Childhood Trajectories of Anxiousness and Disruptiveness as Predictors of Suicide Attempts

Objective: To investigate the association of childhood trajectories of anxiousness and disruptiveness with suicide attempts in early adulthood. Design: Prospective cohort study. Setting: Public francophone schools in Quebec, Canada, from the 1986 to 1988 school years. Participants: Of 4488 French Canadian children attending kindergarten, a representative group of 1001 boys and 999 girls was chosen for follow-up. Of these, 1144 individuals participated in the study during early adulthood. Main Outcome Measures: Suicide attempt histories by early adulthood, adjusted odds ratios (ORs) associated with membership in high- vs low-risk trajectories of anxiousness and disruptiveness, moderation (by sex), and mediation (by adolescent Axis I disorders). Results: We observed 4 distinct developmental profiles of anxiousness and disruptiveness and a frequent cooccurrence of similar levels of these traits. In contrast to anxiousness trajectories (OR = 1.60; 95% confidence interval, 1.00-2.65), disruptiveness (OR = 1.80; 95% confidence interval, 1.03-3.13) and joint (OR = 1.88; 95% confidence interval, 1.05-3.37) trajectories made statistically significant contributions to suicide attempts. We found no support for mediation by adolescent anxiety/mood or disruptive disorders. Sex, however, moderated the effect of joint trajectories, increasing the risk of suicide attempts in women (OR = 3.60; Wald chi(2) = 10.93; P < .001) but not men (OR = 0.80; Wald chi(2) = 0.23; P = .64) displaying both anxious and disruptive traits as children. Conclusions: Anxious-disruptive girls and disruptive boys appear to be more likely than their peers to attempt suicide by early adulthood. Preventive efforts will require more research into the possible mechanisms behind this early sex difference, ie, gene-environment interplays and nonpsychiatric mediators.