Childhood adversity and risk of suicide: cohort study of 548 721 adolescents and young adults in Sweden

Björkenstam, Charlotte; Kosidou, Kyriaki; Björkenstam, Emma

doi:10.1136/bmj.j1334

Cited by 110 publications

(101 citation statements)

References 27 publications

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“…In particular, future studies should investigate the role of psychosocial factors such as family adversities or peer victimization, which were associated with irritability and suicidal behaviors in previous studies. 30,35,42 Such studies also could suggest possible targets for psychosocial interventions.…”

Section: Discussionmentioning

confidence: 99%

Pathways of Association Between Childhood Irritability and Adolescent Suicidality

Orri

Galèra

Turecki

et al. 2019

Journal of the American Academy of Child & Adolescent Psych

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Objective: Childhood irritability predicts suicidal ideation/attempt (suicidality), but it is unclear whether irritability is an independent and direct risk factor for suicidality or a marker of intermediate mental health symptoms associated with suicidality. This study aimed to identify developmental patterns of childhood irritability and to test whether childhood irritability is directly associated with suicidality or indirectly associated with intermediate mental health symptoms. Method: One thousand three hundred ninety-three participants from the Qu ebec Longitudinal Study of Child Development were followed from birth to 17 years. Teachers assessed irritability yearly (at 6-12 years) and children self-reported intermediate mental health symptoms (depression, anxiety, disruptiveness, and hyperactivity-impulsivity; at 13 years) and suicidality (at 15 and 17 years). Results: Four irritability trajectories were identified: low (74.7%), rising (13.0%), declining (7.4%), and persistent (5.0%). Children following a rising irritability trajectory (versus a low trajectory) were at higher suicidality risk. A large proportion of this association was direct (odds ratio 2.11, 95% CI 1.30-3.43) and a small proportion was indirect by depressive symptoms (accounting for 23% of the association; odds ratio 1.17, 95% CI 1.03-1.34). Children on a persistent irritability trajectory (versus a low trajectory) were at higher risk of suicidality and this association was uniquely indirect by depressive symptoms (accounting for 73% of the association; odds ratio 1.51, 95% CI 1.16-1.97). The declining trajectory was not related to suicidality; no association with anxiety, disruptiveness, and hyperactivity-impulsivity was found. Conclusion: Rising irritability across childhood represents a direct risk for suicidality. Persistent irritability appears to be a distal marker of suicidality acting through more proximal depressive symptoms.

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Section: Discussionmentioning

confidence: 99%

Pathways of Association Between Childhood Irritability and Adolescent Suicidality

Orri

Galèra

Turecki

et al. 2019

Journal of the American Academy of Child & Adolescent Psych

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“…Future studies should also further investigate the more elusive subjective aspects of suicide risk, such as SI, as well as implicated psychological constructs such as hopelessness, rumination, and anhedonia [209][210][211], which may be relevant across diagnoses. Similarly, social experiences such as childhood maltreatment and peer bullying form a strong prelude to STB in later life [208,212,213], and impact on the neural structures implicated in STB (e.g., DMPFC structure and function [214,215]). Therefore, adverse experiences should be taken into account in future studies on the neurobiology of STB.…”

Section: Future Directionsmentioning

confidence: 99%

Imaging suicidal thoughts and behaviors: a comprehensive review of 2 decades of neuroimaging studies

et al. 2019

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Identifying brain alterations that contribute to suicidal thoughts and behaviors (STBs) are important to develop more targeted and effective strategies to prevent suicide. In the last decade, and especially in the last 5 years, there has been exponential growth in the number of neuroimaging studies reporting structural and functional brain circuitry correlates of STBs. Within this narrative review, we conducted a comprehensive review of neuroimaging studies of STBs published to date and summarize the progress achieved on elucidating neurobiological substrates of STBs, with a focus on converging findings across studies. We review neuroimaging evidence across differing mental disorders for structural, functional, and molecular alterations in association with STBs, which converges particularly in regions of brain systems that subserve emotion and impulse regulation including the ventral prefrontal cortex (VPFC) and dorsal PFC (DPFC), insula and their mesial temporal, striatal and posterior connection sites, as well as in the connections between these brain areas. The reviewed literature suggests that impairments in medial and lateral VPFC regions and their connections may be important in the excessive negative and blunted positive internal states that can stimulate suicidal ideation, and that impairments in a DPFC and inferior frontal gyrus (IFG) system may be important in suicide attempt behaviors. A combination of VPFC and DPFC system disturbances may lead to very high risk circumstances in which suicidal ideation is converted to lethal actions via decreased top-down inhibition of behavior and/or maladaptive, inflexible decision-making and planning. The dorsal anterior cingulate cortex and insula may play important roles in switching between these VPFC and DPFC systems, which may contribute to the transition from suicide thoughts to behaviors. Future neuroimaging research of larger sample sizes, including global efforts, longitudinal designs, and careful consideration of developmental stages, and sex and gender, will facilitate more effectively targeted preventions and interventions to reduce loss of life to suicide.

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“…Besides mental disorders, some of the other well‐documented risk factors emerged in the present study only on the univariate level, such as adverse childhood experiences (both suicide and sudden violent death), being sexually assaulted (suicides), and severity of stressful life events in the previous year (both groups). Previous research indicated that independently of other psychosocial and psychiatric factors, early and late life adversities, and particularly accumulated adversities, are a risk factor for suicidal behavior (Björkenstam, Kosidou, & Björkenstam, ; Fergusson et al, ; Foster, ; Joiner et al, ; Liu & Miller, ; Read, Agar, Barker‐Collo, Davies, & Moskowitz, ; Séguin, Renaud, Lesage, Robert, & Turecki, ). However, a new finding is the importance of adverse life events as a risk factor for sudden violent death.…”

Section: Discussionmentioning

confidence: 99%

Who Is at Risk of Dying Young from Suicide and Sudden Violent Death? Common and Specific Risk Factors among Children, Adolescents, and Young Adults

Törnblom

Sorjonen

Runeson

et al. 2020

Suicide & Life Threat Behav

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Objective Suicides and other sudden violent deaths are the most common causes of death among young people worldwide. This case–control study compared risk factors for suicide and other sudden violent death among young people. Method A total of 436 psychological autopsy interviews with next of kin were performed. The samples aged 10–25 years included 63 cases of suicide, 62 cases of other sudden violent death, and 104 matched living controls. Two stepwise multiple logistic regression analyses were performed. Results The number of recent stressful life events was the only common risk factor for suicide and other sudden violent death. Specific risk factors for suicide were any form of addiction and being an inpatient in adult psychiatric care. Specific risk factors for other sudden violent death were lower elementary school results, lower educational level, and abuse of psychoactive drugs. Conclusions The suicide group seems to have been more vulnerable and exposed to different kinds of stressors, whereas the sudden violent death group seems to have been more acting out and risk‐taking. Both groups must be the subject of prevention and intervention programs.

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Childhood adversity and risk of suicide: cohort study of 548 721 adolescents and young adults in Sweden

Abstract: ObjeCtiveTo examine the relation between childhood adversity, the role of school performance, and childhood psychopathology and the risk of suicide.

Cited by 110 publications

References 27 publications

Pathways of Association Between Childhood Irritability and Adolescent Suicidality

Pathways of Association Between Childhood Irritability and Adolescent Suicidality

Imaging suicidal thoughts and behaviors: a comprehensive review of 2 decades of neuroimaging studies

Who Is at Risk of Dying Young from Suicide and Sudden Violent Death? Common and Specific Risk Factors among Children, Adolescents, and Young Adults

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