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Perinatal adversity profiles and suicide attempt in adolescence and young adulthood: longitudinal analyses from two 20-year birth cohort studies

Published online by Cambridge University Press:  06 October 2020

Massimiliano Orri
Affiliation:
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
Abigail E. Russell
Affiliation:
Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol,Bristol, UK (Mars, Gunnell)
Becky Mars
Affiliation:
Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol,Bristol, UK (Mars, Gunnell)
Gustavo Turecki
Affiliation:
Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
David Gunnell
Affiliation:
Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol,Bristol, UK (Mars, Gunnell)
Jon Heron
Affiliation:
Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
Richard E. Tremblay
Affiliation:
School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland (Tremblay) Departments of Pediatrics and Psychology, University of Montréal, Montreal, QC, Canada (Tremblay)
Michel Boivin
Affiliation:
School of Psychology, Université Laval, Québec City, Québec, Canada (Boivin)
Anne-Monique Nuyt
Affiliation:
Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine Research Center, University of Montreal, Montreal, QC, Canada (Nuyt)
Sylvana M. Côté
Affiliation:
Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada (Côté)
Marie-Claude Geoffroy*
Affiliation:
Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada (Geoffroy)
*
Author for correspondence: Marie-Claude Geoffroy, E-mail: marie-claude.geoffroy@mcgill.ca

Abstract

Background

We aimed to identify groups of children presenting distinct perinatal adversity profiles and test the association between profiles and later risk of suicide attempt.

Methods

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.

Results

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.

Conclusions

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.

Type
Original Articles
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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