Bullying and psychotic symptoms in youth with bipolar disorder

• Published in: Journal of affective disorders 2020-03, Vol.265, p.603-610
• Main Authors: Acosta, Jandira Rahmeier, Librenza-Garcia, Diego, Watts, Devon, Francisco, Ana Paula, Zórtea, Franco, Raffa, Bruno, Kohmann, André, Mugnol, Fabiana Eloisa, Motta, Gledis Lisiane, Tramontina, Silzá, Passos, Ives Cavalcante
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Bipolar Disorder - epidemiology; Bullying; Child; Cross-Sectional Studies; Humans; Psychiatric Status Rating Scales; Psychotic Disorders - epidemiology
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2019.11.101

•Study participants (N = 64) included those who had a lifetime history of psychotic symptoms (n = 21; 32.8%), and those who reported being bullied (n = 24; 37.5%).•A lifetime history of psychotic symptoms was associated with bullying, suicidal behavior, low socioeconomic status, and higher clinical global impression-severity (CGI-S) scale scores.•Only bullying and suicidal behavior remained significant after adjusting for potential confounders.•In a supplementary analysis, using a supervised machine learning model, the most relevant predictive variables in differentiating participants with vs without psychotic symptoms were bullying, CGI-S scale scores, and suicidal behavior.•Study limitations include the small sample size, use of a cross-sectional design, and the generalizability of findings beyond the outpatient clinical sample. Childhood trauma is associated with psychosis in adults with bipolar disorder (BD). Although bullying represents a widespread form of childhood trauma, no studies thus far have investigated the association of bullying and psychosis in pediatric bipolar disorder (PBD). We aim to examine the association between psychosis in PBD with bullying victimization. We included 64 children and adolescents (age± mean= 12±3.43) outpatients with BD spectrum disorders. Psychiatric diagnoses were assessed with the semi- structured interview Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime (KSADS-PL) version with additional depression and manic symptom items derived from the Washington University in St. Louis Kiddie Schedule for Affective Disorders (WASH-U-KSADS). Bullying, demographic, and clinical variables were assessed during the clinical interview. A lifetime history of psychotic symptoms was associated with bullying (p = 0.002), suicidal behavior (p = 0.006), low socioeconomic status (p = 0.04), and severity of PBD (p = 0.02). Only bullying (OR = 7.3; 95%CI = 2–32) and suicidal behavior (OR = 7.6; 95%CI = 1.5–47.8) remained significant after adjustment for confounders. In a supplementary analysis, we developed a model using supervised machine learning to identify the most relevant variables that differentiated participants with psychotic symptoms, which included bullying, Clinical Global Impression-Severity scale (CGI-S), and suicidal behavior (accuracy = 75%, [p = 0.03]; sensitivity = 77.91%; specificity = 69.05%; area under the curve [AUC] = 0.86). Small sample, cross-sectional design, and gen