Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-23T00:43:36.821Z Has data issue: false hasContentIssue false
  • English
  • Français

Natural history of suicidal behaviors in a population-based sample of young adults

Published online by Cambridge University Press:  02 May 2007

JELENA BREZO ,
JOEL PARIS ,
EDWARD DYLAN BARKER ,
RICHARD TREMBLAY ,
FRANK VITARO ,
MARK ZOCCOLILLO ,
MARTINE HÉBERT  and
GUSTAVO TURECKI
JELENA BREZO
Affiliation:
McGill Group for Suicide Studies, Douglas Hospital Research Center, Montreal, Canada
JOEL PARIS
Affiliation:
Department of Psychiatry, McGill University, Montreal, Canada
EDWARD DYLAN BARKER
Affiliation:
GRIP, University of Montreal, Montreal, Canada
RICHARD TREMBLAY
Affiliation:
GRIP, University of Montreal, Montreal, Canada
FRANK VITARO
Affiliation:
GRIP, University of Montreal, Montreal, Canada
MARK ZOCCOLILLO
Affiliation:
Montreal Children's Hospital, McGill University, Montreal, Canada
MARTINE HÉBERT
Affiliation:
Department of Sexology, University of Quebec, Montreal, Canada
GUSTAVO TURECKI*
Affiliation:
McGill Group for Suicide Studies, Douglas Hospital Research Center, Montreal, Canada Department of Psychiatry, McGill University, Montreal, Canada
*
*Address for correspondence: Dr Gustavo Turecki, McGill Group for Suicide Studies, Douglas Hospital, McGill University, 6875 LaSalle blvd, Montreal QC H4H 1R3, Canada. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Suicidal behaviors in young individuals represent an important public health problem. Understanding their natural history and relationships would therefore be of clinical and research value. In this study, we examined the natural histories of several suicidal behaviors and investigated two conceptual models of suicidality (dimensional and categorical) in the context of adolescent and adult-onset suicide attempts.

Method

Participants were members of a prospectively studied, representative, population-based school cohort followed since age 6 (n=3017) through mid-adolescence (n=1715) to their early twenties (n=1684). Outcome measures included suicidal ideation, attempts and completions.

Results

Approximately one in 500 individuals died by suicide. About 33% had suicidal ideas and 9·3% made at least one suicide attempt. Over half (4·9%) of the self-reported attempters made their first attempt before age 18. With the exception of current suicidal ideas, non-fatal suicidal behaviors were more prevalent in females. In general, parental and cross-sectional self-reports underestimated suicidality rates. Aikaike (AIC) and Bayesian (BIC) information criteria suggested the ordinal model, and dimensional conceptualization of suicide attempts of different onset age, to be more optimal than its multinomial/categorical counterpart (ordinal: AIC 567.55, BIC 635.67; multinomial: AIC 616.59, BIC 723.83). Both models, nevertheless, identified five common factors of relevance to suicidal diathesis: gender, disruptive disorders, childhood anxiousness and abuse, and suicidal thoughts.

Conclusions

Non-fatal suicidal behaviors in adolescents and young adults are more common than suggested by cross-sectional studies and parental reports. The dimensional model may be more useful in explaining the relationship of suicide attempts of different age of onset.

Type
Original Article
Information
Psychological Medicine , Volume 37 , Issue 11 , November 2007 , pp. 1563 - 1574
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Barratt, E. (1985). Impulsive subtraits: arousal and information processing. In Motivation, Emotion, and Personality (ed. Spence, J. T. and Izard, C. E.), pp. 137–146. Elsevier: New York.Google Scholar
Beautrais, A. L. (2000). Risk factors for suicide and attempted suicide among young people. The Australian and New Zealand Journal of Psychiatry 34, 420–436.Google Scholar
Beck, A. T., Kovacs, M. & Weissman, A. (1979). Assessment of suicidal intention: the Scale of Suicidal Ideation. Journal of Consulting and Clinical Psychology 47, 343–352.CrossRefGoogle Scholar
Beck, A. T., Schuyler, D. & Herman, I. (1974). Development of suicide intent scales. In The Prediction of Suicide (ed. Beck, A., Resnik, H. L. P. and Lettier, D. J.), pp. 45–56. Charles Press: Philadelphia.Google Scholar
Bland, R. C., Newman, S. C. & Dyck, R. J. (1994). The epidemiology of parasuicide in Edmonton. Canadian Journal of Psychiatry 39, 391–396.Google Scholar
Blum, R. W. & Nelson-Mmari, K. (2004). The health of young people in a global context. Journal of Adolescent Health 35, 402–418.CrossRefGoogle Scholar
Boden, J. M., Fergusson, D. M. & John, Horwood L. (2007). Anxiety disorders and suicidal behaviours in adolescence and young adulthood: findings from a longitudinal study. Psychological Medicine 37, 431–440.Google Scholar
Brent, D. A., Oquendo, M., Birmaher, B., Greenhill, L., Kolko, D., Stanley, B., Zelazny, J., Brodsky, B., Firinciogullari, S., Ellis, S. P. & Mann, J. J. (2003). Peripubertal suicide attempts in offspring of suicide attempters with siblings concordant for suicidal behavior. American Journal of Psychiatry 160, 1486–1493.Google Scholar
Brent, D. A., Perper, J. A., Moritz, G., Allman, C., Friend, A., Roth, C., Schweers, J., Balach, L. & Baugher, M. (1993). Psychiatric risk factors for adolescent suicide: a case-control study. Journal of the American Academy of Child and Adolescent Psychiatry 32, 521–529.Google Scholar
Breton, J. J., Bergeron, L., Valla, J. P., Berthiaume, C. & St-Georges, M. (1998). Diagnostic Interview Schedule for Children (DISC-2.25) in Quebec: reliability findings in light of the MECA study. Journal of the American Academy of Child and Adolescent Psychiatry 32, 521–529.Google Scholar
Breton, J. J., Tousignant, M., Bergeron, L. & Berthiaume, C. (2002). Informant-specific correlates of suicidal behavior in a community survey of 12- to 14-year-olds. Journal of the American Academy of Child and Adolescent Psychiatry 41, 723–730.CrossRefGoogle Scholar
Brezo, J., Paris, J. & Turecki, G. (2006). Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review. Acta Psychiatrica Scandinavica 113, 180–206.CrossRefGoogle ScholarPubMed
Butterworth, P., Fairweather, A. K., Anstey, K. J. & Windsor, T. D. (2006). Hopelessness, demoralization and suicidal behaviour: the backdrop to welfare reform in Australia. The Australian and New Zealand Journal of Psychiatry 40, 648–656.Google Scholar
Caspi, A., Moffitt, T. E., Newman, D. L. & Silva, P. A. (1996). Behavioral observations at age 3 years predict adult psychiatric disorders. Longitudinal evidence from a birth cohort. Archives of General Psychiatry 53, 1033–1039.CrossRefGoogle ScholarPubMed
D'Eramo, K. S., Prinstein, M. J., Freeman, J., Grapentine, W. L. & Spirito, A. (2004). Psychiatric diagnoses and comorbidity in relation to suicidal behavior among psychiatrically hospitalized adolescents. Child Psychiatry and Human Development 35, 21–35.Google Scholar
Dean, P. J. & Range, L. M. (1996). The escape theory of suicide and perfectionism in college students. Death Studies 20, 415–424.CrossRefGoogle ScholarPubMed
Dhossche, D., Ferdinand, R., van der Ende, J., Hofstra, M. B. & Verhulst, F. (2002). Diagnostic outcome of adolescent self-reported suicidal ideation at 8-year follow-up. Journal of Affective Disorders 72, 273–279.Google Scholar
Evans, E., Hawton, K. & Rodham, K. (2005). Suicidal phenomena and abuse in adolescents: a review of epidemiological studies. Child Abuse and Neglect 29, 45–58.Google Scholar
Fanous, A. H., Prescott, C. A. & Kendler, K. S. (2004). The prediction of thoughts of death or self-harm in a population-based sample of female twins. Psychological Medicine 34, 301–312.Google Scholar
Farberow, N. L. (1981). Assessment of Suicide. Jossey-Bass: San Francisco.Google Scholar
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P. & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine 14, 245–258.CrossRefGoogle ScholarPubMed
Fergusson, D. M., Beautrais, A. L. & Horwood, L. J. (2003). Vulnerability and resiliency to suicidal behaviours in young people. Psychological Medicine 33, 61–73.CrossRefGoogle ScholarPubMed
Fergusson, D. M., Horwood, L. J. & Lynskey, M. T. (1996). Childhood sexual abuse and psychiatric disorder in young adulthood: II. Psychiatric outcomes of childhood sexual abuse. Journal of the American Academy of Child and Adolescent Psychiatry 35, 1365–1374.CrossRefGoogle ScholarPubMed
Fergusson, D. M., Horwood, L. J., Ridder, E. M. & Beautrais, A. L. (2005). Suicidal behaviour in adolescence and subsequent mental health outcomes in young adulthood. Psychological Medicine 35, 983–993.Google Scholar
Fergusson, D. M. & Lynskey, M. T. (1995). Suicide attempts and suicidal ideation in a birth cohort of 16-year-old New Zealanders. Journal of the American Academy of Child and Adolescent Psychiatry 34, 1308–1317.CrossRefGoogle Scholar
Garrison, C. Z., Addy, C. L., Jackson, K. L., McKeown, R. E. & Waller, J. L. (1991). A longitudinal study of suicidal ideation in young adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 30, 597–603.Google Scholar
Giuffra, L. A. & Risch, N. (1994). Diminished recall and the cohort effect of major depression: a simulation study. Psychological Medicine 24, 375–383.Google Scholar
Goldney, R. D., Smith, S., Winefield, A. H., Tiggeman, M. & Winefield, H. R. (1991). Suicidal ideation: its enduring nature and associated morbidity. Acta Psychiatrica Scandinavica 83, 115–120.Google Scholar
Gould, M. S., King, R., Greenwald, S., Fisher, P., Schwab-Stone, M., Kramer, R., Flisher, A. J., Goodman, S., Canino, G. & Shaffer, D. (1998). Psychopathology associated with suicidal ideation and attempts among children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 37, 915–923.Google Scholar
Gunnell, D., Harbord, R., Singleton, N., Jenkins, R. & Lewis, G. (2004). Factors influencing the development and amelioration of suicidal thoughts in the general population. Cohort study. British Journal of Psychiatry 185, 385–393.CrossRefGoogle ScholarPubMed
Hawton, K. & Van Heeringen, K. (2000). The International Handbook of Suicide and Attempted Suicide. Wiley & Sons: Chichester.Google Scholar
Heila, H., Isometsa, E. T., Henriksson, M. M., Heikkinen, M. E., Marttunen, M. J. & Lonnqvist, J. K. (1997). Suicide and schizophrenia: a nationwide psychological autopsy study on age- and sex-specific clinical characteristics of 92 suicide victims with schizophrenia. American Journal of Psychiatry 154, 1235–1242.Google Scholar
Hintikka, J., Pesonen, T., Saarinen, P., Tanskanen, A., Lehtonen, J. & Viinamaki, H. (2001). Suicidal ideation in the Finnish general population. A 12-month follow-up study. Social Psychiatry and Psychiatric Epidemiology 36, 590–594.Google Scholar
Horney, J. (2001). Crime and the criminal events perspective. In The Process and Structure of Crime: Criminal Events and Crime Analysis (ed. Meier, R. F., Kennedy, L. W. and Sacco, V. F.), pp. 141–167. Transaction Publishing: New Brunswick, NJ.Google Scholar
Hosmer, D. W. & Lemeshow, S. (2000). Applied Logistic Regression. Wiley & Sons: New York.Google Scholar
Kaslow, N. J., Thompson, M. P., Meadows, L. A., Jacobs, D., Chance, S., Gibb, B., Bornstein, H., Hollins, L., Rashid, A. & Phillips, K. (1998). Factors that mediate and moderate the link between partner abuse and suicidal behavior in African American women. Journal of Consulting and Clinical Psychology 66, 533–540.Google Scholar
Kelly, T. M., Cornelius, J. R. & Clark, D. B. (2004). Psychiatric disorders and attempted suicide among adolescents with substance use disorders. Drug Alcohol and Dependence 73, 87–97.Google Scholar
Kessler, R. C., Borges, G. & Walters, E. E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry 56, 617–626.Google Scholar
King, R. A., Schwab-Stone, M., Flisher, A. J., Greenwald, S., Kramer, R. A., Goodman, S. H., Lahey, B. B., Shaffer, D. & Gould, M. S. (2001). Psychosocial and risk behavior correlates of youth suicide attempts and suicidal ideation. Journal of the American Academy of Child and Adolescent Psychiatry 40, 837–846.Google Scholar
Kirkcaldy, B. D., Siefen, G. R., Urkin, J. & Merrick, J. (2006). Risk factors for suicidal behavior in adolescents. Minerva Pediatrica 58, 443–450.Google ScholarPubMed
Langhinrichsen-Rohling, J., Lewinsohn, P., Rohde, P., Seeley, J., Monson, C. M., Meyer, K. A. & Langford, R. (1998). Gender differences in the suicide-related behaviours of adolescents and young adults. Sex Roles 39, 839–854.Google Scholar
Lewinsohn, P. M., Rohde, P. & Seeley, J. R. (1996). Adolescent suicidal ideation and attempts: prevalence, risk factors, and clinical implications. Clinical Psychology Science and Practice 3, 25–46.Google Scholar
Linehan, M. M., Chiles, J. A., Egan, K. J., Devine, R. H. & Laffaw, J. A. (1986). Presenting problems of parasuicides versus suicide ideators and nonsuicidal psychiatric patients. Journal of Consulting and Clinical Psychology 54, 880–881.Google Scholar
Livesley, W. J., Jang, K. L. & Vernon, P. A. (1998). Phenotypic and genetic structure of traits delineating personality disorder. Archives of General Psychiatry 55, 941–948.Google Scholar
Maris, R. W., Berman, A. L., Maltsberger, J. T. & Yufit, R. I. (1992). Assessment and Prediction of Suicide. Guilford Press: New York.Google Scholar
Masse, L. C. & Tremblay, R. E. (1997). Behavior of boys in kindergarten and the onset of substance use during adolescence. Archives of General Psychiatry 54, 62–68.CrossRefGoogle Scholar
Norlev, J., Davidsen, M., Sundaram, V. & Kjoller, M. (2005). Indicators associated with suicidal ideation and suicide attempts among 16–35-year-old Danes: a national representative population study. Suicide and Life-threatening Behavior 35, 291–308.CrossRefGoogle Scholar
O'Boyle, M. & Brandon, E. A. (1998). Suicide attempts, substance abuse, and personality. Journal of Substance Abuse Treatment 15, 353–356.CrossRefGoogle ScholarPubMed
Renaud, J., Chagnon, F., Turecki, G. & Marquette, C. (2005). Completed suicides in a youth centres population. Canadian Journal of Psychiatry 50, 690–694.Google Scholar
Robins, L. N., Cottler, L. B., Bucholtz, K. & Compton, W. (1995). Diagnostic Interview Schedule for DSM-IV. Washington University: St Louis, MO.Google Scholar
Rudd, M. D., Joiner, T. & Rajab, M. H. (1996). Relationships among suicide ideators, attempters, and multiple attempters in a young-adult sample. Journal of Abnormal Psychology 105, 541–550.Google Scholar
Santa, Mina E. E. & Gallop, R. M. (1998). Childhood sexual and physical abuse and adult self-harm and suicidal behaviour: a literature review. Canadian Journal of Psychiatry 43, 793–800.Google Scholar
Sourander, A., Helstela, L., Haavisto, A. & Bergroth, L. (2001). Suicidal thoughts and attempts among adolescents: a longitudinal 8-year follow-up study. Journal of Affective Disorders 63, 59–66.Google Scholar
Spirito, A., Valeri, S., Boergers, J. & Donaldson, D. (2003). Predictors of continued suicidal behavior in adolescents following a suicide attempt. Journal of Clinical Child and Adolescent Psychology 32, 284–289.Google Scholar
St-Laurent, D. & Bouchard, C. (2004). L'épidémiologie du suicide au Québec: que savons-nous de la situation récente? Institut National de Santé Publique: Québec.Google Scholar
Statham, D. J., Heath, A. C., Madden, P. A., Bucholz, K. K., Bierut, L., Dinwiddie, S. H., Slutske, W. S., Dunne, M. P. & Martin, N. G. (1998). Suicidal behaviour: an epidemiological and genetic study. Psychological Medicine 28, 839–855.CrossRefGoogle ScholarPubMed
Straus, M. A., Hamby, S. L., Boney-McCoy, S. & Sugarman, D. B. (1996). The revised conflict tactics scales (CTS2). Development and preliminary psychometric data. Journal of Family Issues 17, 283–316.Google Scholar
Straus, M. A. & Kantor, G. K. (1994). Corporal punishment of adolescents by parents: a risk factor in the epidemiology of depression, suicide, alcohol abuse, child abuse, and wife beating. Adolescence 29, 543–561.Google Scholar
Turecki, G. (2001). Suicidal behavior: is there a genetic predisposition? Bipolar Disorder 3, 335–349.CrossRefGoogle ScholarPubMed
Turner, R. J. (1983). Social support: conceptualization, measurement, and implications for mental health. Research in Community and Mental Health 3, 67–111.Google Scholar
Van Heeringen, C. (2001). Suicide in adolescents. International Clinical Psychopharmacology 16 (Suppl. 2), S1–S6.CrossRefGoogle ScholarPubMed
Vilhjalmsson, R., Kristjansdottir, G. & Sveinbjarnardottir, E. (1998). Factors associated with suicide ideation in adults. Social Psychiatry and Psychiatric Epidemiology 33, 97–103.Google Scholar
Welch, S. S. (2001). A review of the literature on the epidemiology of parasuicide in the general population. Psychiatric Services 52, 368–375.Google Scholar
Wichstrom, L. (2000). Predictors of adolescent suicide attempts: a nationally representative longitudinal study of Norwegian adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 39, 603–610.Google Scholar