Early diagnosis of bipolar disorders may improve suicide rates among adolescents: JAMA

A new study by Peter Andersson and team showed that regional bipolar disorder diagnosis rates were strongly correlated with decreased suicide death rates in teenage boys, with an estimated magnitude of 4.7% of the mean nationwide suicide death rate. The findings of this study were published in the Journal of American Medical Association.

Unknown is the relationship between early bipolar illness diagnosis and treatment and adolescent suicide mortality (ASM). In order to evaluate geographical correlations between ASM and bipolar illness diagnostic rates, this study was carried out.

This cross-sectional study looked at the relationship between bipolar disorder diagnosis rates and yearly regional ASM in Swedish teenagers aged 15 to 19 from January 1, 2008, to December 31, 2021. 585 suicide fatalities were included in the aggregated data without exclusions provided at the regional level, totaling 588 distinct observations. Lithium prescription rates and bipolar disorder diagnostic frequencies were identified as fixed-effects variables. Independent fixed-effects variables included an interaction term between rates of psychiatric care affiliation and the percentage of psychiatric visits to inpatient and outpatient clinics. Random intercept effect modifiers included the region and the year. Population adjustments and variation in reporting standards corrections were made to the variables.

Generalized linear mixed-effects models were used to analyse the sex-segregated, regional, and yearly ASM rates in adolescents aged 15 to 19 per 100,000 people.

The key findings of this study were:

1. Nearly three times as many female teenagers as male adolescents received a bipolar illness diagnosis in the past year.

2. In comparison to the national median, regional prevalence rates of bipolar disorder in males and females, respectively, ranged by a ratio of 0.46 to 2.61 and 0.00 to 1.82.

3. Independent of lithium medication and psychiatric care affiliation rates, the prevalence of bipolar illness diagnoses was negatively correlated with male ASM.

4. After correcting for yearly regional diagnostic rates of major depressive disorder and schizophrenia, both models with a dichotomized quartile 4 ASM variable that reproduced this link were robust.

5. For females, no such connection was seen.

The outcomes could be linked to treatment effectiveness, advantages of early diagnosis (and management), or other unaccounted-for factors that may be connected to local rates of youth bipolar disorder diagnosis, adding to the body of knowledge about the benefits of early diagnosis and management.

Reference: 

Andersson, P., Jokinen, J., Jarbin, H., Lundberg, J., & Desai Boström, A. E. (2023). Association of Bipolar Disorder Diagnosis With Suicide Mortality Rates in Adolescents in Sweden. In JAMA Psychiatry. American Medical Association (AMA). https://doi.org/10.1001/jamapsychiatry.2023.1390