Talk About Tragedy Newsletter Archives

What Causes Children to Suicide? Feb 2006

February 15, 2006

Dear

In This Issue:

1. In the News:


2. Children and Mental Illness


3. Tell Us What You Think

In the news: Study on Children and Bipolar Disorder

Largest Study to Date on Pediatric Bipolar Disorder Describes Disease Characteristics And Short-Term Outcomes

Recent findings from the multi-site, NIMH-funded Course and Outcome of Bipolar Illness in Youth (COBY) study are helping to shape the understanding of three major subtypes of bipolar disorder that affect children and adolescents and how this diagnosis may affect them as adults.

Also known as manic-depressive illness because of its recurring episodes of mania and depression, bipolar disorder is a serious, chronic illness which causes shifts in a person's mood, energy, and ability to function.

Before the COBY study, there had been few studies on the symptom patterns and course of the disorder in the pediatric population.

Understanding the effects of bipolar disorder early in life may lead to better treatments and improve long-term outcomes as these children and adolescents become adults.

Overall, bipolar disorder appears to affect children and adolescents more severely than adults. Study participants had comparatively longer symptomatic stages and more frequent cycling (changing from one mood to another) or mixed episodes.

Children and adolescents also converted from a less severe form of bipolar disorder to a more severe form at a much higher rate than seen in adults.

This study comprises the largest pediatric bipolar population to date, following the course and outcome of 263 children and adolescents, ages 7-17 years.

These findings were published in the February 2006 issue of the Archives of General Psychiatry.

Future reports will cover in more detail the characteristics of bipolar spectrum disorders in children and adolescents, the longer-term disease progression, predictive factors of disease outcome, such as co-occurring disorders or family psychiatric history, and the effects of different types of treatments.

Subtypes of Bipolar Disorder

The three major subtypes of bipolar disorder (BP) included in this study were BP-I, BP-II, and Bipolar Disorder Not Otherwise Specified (BP-NOS), the most commonly seen subtype in pediatric psychiatric clinics.

In accordance to guidelines set by the Diagnostic and Statistical Manual-IV (DSM-IV), BP-I was determined by primarily manic (abnormally "high" and/or irritated) episodes and BP-II was determined by an alternating pattern between depressive and hypomanic (a less severe form of mania) episodes.

BP-NOS is not clearly defined in the DSM-IV, so the researchers determined this type by "the presence of elated mood, plus two associated DSM-IV symptoms, or irritable mood plus three DSM-IV associated symptoms, along with a change in the level of functioning;" the symptoms had to have lasted at least 4 hours within a 24-hour period for at least 4 "cumulative lifetime days."

Of the total study population who had at least one follow-up assessment over an average time of 1.5 years, 57 percent had BP-I, 8 percent had BP-II, and 35 percent had BP-NOS.

Researchers tracked changes in symptoms and instances of recovery or recurrence. Recovery was defined as having 8 consecutive weeks with minimal or no symptoms.

Recurrence, or having a new episode, was defined as meeting the full DSM-IV criteria for a particular diagnosis with different degrees of severity or impairment for one week in the case of mania or hypomania (a less severe form of mania), or two weeks in the case of depression.

Symptom Course, Recovery, and Recurrence

Approximately 70 percent of all the study participants recovered from their index episode (the episode that brought them to the study's attention) and 50 percent had at least one recurrence.

Those with BP-I recovered and recurred more frequently than those with BP-NOS, who took the longest time to reach recovery or recurrence.

On average, during the follow-up period, the participants spent 39.2 percent of the time symptom-free, 22.6 percent meeting the criteria for a DSM-IV episode, and 38.2 percent with some symptoms but not meeting DSM-IV criteria.

However, even during the symptom-free periods, many participants had ongoing co-occurring psychiatric disorders (such as attention deficit hyperactivity disorder, or ADHD).

In addition, 12 percent experienced at least one week of psychotic symptoms (such as hallucinations or delusions) and 15 percent made at least one suicide attempt or gesture.

There were no completed suicides in the COBY study. Over the follow-up period, 20 percent of those with BP-II converted to BP-I; of those with BP-NOS, 18.5 percent converted to BP-I and 6.5 percent converted to BP-II.

Predictors of Outcome

Younger age of onset, low socio-economic status, and psychotic symptoms were common factors in study participants who had worse outcomes.

In comparison with studies of bipolar disorder in adults, the researchers found major differences in the course of illness in children, which may have a serious impact on their emotional, cognitive, and social development.

Compared to adults with BP-I, COBY participants with BP-I spent significantly more time in a symptomatic stage and had more mixed and cycling (changing from one mood to another) episodes, mood symptom changes, and polarity switches.

Also, the rate of conversion between BP-II and BP-I found in COBY is higher than the rate of conversion commonly reported in studies on adults.

Furthermore, this is the first study to suggest the relative instability of the BP-NOS subtype, due to the number of participants who converted to BP-I or II.

Children and Mental Illness

• Over 90 percent of suicide victims have a significant psychiatric illness at the time of their death.

  These are often undiagnosed, untreated, or both. Mood disorders and substance abuse are the two most common.

  When both mood disorders and substance abuse are present, the risk for suicide is much greater, particularly for adolescents and young adults.




• Research has shown that when open aggression, anxiety or agitation is present in individuals who are depressed, the risk for suicide increases significantly.

Tell Us What You Think

We welcome your comments, and encourage you to contact us with your suggestions and comments.

If you found this helpful, please forward this newsletter to a friend.

Talk About Tragedy June 2006

1. Explaining Suicide to Children



2. What's Happening to Coping-With-Suicide?




3. Tell Us What You Think

Basic Principles for Explaining Suicide.

June 28, 2006 (This is an excerpt from the ebook Grieving the Suicide of a Loved One, by Karen E. Grisham.)

Getting the message across in times of grief after suicide is much the same as at any other time.

It is important to be:

• brief:

  Give only the information that the child needs at the time. You can always leave the door open for questions later.



• clear:

  Children may imagine a worse situation than really exists if you aren't direct and to the point.

  "Aunt Bee has died" is clearer communication than other phrases like 'Aunt Bee passed away', 'Aunt Bee went home to be with the Lord', or 'we lost Aunt Bee'.

  One can then follow with a statement like, "What would you like to know or ask me about?" Indirect terms can be confusing to children.

  They may suggest that the situation is temporary, or less important. This can interfere with the first necessary step of facing the loss.




• honest:

  'Beating around the bush' is frustrating to the hearer. Honesty is also important when talking about dying persons.

  A child or adolescent deserves the right to prepare for a death, just as an adult does.

  Children will manage the death more easily if they are able to talk about what will happen when Aunt Bee dies.

  There will be less confusions and trauma when the event occurs.



• confident:

  We will need to practice using words about death, if we are going to make the message easy for a child to understand.

  This approach helps us get used to the terms and makes them easier to get out in times of stress.



• comfortable:

  Talking openly about death and dying helps normalize the process of dying as a part of the life cycle, instead of making it a taboo subject.

  It is better to say, "I am so sorry your doggie died", than to just not talk about it.

  You will help the child get used to the fact that the dog won't be coming back, and also make it easier for him to ask questions.



• respectful:

  We do not mean to be disrespectful, but in trying to 'protect' the hearer from the pain of the news, we can come across as 'talking down' to the person. This can give the impression that the person is somehow inferior, weak, or can't handle it.

  This is just as important when talking to a child as when talking to an adult.

What's Happening to Coping-With-Suicide?

When you visit the coping-with-suicide home page, you will notice that there is a link to our comfortyourheart.com site.

This is because we are combining the sites to bring you a more comprehensive and useful, one-stop-resource for your mental health and personal growth needs.

You will find the same pages you are used to seeing on this site, and with added resources for other forms of grief, and treatment options.

We are excited about the enhanced comfortyourheart site, and invite you to sign up for the combined newsletter.

Because of SPAM policies, you will need to re-register. I know this is an inconvenience, but it is for your protection, so I hope that you will do that, and I promise to be better about these letters!!

I appreciate each one of you and want to meet your needs, so visit us at Comfort Your Heart. Your participation is what make this website work, so please feel free to write, your privacy will be protected, and we will use first names only.

You can ask questions or make comments on any topic in the website, and if you have a word of encouragement for others, you may do that as well.

Tell Us What You Think

We welcome your comments, and encourage you to contact us with your suggestions and comments.

If you found this helpful, please forward this newsletter to a friend.

Email us at

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Comfort Your Heart with Sympathy Words

Suicide and Grief