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Abstract
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Second, 2 errors in the abstract related to the number of articles included in the analysis. In the Methods section of the abstract, a total of "nine" abstracts is mentioned, and in the Results section of the abstract, "12." These two numbers should read "13," which was the final, correct number of studies analyzed. Also, in the Results section of the abstract, "In the literature review" was replaced with "In the systematic review." Below we reproduce the complete corrected version of the abstract, with the corrections underlined: Objective: Patients with bipolar disorders have a high risk of suicidal behavior. Childhood maltreatment is a well-established risk factor for suicidal behavior. The objective of this study was to examine the association between childhood-maltreatment subtypes and vulnerability to suicide attempts in bipolar disorder using the Childhood Trauma Questionnaire (CTQ).
METHODS: A literature review was performed using the MEDLINE, Embase, and PsycINFO databases. Thirteen studies met the selection criteria. In the meta-analysis, the Childhood Trauma Questionnaire (CTQ) was used to assess a wide range of childhood maltreatment subtypes, which were analyzed by using a random-effects model to account for the likely variations of true effect sizes between the included studies.
RESULTS: In the systematic review, 13 studies met the selection criteria. The CTQ was selected for the meta-analysis to increase the homogeneity of assessment and to encompass a wide range of childhood-maltreatment subtypes. The data were analyzed using a random-effects model. Compared to bipolar non-attempters, bipolar suicide attempters had experienced childhood maltreatment with a significantly higher frequency and had higher total CTQ scores (Hedges' g =-0.38, 95%CI-0.52 to-0.24, z =-5.27, p o 0.001) and CTQ sub-scores (sexual abuse: g =-0.39, 95%CI-0.52 to-0.26, z =-5.97; physical abuse: g =-0.26, 95%CI-0.39 to-0.13, z =-4.00; emotional abuse: g =-0.39, 95%CI-0.65 to-0.13, z =-2.97; physical neglect: g =-0.18, 95%CI-0.31 to-0.05, z =-2.79; emotional neglect: g =-0.27, 95%CI-0.43 to-0.11, z =-3.32).
CONCLUSIONS: Childhood maltreatment, as assessed by the CTQ, may contribute to an increased risk of suicidal behavior among people with bipolar disorders. Recognizing maltreatment as an etiological risk factor is a crucial step toward furthering science-based preventive psychiatry. Although eligible and included in the systematic review (Table 1), five studies were not included in the meta-analysis because: 1) precise means and standard deviations (SD) were not available in the paper35; 2) they did not report CTQ scores for BD patients who attempted suicide vs. those who did not, and they did not report CTQ sub-scores29; 3) only the most recent study of Janiri et al.28 was selected to prevent sample overlapping.34 Of note, the second study performed a logistic regression to explore the association between childhood maltreatment and each BD severity indicator (i.e., unemployment, more than five lifetime depressive episodes, more than five lifetime manic episodes, history of psychotic symptoms, one or more hospitalizations for BD, and suicide attempts). Although requested, data could not be obtained directly from Janiri et al. about either study. Finally, two studies that used CTQ were excluded, one for not evaluating suicide behavior45 and the other for not addressing patients with major depressive disorder.46 Finally, two adjustments were made in the Discussion section of the paper, as described below. 1) Towards the end of the first paragraph, the sentence "Given the effect sizes, emotional abuse, sexual abuse and emotional neglect might contribute more to SB in BD, whereas physical trauma (abuse or neglect) might contribute less" should read "Given the effect sizes, emotional abuse, sexual abuse and emotional neglect might contribute more to SB in BD in comparison to physical trauma (abuse or neglect)." 2) In the sixth paragraph of the Discussion, the last word of the second sentence needs to be corrected from "CB" to "SB": "Aside from the studies included in our systematic review, there is no uniformity for assessing CM and its potential association between BD and SB." Epub Aug 07 2020. © 2020, Associacao Brasileira de Psiquiatria. All rights reserved.
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