Table 1. Review of studies exploring childhood abuse in BD patients with SB.
| Author (country) | Study type and population | Medication | Source of information on SB* | Instrument | Results |
|---|---|---|---|---|---|
| Janiri28 (Italy) | Cross-sectional study Outpatients diagnosed with BD-I (n=58) or II (n=46) (DSM-IV) (n=104) SA BD I (n= 49) >PC BD I (n=50) SA BD II (n=21) PC BD II (n=35) |
Stable drug treatment for at least of 6 months | Semi-structured questionnaire | CTQ | SA > PC: higher CTQ emotional abuse sub-scores were associated with lifetime suicide attempts. Only hyperthymic temperament differentiated patients with a history of suicidal ideation vs. those with a history of suicide attempt. The only statistically significant demographic difference between BD patients with and without SA was gender; there were more males in the non-suicidal group. |
| Pavlova29 (Canada) | Cross-sectional study Out- and inpatients diagnosed with BD-I (n=81) and BD-II (n=93) SA (n=69) PC (n=105) |
N/A | MINI-Plus | CTQ | None of the specific severity indicators for BD and childhood-maltreatment (total CTQ scores) were significantly associated with a history of suicide attempts. No CTQ sub-scores were evaluated. There was no statistically significant difference in age and gender between groups. |
| Duarte30 (Brazil) | Case-control study Outpatients diagnosed with BD-I (n=39) (DSM-IV) SA (n=20) PC (n=19) |
Yes† ‡ § || | MINI-Plus | CTQ | SA > PC: higher total CTQ scores and higher CTQ sub-scores (emotional, physical, and sexual abuse; emotional and physical neglect). No statistically significant difference in age, gender, education level, and parental education between groups. |
| Cakir31 (Turkey) | Cross-sectional study from an ongoing follow-up project Outpatients diagnosed with BD-I (n=135) (DSM-IV) SA (n=21) PC (n=114) |
Yes† ‡ § || | SCID-I | CTQ | SA > PC: higher total CTQ scores, higher CTQ emotional neglect sub-scores followed by emotional abuse subscale. No demographic comparison between BD with SA vs. BD without SA. |
| Bernegger32 (Austria) | Cross-sectional study Inpatients or outpatients with either major depressive (n=211) or BD (n=44) (DSM-IV-TR) SA BD (n=12, 17.1%) PC BD (n=32, 17.3%) |
N/A | VI-SURIAS SBQ-R | CTQ | SA > PC: higher total CTQ scores and higher CTQ sub-scores (emotional, physical, and sexual abuse; emotional and physical neglect) in females. No statistically significant difference in gender between groups. |
| Mert33 (Turkey) | Cross-sectional study Inpatients or outpatients diagnosed with BD-I (n=91) (DSM-IV) SA BD (n=61, 67%) PC BD (n=30, 33%) |
N/A | MINI-Plus | CTQ | SA BD-I: number of major depressive episodes and history of emotional neglect were predictors of suicide attempts in BD-I patients. No statistically significant difference in age, gender, education level, and marital and employment status between groups. |
| Janiri34 (Italy) | Cross-sectional study Outpatients diagnosed with BD-I (n=58) or II (n=46) (DSM-IV) (n=104) SA BD I (n=12) PC BD I (n=46) SA BD II (n=14) PC BD II (n=32) |
Stable medication for a minimum of 6 months | Semi-structured questionnaire | CTQ | SA BD-I > PC BDI: higher total CTQ scores and higher CTQ sub-scores for emotional and sexual abuse. SA BDII > PC BDII: higher total CTQ scores and higher CTQ sub-scores for emotional abuse. Emotional abuse: independent predictor of lifetime suicide attempts in BD patients. No statistically significant difference in age, gender, and education level between groups. |
| Li35 (China) | Cross-sectional study Outpatients diagnosed with diagnosis BD type I (DSM-IV) SA (n=31) PC (n=101) |
N/A | SCID-I | CTQ-SF | SA > PC: higher total CTQ scores and higher CTQ sub-scores (emotional, physical, and sexual abuse, as well as emotional and physical neglect), but not statistically significant. No demographic comparison between BD with SA vs. BD without SA. |
| Erten36 (Turkey) | Cross-sectional study Outpatients diagnosed BD (n=116) (DSM-IV) SA BD (n=36) PC BD (n=80)CHT history (at least one type: n=71, 61.2%) |
N/A | SI-HDRS-21 | CANQ | SA >PC: significant correlation between any type of CHT and suicide attempt. SA > PC: higher total CTQ scores and higher CTQ sub-scores for physical, sexual, and emotional abuse. No demographic comparison between BD with SA vs. BD without SA. Broad demographic description of the sample. |
| Watson37 (England) | Cross-sectional study Outpatients diagnosed with BD I (n=31), II (n=25), or NOS (n=4) (DSM-IV) SA (n=31) PC (n=24) |
Stable medication for a minimum of 4 weeks | SCID-IHDRS-17 | CTQ | SA > PC: higher total CTQ scores, higher CTQ emotional neglect sub-scale score followed by emotional abuse sub-scale. No demographic comparison between BD with SA vs. BD without SA. Broad demographic description of the sample. |
| Etain38 (France and Norway) | Cross-sectional study In and outpatients diagnosed BD (type I, type II, or NOS) (n=587) (DSM-IV) SA (n=211) PC (n=376) |
Yes† | SCID-I | CTQ | SA > PC: higher total CTQ scores and higher CTQ sub-score (emotional, physical and sexual abuse). Emotional and sexual abuse were independently associated with increased history of suicide attempt. No demographic comparison between BD with SA vs. BD without SA. Broad demographic description of the sample. |
| Pompili39 (Italy) | Cross-sectional study Inpatients with psychiatric disorder (DSM IV-TR) (n=62) (15% BD I, 26% BD II, 7% major depressive episode, 15% psychosis, or 8% other specified diagnosis) HSR (n=20) LSR (n=42) |
Yes | MMPI-2 | CTQ | HSR > LSR: higher risk of suicide with history of physical or sexual abuse. Patients who reported physical abuse by family members were more likely to be at higher risk for suicide. Being insulted - six times; bruises or marks - nine times; and punishment with a belt or hard object - 20 times more likely to be at higher risk for suicide. No demographic comparison between BD with SA vs. BD without SA. |
| Garno40 (USA) | Cross-sectional study Out and inpatients diagnosed with BD (n=100) (DSM-IV) |
Yes | SADS | CTQ | SA > PC: a near-significant relationship between lifetime suicide attempts and history of sexual abuse. Demographic comparison of BD with and without cluster B personality disorder. No demographic comparison between groups with and without SA. |
BD = bipolar disorder; CANQ = Childhood Abuse and Neglect Questionnaire; CHT = ; CTQ = Childhood Trauma Questionnaire; CTQ-SF = Childhood Trauma Questionnaire-Short Form; HDRS-17 = 17-item version of the Hamilton Depression Rating Scale41,42; HSR = higher suicidal risk; LSR = lower suicidal risk; MINI-Plus = Mini International Neuropsychiatric Interview-Plus; MMPI-2 = Minnesota Multiphasic Personality Inventory-2; N/A = not available; NOS = not otherwise specified; PC = patient controls (i.e., patients with no history of suicide attempt); SA = suicide attempters (i.e., patients with a history of suicide attempt); SADS = Schedule for Affective Disorders and Schizophrenia; SB = suicidal behavior; SBQ-R = Revised Suicidal Behaviors Questionnaire43; SCID = Structured Clinical Interview for DSM-IV Axis I disorders; SI-HDRS-21 = Structured Interview for Hamilton Depression Rating Scale-2144; VI-SURIAS = Viennese Suicide Risk Assessment Scale.
*
All studies included defined suicidal behavior as suicide attempt and focused on lifetime history of SA.
†
Antipsychotic medication.
‡
Antidepressant medication.
§
Anxiolytic medication.
||
Mood stabilizers (lithium, valproic acid, or carbamazepine).