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Vidal-Ribas P, Govender T, Yu J, Sundaram R, Perlis RH, Gilman SE. Children's cognitive performance and suicide risk through middle adulthood. J Child Psychol Psychiatry 2023; 64:1480-1491. [PMID: 37263773 PMCID: PMC10524389 DOI: 10.1111/jcpp.13841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Longitudinal studies show that lower cognitive performance in adolescence and early adulthood is associated with higher risk of suicide death throughout adulthood. However, it is unclear whether this cognitive vulnerability originates earlier in childhood since studies conducted in children are scarce and have inconsistent results. METHODS Vital status of 49,853 individuals born between 1959 and 1966 to participants in the Collaborative Perinatal Project cohort was determined by a probabilistic linkage to the National Death Index, covering all US deaths occurring from 1979 through 2016. Cox proportional hazard models were used to examine associations of general, verbal, and non-verbal intelligence at ages 4 and 7, and academic skills at age 7 with suicide death coded according to ICD-9/10 criteria, while accounting for sociodemographic and pregnancy factors previously associated with suicide in this sample. RESULTS By the end of 2016, 288 cohort members had died by suicide. Cognitive performance at 7 years on tests with verbal components was associated with suicide risk (average vs. high verbal intelligence, HR = 1.97, 95% CI 1.05-3.71; low vs. high spelling skills, HR = 2.02, 95% CI 1.16-3.51; low vs. high reading skills, HR = 2.01, 95% CI 1.27-3.17). Associations were still evident, especially for verbal intelligence and reading skills, but hazard ratios were attenuated after adjusting for prenatal and sociodemographic factors at birth (verbal intelligence, HR = 1.97, 95% CI 1.03-3.78; spelling, HR = 1.61, 95% CI 0.90-2.88; reading, HR = 1.67, 95% CI 1.02-2.72). CONCLUSIONS Childhood neurocognitive performance is associated with vulnerability to suicide mortality through middle-adulthood, suggesting that there might be a cognitive diathesis for suicide originating in early childhood. Future studies should examine how multiple domains of childhood cognitive performance contribute to vulnerability to suicide risk, including by increasing risk for social and environmental factors that are associated not only with suicide but also with many types of psychiatric disorders.
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Affiliation(s)
- Pablo Vidal-Ribas
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, US
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Theemeshni Govender
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, US
| | - Jing Yu
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, US
| | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, US
| | - Roy H. Perlis
- Center for Quantitative Health, Center for Genomic Medicine and Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, US
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, US
| | - Stephen E. Gilman
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, US
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, US
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Geoffroy MC, Arseneault L, Girard A, Ouellet-Morin I, Power C. Association of childhood bullying victimisation with suicide deaths: findings from a 50-year nationwide cohort study. Psychol Med 2023; 53:4152-4159. [PMID: 35388770 PMCID: PMC10317807 DOI: 10.1017/s0033291722000836] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bullying victimisation has been associated with increased risk of suicide ideation and attempt throughout the lifespan, but no study has yet examined whether it translates to a greater risk of death by suicide. We aimed to determine the association of bullying victimisation with suicide mortality. METHODS Participants were drawn from the 1958 British birth cohort, a prospective follow-up of all births in 1 week in Britain in 1958. We conducted logistic regressions on 14 946 participants whose mothers reported bullying victimisation at 7 and 11 years with linked information on suicide deaths through the National Health Service Central Register. RESULTS Fifty-five participants (48 males) had died by suicide between the age 18 and 52 years. Bullying victimisation was associated with suicide mortality; a one standard deviation increases in bullying victimisation linked to an increased odds for suicide mortality [odds ratio (OR) 1.29; 1.02-1.64] during adulthood. The OR attenuated by 11% after adjustment for individual (e.g. behavioural and emotional problems) and familial characteristics (e.g. adverse childhood experiences, 1.18; 0.92-1.51). Analysis of bullying victimisation frequency categories yields similar results: compared with individuals who had not been bullied, those who had been frequently bullied had an increased odds for suicide mortality (OR 1.89; 0.99-3.62). CONCLUSION Our study suggests that individuals who have been frequently bullied have a small increased risk of dying by suicide, when no other risk factors is considered. Suicide prevention might start in childhood, with bullying included in a range of inter-correlated vulnerabilities encompassing behavioural and emotional difficulties and adverse experiences within the family.
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Affiliation(s)
- Marie-Claude Geoffroy
- Departments of Psychiatry and Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Louise Arseneault
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alain Girard
- CHU Sainte-Justine Research Center, Montreal, Canada
| | | | - Chris Power
- UCL Great Ormond Street Institute of Child Health, London, UK
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Richard-Devantoy S, Badillo I, Bertrand JA, Dicker M, Banikyan A, Turecki G, Geoffroy MC, Orri M. Association between childhood cognitive skills & adult suicidal behavior: A systematic review and meta-analysis. J Affect Disord 2023; 325:158-168. [PMID: 36592672 DOI: 10.1016/j.jad.2022.12.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND It is unclear whether cognitive skill deficits during childhood carry risk for suicide attempt or mortality later in adulthood at the population level. We conducted a systematic review and meta-analysis of population-based studies examining the association between childhood cognitive skills and adult suicidal behavior, namely attempt and mortality. METHOD We systematically searched databases for articles then extracted study characteristics and estimates on the association between childhood cognitive skills (i.e., IQ or school performance at age ≤ 18 years) and later suicide attempt and mortality. Random-effect meta-analysis was used to quantify this association across all studies with available data. RESULTS Twenty-three studies met the inclusion criteria and suggest an association between lower childhood cognitive skills and increased risk of suicidal behavior. Meta-analysis of the adjusted estimates from 11 studies (N = 2,830,191) found the association to be small but statistically significant. Heterogeneity was significant but moderate, and results were unlikely to be influenced by publication bias. In subgroup analyses, associations were significant only for males. No difference in effect size was found between suicide attempt and suicide mortality. LIMITATIONS Cognitive skills were measured with different cognitive subtests. Heterogeneity in the age of cognitive skills assessment. Meta-regression and subgroup analyses were based on a relatively low number of studies. CONCLUSIONS Individuals with lower cognitive skills in childhood have a greater risk of suicidal behavior in adulthood, especially males. Although the association was small, interventions improving cognitive skills may yield large effects on suicide prevention at the population level if the association is causal.
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Affiliation(s)
- S Richard-Devantoy
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, Montréal, Québec, Canada; CISSS des Laurentides, St-Jerome, Quebec, Canada.
| | - I Badillo
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, Montréal, Québec, Canada
| | - J A Bertrand
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, Montréal, Québec, Canada; Centre de recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - M Dicker
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, Montréal, Québec, Canada
| | - A Banikyan
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, Montréal, Québec, Canada; Université de Bordeaux, Unité de formation de Mathématiques et Interactions, Bordeaux, Nouvelle-Aquitaine, France
| | - G Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, Montréal, Québec, Canada
| | - M C Geoffroy
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, Montréal, Québec, Canada; McGill University, Department of Educational and Counselling Psychology, Montréal, Québec, Canada
| | - M Orri
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, Montréal, Québec, Canada
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Vidal-Ribas P, Govender T, Yu J, Livinski AA, Haynie DL, Gilman SE. The developmental origins of suicide mortality: a systematic review of longitudinal studies. Eur Child Adolesc Psychiatry 2022:10.1007/s00787-022-02092-6. [PMID: 36205791 PMCID: PMC10207387 DOI: 10.1007/s00787-022-02092-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 09/23/2022] [Indexed: 11/30/2022]
Abstract
Suicide prevention efforts generally target acute precipitants of suicide, though accumulating evidence suggests that vulnerability to suicide is partly established early in life before acute precipitants can be identified. The aim of this systematic review was to synthesize evidence on early life vulnerability to suicide beginning in the prenatal period and extending through age 12. We searched PubMed, Embase, PsycNet, Web of Science, Scopus, Social Services Abstracts, and Sociological Abstracts for prospective studies published through January 2021 that investigated early life risk factors for suicide mortality. The search yielded 13,237 studies; 54 of these studies met our inclusion criteria. Evidence consistently supported the link between sociodemographic (e.g., young maternal age at birth, low parental education, and higher birth order), obstetric (e.g., low birth weight), parental (e.g., exposure to parental death by external causes), and child developmental factors (e.g., exposure to emotional adversity) and higher risk of suicide death. Among studies that also examined suicide attempt, there was a similar profile of risk factors. We discuss a range of potential pathways implicated in these associations and suggest that additional research be conducted to better understand how early life factors could interact with acute precipitants and increase vulnerability to suicide.
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Affiliation(s)
- Pablo Vidal-Ribas
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
| | - Theemeshni Govender
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Jing Yu
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Alicia A Livinski
- Office of Research Services, National Institutes of Health Library, OD, NIH, Bethesda, MD, USA
| | - Denise L Haynie
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Stephen E Gilman
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Orri M, Russell AE, Mars B, Turecki G, Gunnell D, Heron J, Tremblay RE, Boivin M, Nuyt AM, Côté SM, Geoffroy MC. Perinatal adversity profiles and suicide attempt in adolescence and young adulthood: longitudinal analyses from two 20-year birth cohort studies. Psychol Med 2022; 52:1255-1267. [PMID: 33019954 DOI: 10.1017/s0033291720002974] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND We aimed to identify groups of children presenting distinct perinatal adversity profiles and test the association between profiles and later risk of suicide attempt. METHODS Data were from the Québec Longitudinal Study of Child Development (QLSCD, N = 1623), and the Avon Longitudinal Study of Parents and Children (ALSPAC, N = 5734). Exposures to 32 perinatal adversities (e.g. fetal, obstetric, psychosocial, and parental psychopathology) were modeled using latent class analysis, and associations with a self-reported suicide attempt by age 20 were investigated with logistic regression. We investigated to what extent childhood emotional and behavioral problems, victimization, and cognition explained the associations. RESULTS In both cohorts, we identified five profiles: No perinatal risk, Poor fetal growth, Socioeconomic adversity, Delivery complications, Parental mental health problems (ALSPAC only). Compared to children with No perinatal risk, children in the Poor fetal growth (pooled estimate QLSCD-ALSPAC, OR 1.89, 95% CI 1.04-3.44), Socioeconomic adversity (pooled-OR 1.42, 95% CI 1.08-1.85), and Parental mental health problems (OR 1.74, 95% CI 1.27-2.40), but not Delivery complications, profiles were more likely to attempt suicide. The proportion of this effect mediated by the putative mediators was larger for the Socioeconomic adversity profile compared to the others. CONCLUSIONS Perinatal adversities associated with suicide attempt cluster in distinct profiles. Suicide prevention may begin early in life and requires a multidisciplinary approach targeting a constellation of factors from different domains (psychiatric, obstetric, socioeconomic), rather than a single factor, to effectively reduce suicide vulnerability. The way these factors cluster together also determined the pathways leading to a suicide attempt, which can guide decision-making on personalized suicide prevention strategies.
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Affiliation(s)
- Massimiliano Orri
- Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Bordeaux Population Health Research Centre, Inserm U1219, University of Bordeaux, Bordeaux, France
| | - Abigail E Russell
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
- National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK (Mars, Gunnell)
| | - Becky Mars
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
- National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK (Mars, Gunnell)
| | - Gustavo Turecki
- Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - David Gunnell
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
- National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK (Mars, Gunnell)
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Richard E Tremblay
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland (Tremblay)
- Departments of Pediatrics and Psychology, University of Montréal, Montreal, QC, Canada (Tremblay)
| | - Michel Boivin
- School of Psychology, Université Laval, Québec City, Québec, Canada (Boivin)
| | - Anne-Monique Nuyt
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine Research Center, University of Montreal, Montreal, QC, Canada (Nuyt)
| | - Sylvana M Côté
- Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada (Côté)
| | - Marie-Claude Geoffroy
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada (Geoffroy)
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Sörberg Wallin A, Sorjonen K, Lager A, Falkstedt D. Academic performance, subsequent socioeconomic status and suicide attempt in adulthood: path analyses on Swedish cohort data. J Epidemiol Community Health 2020; 74:1002-1007. [PMID: 32796011 DOI: 10.1136/jech-2020-214402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Poor academic performance in childhood is associated with suicide attempt in adulthood, but the mechanisms are not known. We investigated educational attainment as a possible pathway. METHODS We followed two sets of cohorts, born around 1950/1970, respectively, in the Swedish population-representative 'Evaluation Through Follow-up' study for a first suicide attempt in national records up to 2013. Data on grade point average (GPA) at age 13/16 and educational attainment (years of schooling) in adulthood were used. The path models included linear and Cox proportional hazards regressions. A model with matched age range during follow-up was used to compare the cohorts. RESULTS In the 1970 cohort, the association between GPA and suicide attempt between age 26 and 46 was partly mediated by attained education (total association, β=-0.82; via education: -0.29, per SD increase in GPA), but GPA also had a direct path to suicide attempt (β=-0.53). There was no evidence of such a pathway in the 1950 cohort between age 41 and 65. In the age-matched analysis, at age 26-46, the association between GPA and suicide attempt was stronger in the 1970 cohort compared to the 1950 cohort (β=-0.72 and -0.24, respectively). CONCLUSIONS Differences in attained education seem to partly explain the associations of academic performance with suicide attempt up to middle age. Furthermore, there is some indication that academic performance may have become more important for young people's mental health than it was in previous generations.
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Affiliation(s)
- Alma Sörberg Wallin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Kimmo Sorjonen
- Department of Clinical Neurosciences, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Anton Lager
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Daniel Falkstedt
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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