Abstract
Most suicide research focuses on acute precipitants and is conducted in high-risk populations. Yet, vulnerability to suicide is likely established years prior to its occurrence. In this study, we aimed to investigate the risk of suicide mortality conferred by prenatal sociodemographic and pregnancy-related factors. Offspring of participants (N = 49,853) of the Collaborative Perinatal Project, a U.S. population-based cohort of pregnancies enrolled between 1959 and 1966, were linked to the U.S. National Death Index to determine their vital status by the end 2016. We examined associations between sociodemographic factors during pregnancy, pregnancy complications, labor and delivery complications, and neonatal complications with suicide death coded according to ICD-9/10 criteria. By the end of 2016, 3,555 participants had died. Of these, 288 (214 males, 74 females) died by suicide (incidence rate = 15.6 per 100,000 person-years, 95% Confidence Interval [CI] = 13.9–17.5). In adjusted models, male sex (Hazard Ratio [HR] = 2.98, CI: 2.26–3.93), White race (HR = 2.14, CI = 1.63–2.83), low parental education (HR = 2.23, CI = 1.38–3.62), manual parental occupation (HR = 1.38, CI = 1.05–1.82), being a younger sibling (HR = 1.52, CI = 1.10–2.11), higher rates of pregnancy complications (HR = 2.36, CI = 1.08–5.16), and smoking during pregnancy (HR = 1,28, CI = 0.99–1.66) were independently associated with suicide risk, whereas birth and neonatal complications were not. Consistent with the developmental origins of psychiatric disorders, vulnerability to suicide mortality is established early in development. Both sociodemographic and pregnancy factors play a role in this risk, which underscores the importance of considering life course approaches to suicide prevention, possibly including provision of high-quality prenatal care, and alleviating the socioeconomic burdens of mothers and families.
Highlights
Suicide thoughts and behaviors increase dramatically after puberty [1, 2], followed by an increase of suicide rates during late adolescence and early adulthood [3], highlighting the need of early risk identification
Though, emphasizes proximal or acute risk factors among high-risk individuals [4] despite suicide being a multicausal phenomenon influenced by distal and proximal risk factors acting at multiple levels and stages in life [5,6,7]
Vulnerability to suicide is likely established early in life as it happens with the vulnerability to psychiatric conditions, which partly originates during fetal development, and are one of the major risk factors of suicide
Summary
Suicide thoughts and behaviors increase dramatically after puberty [1, 2], followed by an increase of suicide rates during late adolescence and early adulthood [3], highlighting the need of early risk identification. Vulnerability to suicide is likely established early in life as it happens with the vulnerability to psychiatric conditions, which partly originates during fetal development, and are one of the major risk factors of suicide. Prenatal and perinatal conditions leading to fetal undernutrition, along with psychological distress, substance use during pregnancy, maternal and paternal age, and parental sociodemographic factors can impact offspring neurodevelopment and lead to higher risk for depression [8, 9], psychosis [10], disruptive behavior disorders [11, 12], and other mental health problems [13, 14]
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