Childhood psychiatric problems may predict suicide attempts in males

Most males who commit suicide or need hospital care for suicide attempts during their teen or early adult years appear to have high levels of psychiatric problems at age 8, according to a report in the April issue of Archives of General Psychiatry.

However, later suicide attempts in females are not predicted by mental health issues at this age.

"Suicide among adolescents and young adults is a major public health concern worldwide," the authors write as background information in the article. "The rates of mortality [death] by suicide have been found to be high among those with medically serious suicide attempts. For effective prevention, knowledge of the key risk factors for suicide is essential."

Andre Sourander, M.D., of Turku University Hospital, Turku, Finland, and colleagues studied 5,302 Finnish individuals born in 1981. Eight years later, information about psychiatric conditions, school performance and family demographics was gathered from children, parents and teachers. Participants were then tracked through national registers through 2005.

Between ages 8 and 24, 40 participants died, including 24 males and 16 females. Of those, 13 males and two females died from suicide. A total of 54 males and females (1 percent) either completed suicide or made a suicide attempt serious enough to result in hospitalization.

Of the 27 males who either seriously attempted or completed suicide, 78 percent screened positive for psychiatric conditions at age 8, compared with 11 percent of 27 females who had serious or completed suicide attempts. In addition, males who would go on to make life-threatening or completed suicide attempts were more likely at age 8 to live in a family that did not consist of two biological parents, have psychological problems as reported by a teacher or have conduct, hyperactive or emotional problems. However, none of these factors at age 8 predicted later suicidal behavior in females, and depression at age 8 was not associated with suicide attempts for either sex.

"The main finding of our study is that severe suicidality in adolescence and early adulthood has different childhood trajectories among males and females," the authors write. "The present study shows that among males severe suicidality (i.e., completed suicide or serious, life-threatening attempts) shows a pathway of persistence throughout the life cycle, starting in early childhood. Four out of five of these males showed a high level of psychiatric symptoms at the age of 8 years."

Previous research has shown that in females, suicide is associated with depression and other affective disorders, which increase sharply after the beginning of puberty. This may explain why childhood psychiatric conditions do not predict later suicidal behavior in girls, the authors note.

"These findings have considerable public health significance," they conclude. "The development of measures to effectively screen, detect and treat childhood disorders is a key issue in the effort to prevent suicide among males. This focus is particularly important among males with severe conduct problems because, during adolescence, they usually do not seek mental health services. Further studies are warranted to examine the efficacy of such preventive measures in childhood in the reduction of suicide rates among males."

(Arch Gen Psychiatry. 2009;66[4]:398-406.


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