Youth and young adult suicide: A study of life trajectory

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Abstract

Objectives

Explore the unique developmental challenges and early adversity faced by youth and young adult who died of suicide.

Method

Sixty-seven suicide victims (SG) were compared with 56 living control with no suicidal ideations in the last year, matched for age, gender, and geographical region. Mixed methods were used: consensus DSM-IV diagnoses were formulated based on Structured Clinical Interview for DSM-IV (SCID)-I and -II interviews complemented by medical charts. Life calendar method was conducted with closest third party informant. Life-history calendar served to measure life events and adversity throughout the life course and were analyzed by attributing burden of adversity score per five-year segment, which was then cluster-analyzed to define suicide victim profiles.

Results

During the last year, mood disorders, abuse and dependence disorders, and anxiety disorder were between 8 and 63 times more likely to be present in the suicide group. Between 0 and 4 years old, 50% of children in the SG were exposed to abuse, physical and/or sexual violence; 60% between 5 and 9 years old; and by the time they were 10–14 years old, 77% were exposed to these forms of violence. In the control group, the respective figures were 14%, 18% and 34%. In the suicide group, the trajectories leading to suicide are different as we observe two different subgroups, one with early-onset and one with later-onset of adversity. To a large extent, people in the suicide group were exposed to major adversity and they were more likely to present cumulative comorbid disorders.

Section snippets

Recruitment of informants

Through an ongoing partnership with the Quebec’s Coroner’s Office and the Montreal Central Morgue, our research group recruited consecutive suicides representative of suicides occurring in the region. Once referred by the coroner’s office, 75% of close relatives agreed to participate in the study. Suicides are assessed by psychological autopsy, a validated method (Conner et al., 2001, Kelly and Mann, 1996, Schneider et al., 2004) involving closest relatives best acquainted with the deceased

Coding procedures

After all the data were collected, the coding procedure is done quantitatively and qualitatively. The quantitative data consist of identifying every event, the severity and duration of each event occurring over every five-year period. As for the qualitative coding procedure, each individual life trajectory was written up by the interviewers as a case vignette summarizing all life events, their context, adversity and protective factors, psychopathology and use of services. Then, each vignette

Data analysis

Data analysis for the clinical results was carried out using SPSS. For the life trajectories the analysis were carried out with SAS group-based modeling of longitudinal data (Jones et al., 2001). Regressions analysis were used with SPSS, and the SAS-based Traj procedure (Nagin and Tremblay, 2001) provided the capacity to a) identify subgroups of people who followed distinct trajectories based on the severity of their difficulties, b) examine the pattern of variation and stability over time for

Sociodemographic profile

Among participants, 80.6% (n = 54) in the suicide group (SG) and 76.8% (n = 43) in the control group (CG) were men. There was no difference in the distribution of age when comparing SG with CG: 6% and 5.4% younger than 15 years old; 30% and 35.7% between 15 and 19 years old; 58% and 50% between 20 and 24 years old; and finally 6% and 9% between 25 and 29 years old. Almost all were Caucasian: 94% for the SG and 96% for the CG.

Psychopathological profile

There is an important difference between the suicide and the control

Discussion

The results of this study with 67 suicide victims and 56 control participants indicate a difference in the trajectories of the SG compared with the CG. Good control group allows a measure of the populational distribution of risk factors and outcomes. Participants in the control group were not as exposed to hardship, and did not develop as much mental health problems over time as the suicide group, but they were not «super healthy». Indeed, 12% of the participants had major mental health

Conclusion

Suicide among young adult rarely occurs “out of the blue” (Bebbington et al., 2009), but rather in a context of major difficulty and adversity, present from a very young age. The importance of conflictual interactions–first in the parent–child relationship, later at school, with friends—the presence of the social isolation speaks to the lack of protective ability between family members and constitutes a major risk factor for suffering, distress, mental problems and suicide. Numerous authors (

Funding source

This research has been funded by the Canadian Institute of Health Research (CIHR), the funding source has no involvement in the decision to submit the paper for publication.

Conflict of interest

We have no conflict of interest, personal nor financial. The findings did not limit the ability of the authors and the authors were in control of all primary data.

Contributors

Monique Séguin with Johanne Renaud designed the study, wrote the protocol and were responsible for the data analysis; Alain Lesage was responsible for data analysis and reviewed the first draft of the article; Marie Robert searched the literature review and helped in the writing of the first draft and Gustavo Turecki read and reviewed the manuscript. Each of the authors has reviewed the manuscript, agreed to be cited as co-author and has accepted the order of authorship.

Acknowledgments

This research was supported by the Canadian Institutes of Health Research (CIHR).

References (45)

  • J. Renaud et al.

    Current psychiatric morbidity, aggression/impulsivity, and personality dimension in child and adolescent suicide: a case-control study

    Journal of Affective Disorders

    (2008)
  • B. Schneider et al.

    Concordance of DSM-IV axis I and II diagnoses by personal and informant’s interview

    Psychiatric Research

    (2004)
  • T. Afifi et al.

    Population attributable fractions of psychiatric disorders and suicide ideation and attempts associated with adverse childhood experiences

    American Journal of Public Health

    (2008)
  • G. Arsenault-Lapierre et al.

    Psychiatric diagnoses in 3275 suicides: a meta-analysis

    BMC Psychiatry

    (2004)
  • B. Barraclough et al.

    A hundred cases of suicide: clinical aspects

    British Journal of Psychiatry

    (1974)
  • A.L. Beautrais et al.

    Postcard intervention for repeat self-harm: randomised controlled trial

    British Journal of Psychiatry

    (2010)
  • P. Bebbington et al.

    Suicide attempts, gender and sexual abuse: data from the 2000 British psychiatric morbidity survey

    American Journal of Psychiatry

    (2009)
  • J. Beskow et al.

    Psychological autopsies: methods and ethics

    Suicide Life Threatening Behavior

    (1990)
  • D.A. Brent et al.

    The validity of diagnoses obtained through the psychological autopsy procedure in adolescent suicide victims: use of adolescent suicide

    Suicide Life Threatening Behavior

    (1993)
  • U. Bronfenbrenner

    Making human beings human: bioecological perspectives on human development

    (2005)
  • G.W. Brown et al.

    Social origins of depression: a study of psychiatric disorder in women

    (1978)
  • P. Burgess et al.

    Lessons from a comprehensive clinical audit of users of psychiatric services who committed suicide

    Psychiatric Services

    (2000)
  • A. Caspi et al.

    The life history calendar: a research and clinical assessment method for collecting retrospective event-history data

    International Journal of Methods in Psychiatric Research

    (1976)
  • J.T. Cavanagh et al.

    Psychological autopsy studies of suicide: a systematic review

    Psychological Medicine

    (2003)
  • K.R. Conner et al.

    The validity of proxy-based data in suicide research: a study of patients 50 years of age and older who attempted suicide. I. Psychiatric diagnoses

    Acta Psychiatrica Scand

    (2001)
  • K. Dodge et al.

    A biopsychosocial model of the development of chronic conduct problems in adolescence

    Developmental Psychology

    (2003)
  • B.P. Dohrenwend

    Inventoring stressful life events as risk factors for psychopathology: toward resolution of the problem of intracategory variability

    Psychological Bulletin

    (2006)
  • S.R. Dube et al.

    Childhood abuse, household dysfunction and the risk of attempted suicide throughout life span: findings from the adverse childhood experience study

    JAMA

    (2001)
  • A. Dumais et al.

    Is violent method of suicide a behavioral marker of lifetime aggression?

    American Journal of Psychiatry

    (2005)
  • M.W. Enns et al.

    Childhood adversities and risk for suicidal ideation and attempts: a longitudinal population-based study

    Psychological Medicine

    (2006)
  • W. Ensel et al.

    Stress in the life course: a life history approach

    Journal of Aging and Health

    (1996)
  • M.B. First et al.

    The structured clinical interview for DSM-III-R personality disorders (SCID-II). Part I: description

    Journal of Personality Disorders

    (1995)
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