Suicidal thoughts and behaviors in adolescents with mood disorders: Insights from a nationally representative sample

Suicide is a leading cause of death in adolescents, and major mood disorders confer a greatly increased risk. Few population-based studies have investigated the distinct and overlapping clinical correlates of suicidality in adolescents with bipolar disorder (BD) and major depressive disorder (MDD). Understanding these correlates may inform targeted prevention and intervention strategies. This study aims to examine the clinical correlates of suicidal thoughts and behaviors (STBs) in a nationally representative sample of adolescents with and without mood disorders.

Data from the National Comorbidity Survey - Adolescent Supplement (NCS-A; 2001-2004) was examined to compare the prevalence and clinical correlates of suicidal ideation/plan and suicide attempts between adolescents with BD, MDD, and those without mood disorders. Participants, ages 13-18 years, were interviewed using a modified version of the Composite International Diagnostic Interview to confirm diagnoses for BD (n = 295), MDD (n = 1112) or controls without mood disorders (n = 8716).

Lifetime prevalence of suicide attempts in adolescents with BD (14.9 %) and MDD (17.2 %) was higher than in controls (1.4 %). Similarly, suicidal plans/ideation were more prevalent among adolescents with BD (20.4 %) and MDD (22.8 %) than controls (6.5 %). STBs were associated with longer duration of depressive episodes, antidepressant use, mental health treatment, and experiences of physical/sexual abuse in both MDD and BD groups.

STBs are associated with multiple shared clinical correlates alongside diagnosis-specific correlates. These findings highlight the significance of depression burden and reward-related behaviors (smoking, SUD, eating disorders) as risk indicators, which could guide the development of targeted prevention and treatment strategies.