Geoffroy Marie-Claude, Orri Massimiliano, Girard Alain, Perret Lea C, Turecki Gustavo
Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada.
Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada.
Psychol Med. 2021 Aug;51(11):1933-1943. doi: 10.1017/S0033291720000732. Epub 2020 Apr 15.
Suicide is a leading cause of mortality in youth, yet the course of suicide attempts is poorly documented. We explored the vulnerable transition from adolescence to emerging adulthood to identify group trajectories and risk factors.
The National Longitudinal Survey of Children and Youth is a prospective representative cohort of Canadian children. We followed participants aged 7-11 years in 1994-95 to age 23 (2008-09). We modelled self-reported past-year suicide attempts (ages 12 to 23 years) using growth mixture models. We analysed risk factors from self- and parent-report questionnaires at pre-adolescence (ages 10-11) and early adolescence (ages 12-13) using multinomial logistic regressions. Analyses were adjusted for sample non-response and attrition.
In 2233 participants answering questions on teen and adult suicide attempts, we identified three trajectories: never attempted (96.0%), adolescence-limited (2.0%) and persisting into adulthood (2.0%). Adolescent girls aged 12-13 with depression/anxiety symptoms, and with mothers experiencing depression had higher risks of adolescence-limited than never-attempted [relative risk RR 9.27 (95% confidence interval: 1.73-49.82); 2.03 (1.02-3.32), for each standard deviation increase; 1.07 (1.00-1.15); respectively]. Preteen ADHD symptoms increased the risk of attempts persisting into adulthood as compared to never-attempted [RR 2.05 (1.29-3.28) for each standard deviation increase]. Suicide death of schoolmate/acquaintance increased risks of an adulthood trajectory as compared to never-attempted and adolescence-limited [RR 8.41 (3.04-23.27) and 6.63 (1.29-34.06), respectively].
In half the participants attempting suicide, attempts continued into adulthood. We stress the need for preventive strategies in early adolescence and differential clinical/educational interventions as identified for each trajectory.
自杀是青少年死亡的主要原因之一，但自杀未遂的过程记录不完善。我们探讨了从青春期到成年早期这一脆弱的过渡阶段，以确定群体轨迹和风险因素。
加拿大全国儿童与青少年纵向调查是一个具有前瞻性的加拿大儿童代表性队列。我们追踪了1994 - 1995年年龄在7 - 11岁的参与者直至23岁（2008 - 2009年）。我们使用生长混合模型对自我报告的过去一年自杀未遂情况（年龄在12至23岁之间）进行建模。我们使用多项逻辑回归分析了青春期前（10 - 11岁）和青春期早期（12 - 13岁）来自自我报告和家长报告问卷中的风险因素。分析针对样本无应答和损耗进行了调整。
在2233名回答了关于青少年和成人自杀未遂问题的参与者中，我们确定了三种轨迹：从未尝试过（96.0%）、青春期有限型（2.0%）和持续到成年型（2.0%）。12 - 13岁有抑郁/焦虑症状且母亲有抑郁症的青春期女孩，与从未尝试过自杀的女孩相比，处于青春期有限型轨迹的风险更高[相对风险RR为9.27（95%置信区间：1.73 - 49.82）；每增加一个标准差为2.03（1.02 - 3.32）；1.07（1.00 - 1.15），分别对应不同因素]。与从未尝试过自杀的情况相比，青春期前的注意力缺陷多动障碍（ADHD）症状增加了自杀未遂持续到成年的风险[每增加一个标准差RR为2.05（1.29 - 3.28）]。与从未尝试过自杀和青春期有限型轨迹相比，同学/熟人自杀死亡增加了进入成年期轨迹的风险[分别为RR 8.41（3.04 - 23.27）和6.63（1.29 - 34.06）]。
在自杀未遂的参与者中，有一半人的自杀未遂情况持续到了成年。我们强调在青春期早期需要采取预防策略，以及针对每种轨迹确定不同的临床/教育干预措施。
