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

• Published in: Journal of affective disorders 2020-10, Vol.275, p.14-22
• Main Authors: Miklowitz, David J., Merranko, John A., Weintraub, Marc J., Walshaw, Patricia D., Singh, Manpreet K., Chang, Kiki D., Schneck, Christopher D.
• Format: Article
• Language: English
• Subjects: Adolescent; Bipolar Disorder - therapy; Child; Depression; Depressive Disorder, Major - therapy; Expressed Emotion; Family Conflict; Family Therapy; Female; Humans; Prevention; Psychotherapy; Suicidal Ideation; Suicidality; Treatment Outcome
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2020.06.015

•In a randomized trial, family-focused therapy was effective in reducing suicidal ideation and behaviors in youth at high risk for bipolar disorder over 1-4 years.•Changes in family conflict mediated the relation between psychosocial treatments and suicidal ideation scores at follow-up.•Family skill training should be considered as a preventative strategy for youth in the early phases of bipolar disorder. 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. 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. 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. Family conflict was based on questionnaires rather than observer ratings of family interactions. 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.