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.
Psychol Med. 2022 May;52(7):1255-1267. doi: 10.1017/S0033291720002974. Epub 2020 Oct 6.
We aimed to identify groups of children presenting distinct perinatal adversity profiles and test the association between profiles and later risk of suicide attempt.
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.
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.
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.
我们旨在确定具有不同围产期逆境特征的儿童群体，并检验这些特征与之后自杀未遂风险之间的关联。
数据来自魁北克儿童发展纵向研究（QLSCD，N=1623）和阿冯纵向父母与子女研究（ALSPAC，N=5734）。使用潜在类别分析对 32 种围产期逆境（如胎儿、产科、心理社会和父母精神病理学）进行建模，并使用逻辑回归调查与 20 岁时自我报告的自杀未遂之间的关联。我们调查了儿童期情绪和行为问题、受害和认知在多大程度上解释了这些关联。
在两个队列中，我们都确定了五个特征：无围产期风险、胎儿生长不良、社会经济逆境、分娩并发症、父母心理健康问题（仅在 ALSPAC 中）。与无围产期风险的儿童相比，胎儿生长不良（QLSCD-ALSPAC 汇总估计值，OR 1.89，95%CI 1.04-3.44）、社会经济逆境（汇总 OR 1.42，95%CI 1.08-1.85）和父母心理健康问题（OR 1.74，95%CI 1.27-2.40）特征的儿童更有可能尝试自杀。对于社会经济逆境特征，与假定的中介因素相关的效应比例大于其他特征。
与自杀未遂相关的围产期逆境聚集在不同的特征中。自杀预防可能需要从生命早期开始，并需要采用多学科方法，针对来自不同领域（精神科、产科、社会经济）的一系列因素，而不是单一因素，以有效降低自杀脆弱性。这些因素聚集在一起的方式也决定了导致自杀未遂的途径，这可以指导针对个性化自杀预防策略的决策。
