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November 28, 2008 — Anxious-disruptive girls and disruptive boys are more likely to attempt suicide in young adulthood, according to a prospective school-based cohort study.

"This study investigated childhood trajectories of anxiousness and disruptiveness and suggests that suicidal behavior, at least in a portion of individuals, is a developmental problem," study author Gustavo Turecki, MD, from McGill University, in Montreal, Quebec, told Medscape Psychiatry.

Previous studies have shown that attempted suicide is linked to high levels of these behaviors, but this is the first to demonstrate this association by identifying different childhood behavior trajectories, as opposed to looking at cross-sectional 2-point snapshots, he said.

"Pending further research, preventive programs may benefit from considering sex differences in personality markers as early as childhood," the authors write.

The study was published in the November issue of the Archives of Pediatric & Adolescent Medicine.

Vulnerable Groups

Personality traits seen in childhood appear to be linked to a predisposition to suicidality. Having a better understanding of this association would help identify groups of vulnerable people who are at particularly high risk for suicide and who would benefit from timely intervention.

To determine how the pattern of anxiousness and disruptiveness throughout childhood might predict suicide attempts in young adulthood, the researchers studied a representative randomly selected group of 1001 boys and 999 girls who attended kindergarten in Quebec from 1986 to 1988.

The children were assessed annually from ages 6 to 12 years, once in mid-adolescence at a mean age of 15.7 years (range, 15 to 18 years), and once in young adulthood at a mean age of 21.4 years (range, 19 to 24 years).

The children's behavior was assessed on the basis of teacher reports on the Social Behavior Questionnaire, which included 13 items about disruptiveness (such as fighting with other children, fidgeting, and always running and jumping), and 6 items about anxiousness (such as crying easily and being fearful).

Anxious-Disruptive Girls, Disruptive Boys
The researchers identified 4 patterns of childhood anxiousness and 4 patterns of childhood disruptiveness for each trait: very low, low, moderate, and high.
About one-third of the sample had very low levels of both traits, but only 5% had high levels of both traits. In general, participants had similar levels of both traits.

Participants with moderate or high levels of anxiousness throughout childhood had a 60% greater risk for suicide attempt by the time they reached young adulthood, compared with their peers who had very low or low levels of anxiousness in childhood.

Similarly, children with greater disruptiveness in childhood had an 80% greater risk for suicide attempt in young adulthood than their peers.

Having moderate or high levels of both traits conferred an 88% increased risk for suicide attempt.
Risk for Suicide Attempt by Early Adulthood: High-Risk vs Low-Risk Groups*
Childhood TraitOdds Ratio95% CI
Anxiousness1.601.00 – 2.65
Disruptiveness1.801.03 – 3.13
Anxiousness and disruptiveness1.881.05 – 3.37

*High-risk = moderate or high levels of trait throughout childhood; low-risk = very low or low levels of trait throughout childhood.

However, further analysis revealed that the increased risk for suicide attempt related to high levels of both traits was true for girls only (odds ratio [OR], 3.60; P < .001), not for boys (OR, 0.80; P = .64).
The finding that girls at risk for suicide attempt appear to display both anxious and disruptive traits and boys appear to display mostly the latter needs to be examined in research that looks at possible explanations, such as gene-environment interactions, the researchers say.

In addition, they did not find that childhood anxiousness and disruptiveness increased the risk for suicide attempt by increasing the likelihood of adolescent anxiety/mood disorders or disruptive disorders. This may be due to the study's small sample size and should be examined further.


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