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Original Investigation
March 28, 2018

Association of Childhood Irritability and Depressive/Anxious Mood Profiles With Adolescent Suicidal Ideation and Attempts

Author Affiliations
  • 1Bordeaux Population Health Research Centre, Institut National de la Santé et de la Recherche Medicale U1219, Bordeaux, France
  • 2University of Bordeaux, Bordeaux, France
  • 3McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Québec, Canada
  • 4Research Unit on Children’s Psychosocial Maladjustment, Montreal, Québec, Canada
  • 5Department of Child and Adolescent Psychiatry, University of Bordeaux, Charles Perrens Hospital, Bordeaux, France
  • 6Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University, Rome, Italy
  • 7Manulife Centre for Breakthroughs in Teen Depression and Suicide Prevention, Montreal, Québec, Canada
  • 8School of Psychology, Laval University, Québec City, Québec, Canada
  • 9Institute of Genetic, Neurobiological, and Social Foundations of Child Development, Tomsk State University, Tomsk, Russian Federation
  • 10School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
  • 11Department of Pediatrics, University of Montréal, Montreal, Québec, Canada
  • 12Department of Psychology, University of Montréal, Montreal, Québec, Canada
  • 13Department of Social and Preventive Medicine, University of Montreal, Montreal, Québec, Canada
JAMA Psychiatry. Published online March 28, 2018. doi:10.1001/jamapsychiatry.2018.0174
Key Points

Question  Do children showing different profiles of irritability and depressive /anxious mood have different risk for suicide during adolescence?

Findings  In this population-based cohort study, 1430 children presenting with high irritability and high depressive/anxious mood symptoms during childhood (aged 6-12 years) were 2 times more likely to think about suicide or make a suicide attempt in adolescence (aged 13-17 years) compared with children showing depressive/anxious mood only or low irritability and low depressive/anxious mood.

Meaning  Childhood irritability should be considered when assessing adolescent suicidal risk, especially among those presenting with symptoms of high depressive/anxious mood.

Abstract

Importance  Suicidal ideation and suicide attempt (suicidality) are common in adolescence and a public health concern. Childhood depression is a key risk factor for later suicidality and often co-occurs with irritability. No study to date has examined the joint association of depressive mood and irritability during childhood with later suicidality.

Objective  To investigate the association of childhood irritability and depressive/anxious mood profiles with adolescent suicidality.

Design, Setting, and Participants  This population-based cohort study included 1430 participants in the Québec Longitudinal Study of Child Development. Participants underwent assessment yearly or bi-yearly (5 months to 17 years). Data were collected from March 16, 1998, through July 17, 2015.

Exposures  Profiles defined by the joint developmental trajectories of irritability and depressive/anxious mood at 6 to 12 years of age.

Main Outcomes and Measures  Self-reported past-year suicidality (ie, serious suicidal ideation or suicide attempt) at 13, 15, and 17 years of age. Irritability and depressive/anxious mood were assessed using teacher report 5 times from 6 to 12 years of age.

Results  The study included 1430 participants (676 boys [47.3%] and 754 girls [52.7%]) followed up to 17 years of age. Group-based multitrajectory modeling identified the following profiles: combined no irritability and low depressive/anxious mood with low irritability and low depressive/anxious mood (831 [58.1%]; reference group), moderate irritability and low depressive/anxious mood (353 [24.7%]), high depressive/anxious mood only (94 [6.6%]), and high irritability and depressive/anxious mood (152 [10.6%]). Children with high irritability and high depressive/anxious mood reported higher rates of suicidality (25 of 152 [16.4%]) compared with the group with the lowest symptom levels (91 of 831 [11.0%]). In logistic regression analyses, the high irritability and depressive/anxious mood profile (odds ratio [OR], 2.22; 95% CI, 1.32-3.74; number needed to be exposed [NNE], 18) was associated with suicidality. To a lesser extent, the moderate irritability and low depressive/anxious mood profile was also associated with suicidality (OR, 1.51; 95% CI, 1.02-2.25; NNE = 48). The high depressive/anxious mood only profile was not associated with later suicidality (OR, 0.96; 95% CI, 0.47-1.95; NNE = −320). The high irritability and depressive/anxious mood profile was associated with a higher suicidal risk compared with the depressive/anxious mood only profile (OR, 2.28; 95% CI, 1.02-5.15). Girls with the high irritability and high depressive/anxious mood profile had higher risk for suicidality (OR, 3.07; 95% CI, 1.54-6.12; NNE = 5).

Conclusions and Relevance  Children with high irritability and depressive/anxious mood and, to a lesser extent, with moderate irritability only had a higher suicidal risk during adolescence compared with children with low symptom levels. Early manifestation of chronic irritability during childhood, especially when combined with depressive/anxious mood, may be associated with an elevated risk for adolescent suicidality. The putatively causal role of irritability should be investigated.

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