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Childhood Predictors of Completed and Severe Suicide AttemptsFindings From the Finnish 1981 Birth Cohort Study
Andre Sourander, MD;
Anat Brunstein Klomek, PhD;
Solja Niemelä, MD;
Antti Haavisto, MD;
David Gyllenberg, MD;
Hans Helenius, MSc;
Lauri Sillanmäki, BA;
Terja Ristkari, RN, MNSc;
Kirsti Kumpulainen, MD;
Tuula Tamminen, MD;
Irma Moilanen, MD;
Jorma Piha, MD;
Fredrik Almqvist, MD;
Madelyn S. Gould, PhD
Arch Gen Psychiatry. 2009;66(4):398-406.
Context To our knowledge, no prospective, population-based study in existence examines predictive associations between early or middle childhood psychopathologic disorders and later completed suicides.
Objective To study predictive associations between childhood psychopathologic disorders at the age of 8 years and later completed suicides and severe suicide attempts.
Design Birth cohort study of individuals 8 to 24 years old.
Setting Finland.
Participants The sample includes 5302 Finnish people born in 1981 who were examined at the age of 8 years to gather information about psychopathologic conditions, school performance, and family demographics from parents, teachers, and children.
Main Outcome Measures National register-based lifetime information about completed suicides and suicide attempts that prompted hospital admission.
Results Of all 24 deaths among males between 8 and 24 years of age, 13 were suicides, whereas of 16 deaths among females, only 2 were suicides. Fifty-four males and females (1%) had either completed suicide or made a serious suicide attempt, defined as a suicide attempt that prompted hospital admission. Of 27 males with completed or serious suicide attempts, 78% screened positive on parent or teacher Rutter scales at the age of 8 years, whereas of 27 females only 11% screened positive. Among males, completed or serious suicide attempt outcome was predicted at the age of 8 years by living in a nonintact family; psychological problems as reported by the primary teacher; or conduct, hyperkinetic, and emotional problems. However, self-reports of depressive symptoms at the age of 8 years did not predict suicide outcome. No predictive associations between the study variables measured at the age of 8 years and suicide outcome were found among females. Male suicide outcome was predicted most strongly by comorbid conduct and internalizing problems.
Conclusions Most males who completed suicide and/or made serious suicide attempts in adolescence or early adulthood had psychiatric problems by the age of 8 years, indicating a trajectory that persists throughout their lives. However, female severe suicidality is not predicted by psychopathologic disorders at the age of 8 years. The results give additional support to the importance of early detection and treatment of psychiatric problems in males.
Author Affiliations: Departments of Child Psychiatry (Drs Sourander and Haavisto and Ms Ristkari), Psychiatry (Drs Niemelä and Piha), and Biostatistics (Mr Helenius and Ms Sillanmäki), Turku University Hospital, Turku, Finland; Institute of Clinical Medicine, Tromsø University, Tromsø, Norway (Dr Sourander); Departments of Child and Adolescent Psychiatry (Drs Klomek and Gould) and Epidemiology (Dr Gould), Columbia University, New York, New York; Department of Child Psychiatry, Helsinki University, Helsinski, Finland (Drs Gyllenberg and Almqvist); Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland (Dr Kumpulainen); Department of Child Psychiatry, Tampere University Hospital, Tampere, Finland (Dr Tamminen); and Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland (Dr Moilanen).
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