Childhood Trajectories of Anxiousness and Disruptiveness as Predictors of Suicide Attempts

Brezo, Jelena PhD
Barker, Edward D. PhD
Paris, Joel MD
Hébert, Martine PhD
Vitaro, Frank PhD
Tremblay, Richard E. PhD
Turecki, Gustavo MD, PhD

McGill Group for Suicide Studies, Douglas Hospital Research Center (Drs Brezo and Turecki), Research Unit on Children's Psychosocial Maladjustment, University of Montreal (Drs Barker, Vitaro, Tremblay, and Turecki), Department of Psychiatry, McGill University (Drs Paris), and Department of Sexology, University of Quebec (Dr Hébert), Montreal, Quebec, Canada; and King's College London, Institute of Psychiatry, MRC Social, Genetic and Developmental Psychiatry Centre, London, England (Dr Barker).

Correspondence: Gustavo Turecki, MD, PhD, McGill Group for Suicide Studies, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada ([email protected]).

Author Contributions: Drs Tremblay and Turecki share senior authorship of this work. Dr Brezo had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Brezo, Paris, Vitaro, and Turecki. Acquisition of data: Hébert, Vitaro, Tremblay, and Turecki. Analysis and interpretation of data: Brezo, Barker, Paris, Vitaro, and Turecki. Drafting of the manuscript: Brezo and Paris. Critical revision of the manuscript for important intellectual content: Barker, Paris, Hébert, Vitaro, Tremblay, and Turecki. Statistical analysis: Brezo, Barker, and Vitaro. Obtained funding: Paris, Hébert, Vitaro, Tremblay, and Turecki. Administrative, technical, and material support: Paris. Study supervision: Turecki.

Financial Disclosure: None reported.

Funding/Support: This work was supported by grant MOP 151060 from the Canadian Institutes of Health Research and by the National Consortium on Violence Research, Carnegie Mellon University, the Programme National de recherche et de développement en matière de santé, the Conseil Québécois de la recherche sociale, and the Fonds Québécois de la recherche sur la société et la culture.

Accepted for Publication: April 22, 2008.

Archives of Pediatrics & Adolescent Medicine 162(11):p 1015-1021, November 2008.

Objective

To investigate the association of childhood trajectories of anxiousness and disruptiveness with suicide attempts in early adulthood.

Design

Prospective cohort study.

Setting

Public francophone schools in Quebec, Canada, from the 1986 to 1988 school years.

Participants

Of 4488 French Canadian children attending kindergarten, a representative group of 1001 boys and 999 girls was chosen for follow-up. Of these, 1144 individuals participated in the study during early adulthood.

Main Outcome Measures

Suicide attempt histories by early adulthood, adjusted odds ratios (ORs) associated with membership in high- vs low-risk trajectories of anxiousness and disruptiveness, moderation (by sex), and mediation (by adolescent Axis I disorders).

Results

We observed 4 distinct developmental profiles of anxiousness and disruptiveness and a frequent co-occurrence of similar levels of these traits. In contrast to anxiousness trajectories (OR = 1.60; 95% confidence interval, 1.00–2.65), disruptiveness (OR = 1.80; 95% confidence interval, 1.03–3.13) and joint (OR = 1.88; 95% confidence interval, 1.05–3.37) trajectories made statistically significant contributions to suicide attempts. We found no support for mediation by adolescent anxiety/mood or disruptive disorders. Sex, however, moderated the effect of joint trajectories, increasing the risk of suicide attempts in women (OR = 3.60; Wald χ² = 10.93; P < .001) but not men (OR = 0.80; Wald χ² = 0.23; P = .64) displaying both anxious and disruptive traits as children.

Conclusions

Anxious-disruptive girls and disruptive boys appear to be more likely than their peers to attempt suicide by early adulthood. Preventive efforts will require more research into the possible mechanisms behind this early sex difference, ie, gene-environment interplays and nonpsychiatric mediators.