model.

RESULTS

BD subjects exhibited earlier onset of any psychiatric feature compared to UD. Antecedents associated with later BD were: oppositional defiant > specific phobias > ADHD > obsessive compulsive (OCD). Antecedents selectively associated with later UD were: social anxiety and separation anxiety. Factors significantly and independently associated with later BD diagnosis were: [a] emotional dysregulation at onset of the mood disorder; [b] first depressive episode with mixed features; [c] antecedent ADHD; [d] antecedent OCD, and [e] antecedent oppositional-defiance.

CONCLUSION

Identifying developmental differences in BD and UD symptoms can aid clinicians in early identification and treatment planning for bipolar disorder in youth.

Differences in Non-suicidal Self-injury Behaviors between Unipolar Depression and Bipolar Depression in Adolescent Outpatients

OBJECTIVE

Non-suicidal self-injury (NSSI) has a higher prevalence in adolescents with depressive disorders than in community adolescents. This study examined the differences in NSSI behaviors between adolescents with unipolar depression (UD) and those with bipolar depression (BD).

METHODS

Adolescents with UD or BD were recruited from 20 general or psychiatric hospitals across China. The methods, frequency, and function of NSSI were assessed by Functional Assessment of Self-Mutilation. The Beck Suicide Ideation Scale was used to evaluate adolescents' suicidal ideation, and the 10-item Kessler Psychological Distress Scale to estimate the anxiety and depression symptoms.

RESULTS

The UD group had higher levels of depression (19.16 vs.17.37, F=15.23, P<0.001) and anxiety symptoms (17.73 vs.16.70, F=5.00, P=0.026) than the BD group. Adolescents with BD had a longer course of NSSI than those with UD (2.00 vs.1.00 year, Z=-3.39, P=0.001). There were no statistical differences in the frequency and the number of methods of NSSI between the UD and BD groups. Depression (r=0.408, P<0.01) and anxiety (r=0.391, P<0.01) were significantly and positively related to NSSI frequency.

CONCLUSION

Adolescents with BD had a longer course of NSSI than those with UD. More importantly, NSSI frequency were positively and strongly correlated with depression and anxiety symptoms, indicating the importance of adequate treatment of depression and anxiety in preventing and intervening adolescents' NSSI behaviors.

Systematic Review and Meta-analysis: International Prevalence of Suicidal Ideation and Attempt in Youth

OBJECTIVE

Globally, rates of youth suicide vary considerably. Suicidal thoughts and behaviors (STB) are consistently associated with risk of death by suicide. However, international trends in STB have not yet been compared. To address this gap, an international meta-analysis of epidemiological and school-based studies that report on STB in youth was conducted.

METHOD

Systematic searches were conducted in PubMed and PsycINFO through April 2022. Eligible studies included prevalence of active suicidal ideation (SI) or suicide attempts (SA) in community youth younger than age 22. All studies were coded by 2 authors. Mixed models accounting for shared methods and including hypothesized moderators were conducted using the metafor package in R.

RESULTS

There were 371 effect sizes for SI, 94 for SI with a plan, and 316 for SA, representing 149 regions. Year of data collection ranged from 1981 to 2021. Participants were 6 to 21 years old. The prevalence of SI ranged across regions from 14.3% to 22.6%; the prevalence of SA ranged from 4.6% to 15.8%. Year was not associated with increasing STB prevalence except for studies from the United States, which showed increasing rates of SI and SA since 2007.

CONCLUSION

This is the most comprehensive meta-analysis of STB in youth, providing valuable data about how risk factors most commonly associated with suicide vary internationally and over time. International rates of STB among youth are not improving and may be getting worse in the United States, despite efforts to reduce suicide risk. Most studies did not report rates of SI or SA separately for LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and others) youth and youth of color. A better understanding of proximal risk at the individual level will be important to informing future prevention efforts, especially for high-risk groups.

Suicidal Ideation and Electroconvulsive Therapy: Outcomes in Adolescents With Major Depressive Disorder

OBJECTIVE

Few studies on electroconvulsive therapy (ECT) investigate efficacy and safety on depressive adolescents with strong suicidal ideation. Our study examined adolescents (aged 13-18 years) with major depressive disorder to explore ECT effectiveness in improving suicidal ideation and depressive symptoms, as well as its impact on cognitive function.

METHODS

This nonrandomized controlled trial enrolled 183 adolescent patients suffering from major depressive disorder. The ECT group (n = 81) was treated with antidepressants and 8 rounds of ECT for 2 weeks. The control group comprised 79 patients treated with antidepressants only. Depressive symptoms, suicidal ideation, and cognitive functions were assessed at baseline (pre-ECT) and at 2 and 6 weeks post-ECT.

RESULTS

The ECT group showed significant improvements over control in suicidal ideation from the end of treatment to 6 weeks after ( P < 0.001). Depressive symptoms also improved ( P < 0.001). Patients treated with ECT demonstrated poorer performance in delayed memory, attention, and language, but these impairments were transient. Thus, ECT was generally safe in adolescent patients with major depressive disorder.

CONCLUSIONS

Our findings verified ECT as effective and safe for improving suicidal ideation and depressive symptoms of adolescent patients with major depressive disorder. In addition, partially impaired cognitive function recovered gradually after ECT.

The Brief Adolescent Depression Screen: A Brief Screening Tool for Depression and Suicidal Behavior in Inpatient Adolescents

Background

In clinical settings, there is significant need for brief, easily-administered assessment tools for adolescent depression that can be used by mental health clinicians from a variety of training backgrounds. Existing depression screening tools do not assess for duration and consistency of symptoms, two key indicators of pathological depression.

Objective

The Brief Adolescent Depression Screen (BADS) was developed to screen for major and persistent depressive disorders in adolescents in order to meet the assessment needs in an inpatient setting, and the validity of this tool was tested.

Method

The current study used a sample of 396 inpatient adolescents to assess the screening utility of the BADS for detecting whether the adolescent meets criteria for a depressive diagnosis according to a well-validated semi-structured interview, as well as detecting a positive history of suicidal behavior. Further, the screening utility of this measure was compared to the utility of an established depression rating scale.

Results

Analyses first determined the duration of depressive symptoms on the BADS that optimally screened for the presence of Major Depressive Disorder and Persistent Depressive Disorder. Findings indicated that, using these optimal screening cut-offs, the BADS showed a strong screening utility, resulting in a sensitivity and specificity for identifying full depressive diagnoses and a positive history of suicidal behavior with similar or greater accuracy than an established rating scale.

Conclusions

These findings provide initial evidence to suggest that the BADS may be a helpful screening tool for adolescent depressive disorders in inpatient settings.

Rural-urban differences in prevalence and correlates of suicidal ideation in adolescent patients with depression in a large sample of Chinese

BACKGROUND

Suicidal ideation (SI) is severe comorbidity of depression that has been extensively studied in the past. Residence differences between SI have rarely been systematically studied, especially in parental rearing behavior. This large-scale explored the residence differences in the prevalence and correlation of SI adolescent patients with depression.

METHODS

A total of 1417 patients with depression were recruited, and their demographic data and clinical data were collected. The Children's Depression Inventory (CDI) and the Egna Minnen Beträffande Uppfostran (EMBU) scale were used to assess depression, and parental rearing behavior, respectively.

RESULTS

The prevalence of suicidal ideation was higher in urban patients than in rural patients (43.7 % vs.37.7 %, P < 0.05). Patients with SI scored higher on total CDI scores, parental punishment, parental rejection, and paternal overprotection compared to their respective patients without SI. In the urban group, patients with SI had lower parental emotional warmth scores and higher parental intervention scores compared to patients without SI. Logistic regression analysis showed that total CDI score, gender, alcohol consumption, father's emotional warmth, father's rejection, and mother's intervention were significantly associated with SI in urban patients (P < 0.05); total CDI score and mother's rejection were significantly associated with SI in rural patients (P < 0.05).

LIMITATIONS

No causal relationship could be drawn due to the cross-sectional design.

CONCLUSIONS

The results of this study showed significant residential differences in risk and associated factors for SI among adolescents with depression. Focusing on the parenting styles of adolescent patients can help with the early identification and intervention of SI.

Association between electroconvulsive therapy and depressive disorder from 2012 to 2021: Bibliometric analysis and global trends

Background

Depressive disorder is a chronic mental illness that is vulnerable to relapse, imposes a huge economic burden on society and patients, and is a major global public health problem. Depressive disorders are characterized by depressed mood, decreased energy and interest, and suicidal ideation and behavior in severe cases. They can be treated through pharmacotherapy and psychotherapy or physical treatments such as electroconvulsive therapy (ECT). In patients with suicidal ideation, behavior, or refractory depressive disorder ECT has a faster onset of action and better efficacy than pharmacotherapy. This study used bibliometric and visual analyses to map the current state of global research on ECT for depressive disorder and to predict future research trends in this area.

Materials and methods

A literature search was performed for studies on ECT and depressive disorder in the Web of Science Core Collection (WoSCC) database. All studies considered for this paper were published between 2012 and 2021. Bibliometric and co-occurrence analyses were performed using the CiteSpace software.

Results

In total, 2,184 publications were retrieved. The number of publications on ECT and depressive disorder have been increasing since 2012, with China being a emerging hub with a growing influence in the field. Zafiris J. Daskalakis is the top author in terms of number of publications, and The Journal of ECT is not only the most published journal but also the most co-cited journal in the field. Co-occurrence analysis showed that electroconvulsive therapy, treatment-resistant depression, bipolar disorder, hippocampus, efficacy, and electrode placement are current research hotspots. Molecular biomarkers, neuroimaging predictors, and late-life depression will become research hotspots in the future.

Conclusion

Our analysis made it possible to observe an important growth of the field since 2012, to identify key scientific actors in this growth and to predict hot topics for future research.

Comparison of cognitive impairments with lipid profiles and inflammatory biomarkers in unipolar and bipolar depression

Cognitive impairments is one of important accompanied symptom in Unipolar depressive disorder (UD) and bipolar disorder (BD) that was hard to distinguish, as their diagnosis is based on behavioural observations and subjective symptoms. In this study, we could highlight the difference of cognitive ability in UD and BD by testing lipid profiles and inflammatory biomarkers in major depressive episodes (MDE). 207 subjects (96 unipolar and 111 bipolar depressed patients) were included in this study. We applied Montreal Cognitive Assessment (MoCA) to test cognitive ability. The 24-item Hamilton Depression Rating Scale was used for assessment at the beginning of treatment. A series of clinical variables and lipid profiles were collected from clinic record. We detected pro-inflammatory biomarkers Interleukin-1β (IL-1β), Interleukin-6 (IL-6), C-reaction protein (CRP) levels and brain-derived neurotrophic factor (BDNF) by enzyme linked immunosorbent assay. From the results, cognitive impairments were more popular in BD than UD, most obviously in severe cognitive impairments (MoCA score<23). And UD showed better cognitive ability than BD in MoCA, particularly in language domain. Compared lipid profiles like total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (ApoA1), Apolipoprotein B (ApoB) and lipoprotein α (Lpα), we found that ApoB was higher in BD than UD that maybe a risk factor in cognition. There was no obviously difference in TC, TG, HDL-C, LDL-C, ApoA1, or Lpα. Also, we found CRP level in BD was higher than UD, and showed no significant difference in IL-1β and IL-6 levels. Furthermore, BDNF level which was neurotrophic biomarker for cognition and mood was significantly declined in BD compared with UD. Correlation analysis showed that ApoB and CRP was negative closed associated with MoCA scores. And BDNF level was positive related with cognitive ability in MDE patients. From our results mentioned that quantitative lipid profiles and inflammatory biomarkers analysis might help to objectively identify between these disorders and up our understanding of their pathophysiology. And ApoB, CRP and BDNF could be as potential peripheral candidates in cognitive evaluation to distinguish UD and BD.

Latent profile analysis to identify subgroups of Chinese sexual minority adolescents at risk of suicidality

BACKGROUND

This study aimed to identify latent class profiles of sexual minority adolescents (Men Sexually attracted to Men, Women Sexually attracted to Women, and Bisexual) with elevated suicidal ideation.

METHODS

Data were collected from 18 secondary schools in China. Sub-group classifications were identified using variables associated with suicidal ideation in sexual minority adolescents, including parental relationship quality, electronic equipment time, school bullying, and sleep quality using the Chinese version of the Pittsburgh Sleep Quality Index to measure sleep. Anxiety was measured using the Generalized Anxiety Disorder 7 (GAD-7), depression was measured using the Patient Health Questionnaire 9 (PHQ-9), hypomania using the Hypomanic Checklist-32 (HCL-32), positive coping style was identified using the Trait Coping Style Questionnaire, and self-efficacy was measured by the General Self-Efficacy Scale.

RESULTS

Four distinctive profiles were derived from the data. Compared to "low-risk" group (Class 3), the "adolescent with mood problems" group (Class 2) had a 9.81 times higher risk of suicidal ideation; the those who classified as "severe bullied adolescent" (Class 4) had a 9.26 times higher risk of suicidal ideation. and the "adolescents with low self-efficacy" group (Class 1) had a 4.48 times higher risk of suicidal ideation.

CONCLUSIONS

Sexual minority adolescents with mood problems have the highest risk of suicidal ideation, followed by adolescents frequently being bullied at school. Interventions aimed at reducing suicide risk among sexual minority adolescents may benefit from attending to such profile factors identified in this study to develop targeted clinical care.

The psychological characteristics and risk factors of suicidal attempt among mood disorders adolescents accompany with non-suicidal self-injury: A multi-center study

BACKGROUND

Identifying the risk factors of suicide attempts(SA) in adolescents with mood disorders(MD) who engage in non-suicidal self-injury(NSSI) is of great significance for suicide prevention. The aim of the present study was to explore the psychological characteristics and risk factors of SA among MD adolescents engaged in NSSI.

METHODS

We recruited MD outpatients accompany with NSSI aged 12-18 years. SA, NSSI methods and function, suicidal ideation(SI), psychological distress(PD), self-esteem, stress mindset and perceived social support were assessed by valid scales. Classification and regression tree analysis (CART) was employed to explore the characteristics and risk factors of SA among MD adolescent with NSSI.

RESULTS

We included 658 participants in this study. Of 58.1% participants reported SA during the past 12 months. Compared with the adolescents without SA, the attempters used more different NSSI methods and reported more frequent NSSI. SA, SI, PD, self-esteem and amount of thinking time before engaging in self-injury were risk factors of SA among MD adolescents. Interactions between the four risk factors resulted in varying degrees of risk of SA. Compared to adolescents with the characteristics of low level of SI - little consideration before self-injury, adolescents who having multiple characteristics of the high level of SI -high level of PD - low self-esteem were associated with a 15.1-fold increased risk of SA(P < 0.001), and those with the characteristics of high SI - deliberated before engaging in self-injury were associated with a 28.1-fold increased risk of attempted suicide(P < 0.001).

CONCLUSIONS

Our findings identify multiple correlates for SA in MD adolescents accompany with NSSI, including SI, PD, self-esteem and deliberate time they thought before self-injury, which may contribute to the development of suicidal behaviors in an interactive manner.

Association of thyroid-stimulating hormone and lipid levels with suicide attempts among adolescents with major depressive disorder in China

OBJECTIVES

Evidence suggested that thyroid-stimulating hormone (TSH) and lipid levels were associated with major depressive disorder (MDD). However, its role in suicide attempts in adolescents with MDD was unclear. This investigation was to probe into the relationship between TSH, lipid levels, and attempted suicide in adolescents with MDD.

METHODS

A total of 179 adolescents with MDD were included from January 2021 to January 2022. Socio-demographic data and clinical data were obtained through self-made questionnaires. TSH and lipid levels were analyzed by a recognized laboratory. The Epidemiological Studies Depression Scale (CES-D) was used to assess the severity of depression. Questions about whether there was a behavior of suicide attempts were completed through conversation interviews.

RESULTS

Results showed that the CES-D total score, TSH, and low-density lipoprotein cholesterol (LDL-C) of suicide attempters were significantly higher than those of non-suicide attempters. Ordinary family relationships were more likely to attempt suicide than good family relationships. The CES-D total score, ordinary family relationships, TSH and LDL-C were still significant in binary logistic regression, with an adjusted odds ratio (OR) of 1.04, 3.42, 5.14, and 1.76, respectively. The area under the receiver operating characteristic (ROC) curve showed that the area under the ROC curve (AUC) ranged from 0.60 to 0.74.

CONCLUSION

Suicide attempts are common among adolescents with MDD and were associated with CES-D total score, ordinary family relationships, TSH, and LDL-C. Given the association between suicide attempts and TSH and LDL-C, the dynamic changes in TSH and LDL-C levels should be detected regularly.

Inflammation mediated the effect of dietary fiber on depressive symptoms

BACKGROUND AND AIMS

Previous studies showed that inflammation affects depressive symptoms. Dietary fiber may be associated with inflammation and depressive symptoms. We aimed to investigate the relationship between inflammation and depressive symptoms at different levels of dietary fiber intake and to explore whether dietary fiber affects depression through inflammation.

METHODS

A total of 8,430 National Health and Nutrition Examination Survey (NHANES) samples were collected between 2015 and 2018. Factor analysis was used to determine dietary patterns. Linear regression and logistic regression analysis were used to explore the relationship between nutrients, inflammation, and depressive symptoms, and the mediation analysis was conducted using the bootstrap method.

RESULTS

Factor 3 (dietary fiber and vitamins) was inversely associated with depressive symptoms and inflammation. The upper quartile scores of the dietary inflammatory index (DII) and C-reactive protein (CRP) were associated with depressive symptoms compared with controls (DII: OR = 1.851, 95% CI: 1.267-2.705; CRP: OR = 1.737, 95% CI: 1.136-2.656). The DII score and CRP were associated with depressive symptoms in the group with low dietary fiber intake (DII: OR = 2.736, 95% CI: 1.628-4.598; CRP: OR = 2.092, 95% CI: 1.196-3.658) but not in the high dietary fiber intake group. Mediating analysis showed that CRP partially mediated the effect of dietary fiber intake on depressive symptoms (β_indirect = -0.0025, 95% CI: -0.0038 to -0.0013), and the mediated proportion was 10.5%.

CONCLUSION

In this study, we found that DII scores and CRP were not associated with depressive symptoms in participants with high dietary fiber intake, and inflammation partially mediates the effect of dietary fiber on depressive symptoms.

Prevalence of and risk factors for depressive and anxiety symptoms in a large sample of Chinese adolescents in the post-COVID-19 era

BACKGROUND

Depressive and anxiety symptoms are widespread among adolescents today, creating a large social problem. However, few previous studies have addressed depression and anxiety among adolescents in Chinese cohorts. The aim of this study was to evaluate the prevalence of and risk factors for depressive and anxiety symptoms among Chinese middle school adolescent students in the post-COVID-19 era.

METHODS

A total of 22,380 middle school students from Jiangsu Province were surveyed online, and their general demographic data were collected. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms, and the seven-item Generalized Anxiety Disorder (GAD-7) scale was used to measure anxiety symptoms.

RESULTS

Of these participants (aged 12-17 years), 25.6% had depressive symptoms, 26.9% had anxiety symptoms, and 20.6% had a combination of depression and anxiety symptoms. The prevalence of depressive symptoms was higher in female adolescents (27.6%) than in male adolescents (23.7%; χ² = 45.479, P = 0.000), and the proportion with anxiety symptoms was higher among female adolescents (28.6%) than among male adolescents (25.4%; χ² = 29.390, P = 0.000). Furthermore, binary logistic regression analysis showed that gender, region, and parental relationship were significantly associated with depressive symptoms among adolescents, while age, gender, region, and parental relationship were significantly associated with anxiety symptoms.

CONCLUSIONS

Our findings demonstrated that the prevalence of reported depressive and anxiety symptoms in Chinese adolescents are high. Female gender, urban region, and poor parental relationship may be risk factors for depressive and anxiety symptoms. Furthermore, policy makers, schools, and families need to pay more attention to the psychological health of adolescents, develop response plans and take early intervention measures to reduce the prevalence of adolescent depression and anxiety.

Symptoms and Characteristics of Youth Hospitalized for Depression: Subthreshold Manic Symptoms Can Help Differentiate Bipolar from Unipolar Depression

Background: Most people who have major depressive disorder (MDD) or bipolar disorder (BD) will have their first episode of depression in adolescence. However, in the absence of significant [hypo]manic symptoms, there are no clear guidelines for distinguishing bipolar from unipolar depression, which can lead to misdiagnosis and ineffective/harmful treatment. We aimed to compare phenomenological differences among youth with MDD or BD hospitalized for an acute episode of depression. Methods: A retrospective electronic chart review of adolescents hospitalized in an acute care inpatient unit who had a discharge diagnosis of MDD, MDD with mixed or psychotic features (MDD+), BD-I-current episode depressed, or BD-II-current episode depressed, was performed. Results: Altogether, 598 patients (mean age = 15.1 ± 1.5 years, female = 71%, and White = 46%) met study inclusion criteria, i.e., BD-I: n = 39, BD-II: n = 84, MDD: n = 422, and MDD+: n = 53 patients. The admission Hamilton Depression Rating Scale (HAMD) total score was significantly higher in the BD-I (29.3 ± 9.1) and MDD+ (31.2 ± 9.3) groups versus the MDD group (24.3 ± 9.7) (p < 0.05). Although there were some group differences in the severity of individual depression symptoms, these did not line up neatly across BD and MDD groups. At admission, Young Mania Rating Scale (YMRS) total scores were significantly higher in the BD-I (14.4 ± 7.4), BD-II (13.8 ± 6.5), and MDD+ groups (14.3 ± 6.6) versus the MDD group (8.2 ± 4.6, p < 0.05). Additionally, 9 of 11 and 4 of 11 YMRS items scored significantly higher in the BD-II and BD-I groups versus the MDD group, respectively. The motor activity and hypersexuality items, in particular, were scored consistently higher in the BD groups than MDD groups. Limitations: All diagnoses were made based on a clinical interview and not a structured diagnostic interview, and some of the subgroup sample sizes were relatively modest, limiting the power for group comparisons. Conclusion: The presence of subsyndromal manic symptoms during an episode of MDD currently offers the clearest way by which to differentiate bipolar depression from unipolar depression.

Stressful events and adolescents' suicidal ideation during the COVID-19 epidemic: A moderated mediation model of depression and parental educational involvement

This study examined the association between stressful events and adolescents' suicidal ideation and determined the roles of depression as a mediator and parental educational involvement as a moderator during the COVID-19 epidemic. Survey data from a sample of 1595 Chinese adolescents and their parents were subjected to path analysis. The results indicated that stressful events of the COVID-19 epidemic were significantly positively associated with adolescents' suicidal ideation, and this association was mediated by depression. In addition, adolescents' parental educational involvement significantly moderated the path from depression to suicidal ideation. These results highlight the importance of identifying the underlying key mechanisms that moderate the mediated paths between stressful events and adolescents' suicidal ideation during the COVID-19 epidemic. The findings also provide implications for parents and education staff regarding the importance of improving parental educational involvement to prevent adolescents' suicidal ideation during the COVID-19 epidemic.

Prevalence, risk factors and clinical correlates of suicidal ideation in adolescent patients with depression in a large sample of Chinese

BACKGROUND

Suicidal ideation (SI) has a high risk in adolescents and is now a significant concern due to its problematic outcome. However, few systemic studies of suicidal ideation have been conducted in adolescent patients. Therefore, the current study was aimed to assess the prevalence and its clinical correlate of suicidal ideation among adolescent patients with depression.

METHODS

A total of 1635 adolescent patients (748 males/ 887 females) with depression were recruited in this study. The clinical and demographic data were collected by a self-administered questionnaire. Suicidal ideation was assessed by interview. Children's Depression Inventory (CDI) was used to evaluate depressive symptoms, Adolescent Self-Rating Life Events Check List (ASLEC) was used to assess the stressful life events.

RESULTS

The study showed that the prevalence of suicidal ideation in adolescent depression patients was 38.2% (625/1635). Compared to the non-SI patients, SI patients had greater scores on CDI and ASLEC, had inadequate sleeping time, and were more likely to be females. Further logistic regression analysis indicated that suicidal ideation in adolescent patients with depression was significantly associated with females, inadequate sleeping time, the severity of depression, and higher learning pressure.

LIMITATIONS

No causal relationship could be drawn due to the cross-sectional design.

CONCLUSIONS

Our results suggest a high prevalence of suicidal ideation in adolescents with depression. Moreover, the severity of depression, sex, sleep time, and learning pressure are all related to suicidal ideation. Early recognition and treatment of suicidal ideation can effectively prevent the occurrence of suicide among adolescent patients.

Substance Use Disorders (SUD) and Suicidal Behaviors in Adolescents: Insights From Cross-Sectional Inpatient Study

Objectives

To determine the demographic predictors of suicidal behaviors and measure the association between the spectrum of substance use disorders (SUD) and hospitalization for suicidal behaviors in the adolescent population.

Methods

We conducted a cross-sectional study using the nationwide inpatient sample and included 466,244 adolescent inpatients with psychiatric illnesses. The study sample was sub-grouped into suicidal (N = 182,454) and non-suicidal (N = 283,790) cohorts. The odds ratio (OR) of association for demographic characteristics and comorbid SUD in the suicidal group was evaluated using a logistic regression model witha P-value < 0.01.

Results

Our study population included 466,244 adolescent inpatients. Females had higher odds of suicidal behaviors (OR 1.45; 95% CI 1.431-1.470) compared to males. The most prevalent comorbid SUD among suicidal inpatients was cannabis (15.3%) but had a statistically non-significant association with suicidal behaviors (OR 0.98; 95% CI 0.95-0.99). Inpatients with alcohol use disorders had significantly increased odds of association with suicidal behaviors (OR 1.18; CI: 1.142-1.209) compare to other SUD. Among other substances (cannabis and stimulants), there existed a statistically non-significant association with hospitalization for suicidal behaviors.

Conclusion

Adolescent inpatients with comorbid alcohol use disorders were at 18% higher odds of hospitalization for suicidal behaviors. Our study provides a basis for more research while also suggesting potential avenues for early identification and intervention efforts for comorbid SUD in adolescents requiring psychiatric care to improve their prognosis and quality of life.

Eating Disorders and Suicidal Behaviors in Adolescents with Major Depression: Insights from the US Hospitals

Objective: To evaluate the odds of association between suicidal ideation and/or attempt with comorbid eating disorders in adolescents with major depressive disorder (MDD). Methods: We conducted a cross-sectional study and included 122,020 adolescents with a primary diagnosis of MDD from the nationwide inpatient sample (NIS, 2012–2014). They were sub-grouped by a comorbid diagnosis of eating disorders (N = 1675). We calculated the adjusted odds ratio (aOR) using a logistic regression model with demographic confounders for associations of eating disorders with suicidal ideation and attempt. Results: Suicidal ideations were seen in a higher proportion of adolescents with eating disorders (46.3% vs. 14.2% in those without eating disorders). On the contrary, a low proportion of adolescents with eating disorders had suicidal attempts (0.9% vs. 39.4% in those without eating disorders). Overall, eating disorders were associated with higher odds for suicidal ideations (aOR 5.36, 95% CI 4.82–5.97) compared to those without eating disorders, but with lower odds of suicidal attempt (aOR 0.02, 95% CI 0.01–0.03). Conclusions: Adolescents with MDD and comorbid eating disorders had five-times increased odds of suicidal ideations but lower odds of a suicide attempt. Self-harm/injurious behaviors are early signs of suicidal ideations in these patients. A collaborative care model is required for the screening, early diagnosis, and management of adolescents with eating disorders to improve their quality of life.

Comorbid Anxiety Increases Suicidal Risk in Bipolar Depression: Analysis of 9720 Adolescent Inpatients

Objective: To evaluate the risk of association between suicidal behaviors and comorbid anxiety disorders in adolescents with bipolar depression. Methods: We conducted a cross-sectional study using the nationwide inpatient sample (NIS) from the United States. This study included 9720 adolescent inpatients with bipolar depression and further grouped by co-diagnosis of anxiety disorders. Logistic regression analysis was used to evaluate the odds ratio (OR) of suicidal behaviors due to comorbid anxiety after controlling demographic confounders and psychiatric comorbidities. Results: Out of total inpatients, 34.8% (n = 3385) had comorbid anxiety disorders with a predominance in females (70.3%) and White patients (67.7%). About 54.1% of inpatients with comorbid anxiety had suicidal behaviors versus 44.6% in the non-anxiety cohort (p < 0.001). Comorbid anxiety disorders were associated with 1.35 times higher odds (95% CI 1.23–1.47, p < 0.001) for suicidal behaviors. Conclusion: Suicidal behaviors are significantly prevalent in bipolar depression adolescents with comorbid anxiety disorders. Anxiety disorders are an independent risk factor in bipolar depression that increase the risk of suicidal behaviors by 35%. This necessitates careful assessment and management of comorbid anxiety disorders in bipolar youth to mitigate suicidality.