Phd in CLINICAL EXPERIMENTAL NEUROSCIENCE AND PSYCHIATRY

Thesis title: Suicidal behavior in juvenile major depressive and bipolar disorder: a systematic review and meta-analysis

Objective: The primary aim of this study is to assess risk, rates, and lethality of suicidal behavior among juveniles diagnosed with a major depressive disorder (MDD) or a bipolar disorder (BD). Secondarily we aim to compare rates of suicide attempts in children or adolescents diagnosed with BD versus MDD. Methods: We systematically searched for studies of suicidal behavior among juveniles (age ≤18 years), and pooled data on risk (% of subjects) and rates (%/exposure-years), followed by random-effects meta-analysis and multivariable linear regression modeling. The protocol for this review was registered on PROSPERO (CRD42019159676). Results: We included 38 reports (1995–2018) from 14 countries involving 105,874 juveniles (103,772 with MDD, 2,102 with bipolar disorder BD), with exposures ranging 1.00–12.5 years. Suicide attempter-rates averaged 6.55%/year [95%CI: 6.04–7.10] with BD and 2.59%/year [2.55–2.63] with MDD (rate-ratio = 2.53 [2.32–2.75]; p<0.0001), or 2.79%/year overall. Meta-analysis of 6 studies with both diagnostic groups further supported greater risk of attempts with BD (OR=1.71 [CI = 1.33–2.20], p<0.0001). Multivariate regression indicated more suicidal risk with older subjects and shorter exposure-time. Estimated from six studies, suicide rate averaged 125 [56.9–236]/100,000 person-exposure years (100k PEY)—more than 30-times greater than in the general juvenile population. The ratio of attempts/suicides (A/S) was 22.3, indicating more than 11-times greater lethality than estimates of A/S in the juvenile general population. Conclusions: Rates of suicide attempts in juveniles with a major mood disorder averaged 2790/100k PEY, were greater in BD than MDD, among older adolescents and in the first years after assessment. Lethality was greater than the juvenile general population. These results should inform patients, caregivers, and clinicians.