Abstract
Purpose: Adolescence is a key period of transitions in the psychological, cognitive, neurobiological and relational domains, which is associated to high susceptibility to adverse life experiences. However, the way adolescent development alters life paths toward suicide remains unclear. Thereby, we aimed at testing whether and how adolescence interfered with the adversity trajectories of individuals who died by suicide.Methods: In a sample of 303 individuals who died by suicide, longitudinal Burden of Adversity ratings were derived from extensive psychological autopsies and life trajectory narrative interviews conducted with informants. Piecewise Joint Latent Class Models allowed the identification of patterns of adversity trajectories and tested the introduction of breakpoints in life-paths. Classes inferred from the optimal model were compared in terms of socio-demographics, psychopathology, and rate of different adverse life events.Results: The most accurate model derived 2 trajectory patterns with a breakpoint in early adolescence. In the first class (n = 39), the burden of adversity increased steadily from birth to death, which occurred at 23 (SE = 1.29). In the second class (n = 264), where individuals died at 43 years of age (SE = 0.96), the burden of adversity followed a similar trajectory during infancy but stabilized between 10 and 14 years and started to increase again at about 25. Childhood family instability, dependent events, exposure to suicide, intra-family sexual victimization and affective disorders at death were more frequent in class 1.Conclusions: A bifurcation in trajectories between early and late suicides occurs during adolescence. The dynamic pattern of adversity during this period is a key issue to understand the developmental heterogeneity in suicide risk.
Highlights
Among 15 to 29-year-olds, suicide represents the second most common cause of death and accounts for 8.5% of young people dying worldwide [1]
They described distal risk factors as the early biological and environmental determinants that durably shape a person’s vulnerability to suicide, developmental risk factors as the phenotypic expressions of this diathesis and proximal risk factors as the clinical conditions or triggering negative life events that contribute to precipitating suicidal behaviors
In the first class, which included 39 individuals (13% of the sample) who died at mean age 23.2 (SD = 8.0), the Burden of Adversity (BA) started from a non-null value of 1.25 (SE = 0.07) at birth and steadily increased at a rate of 0.51 (SE = 0.09) to 0.72 units (SE = 0.21) per 5 years until death
Summary
Among 15 to 29-year-olds, suicide represents the second most common cause of death and accounts for 8.5% of young people dying worldwide [1]. Developmental approaches, which focus on how risk factors dynamically integrate at an individual level [3], offer a convenient framework to study how the socio-biological transformations of adolescence interferes with life-paths toward suicide [4]. The authors propose to categorize most influential risk factors based on their putative role in the sequence toward suicidal outcomes. They described distal risk factors as the early biological and environmental determinants that durably shape a person’s vulnerability to suicide, developmental risk factors as the phenotypic expressions of this diathesis and proximal risk factors as the clinical conditions or triggering negative life events that contribute to precipitating suicidal behaviors
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