Importance The association of early diagnosis and management of bipolar disorder with adolescent suicide mortality (ASM) is unknown. Objective To assess regional associations between ASM and bipolar disorder diagnosis frequencies. Design, Setting, and Participants This cross-sectional study investigated the association between annual regional ASM and bipolar disorder diagnosis rates in Swedish adolescents aged 15 to 19 years in January 1, 2008, through December 31, 2021. Aggregated data without exclusions reported at the regional level encompassed 585 suicide deaths, constituting 588 unique observations (ie, 21 regions, 14 years, 2 sexes). Exposures Bipolar disorder diagnosis frequencies and lithium dispensation rates were designated as fixed-effects variables (interaction term in the case of males). An interaction term between psychiatric care affiliation rates and the proportion of psychiatric visits to inpatient and outpatient clinics constituted independent fixed-effects variables. Region and year comprised random intercept effect modifiers. Variables were population adjusted and corrected for heterogeneity in reporting standards. Main Outcomes and Measures The main outcomes were sex-stratified, regional, and annual ASM rates in adolescents aged 15 to 19 years per 100 000 inhabitants as analyzed using generalized linear mixed-effects models. Results Female adolescents were diagnosed with bipolar disorder almost 3 times more often than male adolescents (mean [SD], 149.0 [19.6] vs 55.3 [6.1] per 100 000 inhabitants, respectively). Median regional prevalence rates of bipolar disorder varied over the national median by a factor of 0.46 to 2.61 and 0.00 to 1.82 in females and males, respectively. Bipolar disorder diagnosis rates were inversely associated with male ASM (β = -0.00429; SE, 0.002; 95% CI, -0.0081 to -0.0004; P = .03) independent of lithium treatment and psychiatric care affiliation rates. This association was replicated by β-binomial models of a dichotomized quartile 4 ASM variable (odds ratio, 0.630; 95% CI, 0.457-0.869; P = .005), and both models were robust after adjusting for annual regional diagnosis rates of major depressive disorder and schizophrenia. No such association was observed in females. Conclusions and Relevance In this cross-sectional study, lower suicide death rates in adolescent males was robustly associated with regional diagnosis rates of bipolar disorder at an estimated magnitude of approximately 4.7% of the mean national suicide death rate. The associations could be due to treatment efficacy, early diagnosis and management, or other factors not accounted for.

中文翻译：

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瑞典青少年双相情感障碍诊断与自杀死亡率的关联。

重要性 双相情感障碍的早期诊断和治疗与青少年自杀死亡率 (ASM) 的关系尚不清楚。目的 评估 ASM 与双相情感障碍诊断频率之间的区域关联。设计、背景和参与者 这项横断面研究调查了 2008 年 1 月 1 日至 2021 年 12 月 31 日期间瑞典 15 至 19 岁青少年年度地区 ASM 与双相情感障碍诊断率之间的关联。区域层面涵盖 585 例自杀死亡，构成 588 个独特的观察结果（即 21 个区域、14 年、2 种性别）。暴露双相情感障碍诊断频率和锂分配率被指定为固定效应变量（男性情况下的交互项）。精神科护理依从率与住院和门诊精神病科就诊比例之间的相互作用项构成了独立的固定效应变量。地区和年份包含随机拦截效应修正因子。变量经过群体调整并针对报告标准中的异质性进行校正。主要结果和措施 主要结果是使用广义线性混合效应模型进行分析，按性别分层、区域和每 10 万居民中 15 至 19 岁青少年的年度 ASM 率。结果 女性青少年被诊断患有双相情感障碍的频率几乎是男性青少年的 3 倍（平均 [SD]，每 100 000 名居民分别为 149.0 [19.6] 和 55.3 [6.1]）。女性和男性双相情感障碍的区域患病率中位数与全国中位数的差异分别为 0.46 至 2.61 和 0.00 至 1.82。双相情感障碍诊断率与男性 ASM 呈负相关（β = -0.00429；SE，0.002；95% CI，-0.0081 至 -0.0004；P = .03），与锂治疗和精神科护理隶属率无关。这种关联性通过二分四分位数 4 ASM 变量的 β 二项式模型得到了复制（比值比，0.630；95% CI，0.457-0.869；P = .005），并且在调整了主要疾病的年度区域诊断率后，这两个模型都是稳健的。抑郁症和精神分裂症。在女性中没有观察到这种关联。结论和相关性 在这项横断面研究中，青少年男性较低的自杀死亡率与双相情感障碍的区域诊断率密切相关，估计约为全国平均自杀死亡率的 4.7%。这些关联可能是由于治疗效果、早期诊断和管理或其他未考虑的因素造成的。