Psychological Medicine

Original Article

Natural history of suicidal behaviors in a population-based sample of young adults

JELENA BREZOa1, JOEL PARISa2, EDWARD DYLAN BARKERa3, RICHARD TREMBLAYa3, FRANK VITAROa3, MARK ZOCCOLILLOa4, MARTINE HÉBERTa5 and GUSTAVO TURECKIa1a2 c1

a1 McGill Group for Suicide Studies, Douglas Hospital Research Center, Montreal, Canada

a2 Department of Psychiatry, McGill University, Montreal, Canada

a3 GRIP, University of Montreal, Montreal, Canada

a4 Montreal Children's Hospital, McGill University, Montreal, Canada

a5 Department of Sexology, University of Quebec, Montreal, Canada

ABSTRACT

Background Suicidal behaviors in young individuals represent an important public health problem. Understanding their natural history and relationships would therefore be of clinical and research value. In this study, we examined the natural histories of several suicidal behaviors and investigated two conceptual models of suicidality (dimensional and categorical) in the context of adolescent and adult-onset suicide attempts.

Method Participants were members of a prospectively studied, representative, population-based school cohort followed since age 6 (n=3017) through mid-adolescence (n=1715) to their early twenties (n=1684). Outcome measures included suicidal ideation, attempts and completions.

Results Approximately one in 500 individuals died by suicide. About 33% had suicidal ideas and 9·3% made at least one suicide attempt. Over half (4·9%) of the self-reported attempters made their first attempt before age 18. With the exception of current suicidal ideas, non-fatal suicidal behaviors were more prevalent in females. In general, parental and cross-sectional self-reports underestimated suicidality rates. Aikaike (AIC) and Bayesian (BIC) information criteria suggested the ordinal model, and dimensional conceptualization of suicide attempts of different onset age, to be more optimal than its multinomial/categorical counterpart (ordinal: AIC 567.55, BIC 635.67; multinomial: AIC 616.59, BIC 723.83). Both models, nevertheless, identified five common factors of relevance to suicidal diathesis: gender, disruptive disorders, childhood anxiousness and abuse, and suicidal thoughts.

Conclusions Non-fatal suicidal behaviors in adolescents and young adults are more common than suggested by cross-sectional studies and parental reports. The dimensional model may be more useful in explaining the relationship of suicide attempts of different age of onset.

(Online publication May 02 2007)

Correspondence

c1 Address for correspondence: Dr Gustavo Turecki, McGill Group for Suicide Studies, Douglas Hospital, McGill University, 6875 LaSalle blvd, Montreal QC H4H 1R3, Canada. (Email: gustavo.turecki@mcgill.ca)

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