McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, Québec, Canada; Bordeaux Population Health Research Centre, INSERM U1219, University of Bordeaux, France.
Bordeaux Population Health Research Centre, INSERM U1219, University of Bordeaux, France; Charles Perrens Hospital, University of Bordeaux, France.
J Am Acad Child Adolesc Psychiatry. 2019 Jan;58(1):99-107.e3. doi: 10.1016/j.jaac.2018.06.034. Epub 2018 Oct 30.
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.
One thousand three hundred ninety-three participants from the Québec 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).
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.
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.
儿童期易怒可预测自杀意念/企图（自杀），但尚不清楚易怒是否是自杀的独立和直接危险因素，还是与自杀相关的中间心理健康症状的标志物。本研究旨在确定儿童期易怒的发展模式，并检验儿童期易怒是否与自杀直接相关，或是否与中间心理健康症状间接相关。
来自魁北克儿童发展纵向研究的 1393 名参与者从出生到 17 岁被跟踪。教师每年评估一次易怒（6-12 岁），儿童自我报告中间心理健康症状（抑郁、焦虑、多动和冲动；13 岁）和自杀（15 岁和 17 岁）。
确定了四种易怒轨迹：低（74.7%）、升高（13.0%）、下降（7.4%）和持续（5.0%）。跟随升高的易怒轨迹（与低轨迹相比）的儿童自杀风险更高。这种关联的很大一部分是直接的（优势比 2.11，95%置信区间 1.30-3.43），一小部分是通过抑郁症状间接的（占关联的 23%；优势比 1.17，95%置信区间 1.03-1.34）。持续的易怒轨迹（与低轨迹相比）的儿童自杀风险更高，这种关联是通过抑郁症状间接的，占关联的 73%（优势比 1.51，95%置信区间 1.16-1.97）。下降的轨迹与自杀无关；与焦虑、多动和冲动无关联。
儿童期易怒升高代表自杀的直接风险。持续的易怒似乎是通过更接近的抑郁症状表现出自杀的远端标志物。
