Effects of family-focused therapy on suicidal ideation and behavior in youth at high risk for bipolar disorder

Abstract

Background: Youth who are at clinical and familial risk for bipolar disorder (BD) often have significant suicidal ideation (SI). In a randomized trial, we examined whether family-focused therapy (FFT) is associated with reductions in SI and suicidal behaviors in high-risk youth.

Methods: Participants (ages 9-17 years) met diagnostic criteria for unspecified BD or major depressive disorder with active mood symptoms and had at least one relative with BD type I or II. Participants were randomly allocated to 12 sessions in 4 months of FFT or 6 sessions in 4 months of psychoeducation (enhanced care, EC), with pharmacotherapy as needed. Clinician- and child-rated assessments of mood, suicidal thoughts and behaviors, and family conflict were obtained at baseline and 4-6 month intervals over 1-4 years.

Results: Participants (N=127; mean 13.2±2.6 yrs., 82 female) were followed over an average of 105.9±64.0 weeks. Youth with high baseline levels of SI who received FFT had lower levels of (and fewer weeks with) SI at follow-up compared to youth with high baseline SI who received EC. Participants in FFT had longer intervals without suicidal behaviors than participants in EC. Youths' ratings of family conflict significantly mediated the effects of treatment on SI at follow-up.

Limitations: Family conflict was based on questionnaires rather than observer ratings of family interactions.

Conclusions: Family psychoeducation with skill training can be an effective deterrent to suicidal thoughts and behaviors in youth at high risk for BD. Reducing parent/offspring conflict should be a central objective of psychosocial interventions for high-risk youth with SI.

Keywords: Depression; Expressed Emotion; Family Conflict; Prevention; Psychotherapy; Suicidality.

Conflict of interest statement

Declaration of Competing Interest Dr. Miklowitz receives research support from the National Institute of Mental Health (NIMH), the Danny Alberts Foundation, the Attias Family Foundation, the Carl and Roberta Deutsch Foundation, the Kayne Family Foundation, AIM for Mental Health, and the Max Gray Fund; and book royalties from Guilford Press and John Wiley and Sons. Mr. Merranko reports no biomedical financial interests or potential conflicts of interest. Dr. Weintraub reports research support from AIM for Mental Health. Drs. Walshaw receives research support from Bluebird Biotech and Second Sight. Dr. Singh receives research support from Stanford's Maternal Child Health Research Institute, NIMH, National Institute of Aging, Johnson and Johnson, Allergan, and the Brain and Behavior Foundation. She is on the advisory board for Sunovion and is a consultant for Google X and Limbix. Dr. Chang is a consultant on the speaker's bureau for Sunovion. Dr. Schneck receives research support from the NIMH and the Ryan White Foundation.

Copyright © 2020 Elsevier B.V. All rights reserved.

Figures

Fig. 1.. Consort Flow Diagram

Abbreviations: PSR = Psychiatric Status Ratings for the Adolescent Longitudinal Interval Follow-up Evaluation; SIQ = Suicide Ideation Questionnaire

FIG 2.. Baseline Suicide Ideation Questionnaire (SIQ) Scores as a Predictor of Follow-up SIQ Scores in Youth at High Risk for Bipolar Disorder: Effects of Family-Focused Treatment versus Enhanced Care Treatment

Fig. 3.. Changes in Youths’ Perceptions of Family Conflict as a Mediator Between Treatment Group (FFT vs. EC) and Suicidal Ideation Questionnaire Scores