Abstract
The nature of the association between child psychiatric symptoms and adolescent suicide-related thoughts (SRT) and attempts (SA) remains unclear. Our objective was to assess whether child psychiatric symptoms from 6 to 10 years of age mediate the association between exposure to maternal depressive symptoms in childhood and offspring SRT and SA in adolescence. A population-based cohort study was constructed by linking all eight cycles from the National Longitudinal Survey of Children and Youth (NLSCY), a nationally representative Canadian panel survey conducted from 1994 to 2009. Self-reported maternal depressive symptoms were measured when offspring were between 0 and 5 years. Maternal-reported child psychiatric symptoms and psychiatric comorbid symptoms were measured from 6 to 10 years, and offspring self-reported SRT and SA were measured between 11 and 19 years. Indirect effects, the effect proportion mediated and their corresponding bootstrapped 95% confidence intervals (CI) were estimated. Hyperactivity and inattention significantly mediated the association between maternal depressive symptoms in childhood and risk of both SRT and SA from 11 to 19 years, where approximately 60% (SRT 95% CI 23-94%; SA 95% CI 27-95%) of this association was explained by hyperactivity and inattention. Psychiatric comorbid symptoms also significantly mediated this relationship and accounted for 50% (95% CI 18-81%) of this association with SA. Targeting hyperactivity and inattention, and co-occurring psychiatric symptoms in offspring of depressed mothers could reduce risk of SRT, eventual SA and halt progression towards suicide. However, further understanding of comorbid psychiatric symptoms in childhood that most strongly predict adolescent SA is needed.
Highlights
Suicide-related behaviour begins in adolescence, and is strongly associated with the progression to suicide (Bridge et al, 2006), exacting a heavy toll in young populations
Psychological autopsy studies report that approximately 90% of individuals who die by suicide had a prior psychiatric diagnosis (Cavanagh et al, 2003), and community-based surveys of younger populations (14–25 years) with suicide attempts (SA) report prior psychiatric disorders in approximately 90% of cases (Wunderlich et al, 1998)
We have shown that girls exposed to maternal depressive symptom during the first decade of life are at an increased risk of incident and recurrent suicide-related thoughts (SRT) and SA between 11 and 25 years of age
Summary
Suicide-related behaviour begins in adolescence, and is strongly associated with the progression to suicide (Bridge et al, 2006), exacting a heavy toll in young populations. Psychological autopsy studies report that approximately 90% of individuals who die by suicide had a prior psychiatric diagnosis (Cavanagh et al, 2003), and community-based surveys of younger populations (14–25 years) with suicide attempts (SA) report prior psychiatric disorders in approximately 90% of cases (Wunderlich et al, 1998). 40% of youth who die by suicide under age 16 years do not meet full diagnostic criteria for a psychiatric disorder (Bridge et al, 2006). There is evidence that psychiatric symptoms, in part, explain associations between adverse early environments and SA risk (Fergusson et al, 2000; Wanner et al, 2012). Knowledge of other antecedent risk factors of both suicide-related behaviours and psychiatric symptoms and mediating pathways is needed to understand the aetiology of suicide-related behaviour onset to inform preventive strategies
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