Correlates of deliberate self-harm among youth with bipolar disorder

•Youth DSH risk is highest in the first 3 months after a new bipolar disorder episode.•Prior DSH has strongest association with future DSH.•Older age, female sex, and comorbid conditions were associated with increased DSH risk.•Prior psychiatric hospitalization was associated with lower DSH risk.•Suicide and all-cause mortality rates were elevated compared to general population. Youth with bipolar disorder (BD) are at high risk for deliberate self-harm (DSH) and suicide. However, research regarding factors associated with DSH, a key suicide risk factor, among youth with BD is limited. In a population-based sample of youth with BD, we therefore investigated associations between demographic, clinical, and service utilization factors and DSH incidence and compared suicide, unintentional injury, and all-cause mortality to the general population. We analyzed a retrospective cohort of youth aged 5 to 19 years with a new BD episode between 2010 and 2017 (n = 25,244) using Ohio Medicaid claims and death certificate data. Cox proportional hazards models examined associations between different factors and DSH. Mortality rates were compared to the general population using standardized mortality ratios. During follow-up, 1,517 (6.0%) youth had at least one DSH event. Older index age, female sex, comorbid psychiatric/medical conditions, prior DSH/suicidal ideation, and prior ER mental healthcare were associated with increased DSH risk. Prior DSH was most strongly associated with increased DSH risk for 3 months after a new BD episode. Being non-Hispanic Black (vs. White, non-Hispanic) and prior psychiatric hospitalization were associated with decreased DSH hazard. DSH risk was highest for 3 months after a new BD episode. Suicide, unintentional injury, and all-cause mortality rates were elevated in youth with BD. May not generalize to other states or non-Medicaid populations; claims data cannot distinguish suicidal intent of self-harm Early intervention following a new BD episode, particularly among high-risk groups, is key to prevent DSH.