Suicide is a complex social issue. According to the World Health Organization (WHO), each year there are nearly 800,000 deaths from suicide worldwide (1). Among youngsters with ages from 15–29 years old, suicide is the second leading cause of mortality worldwide, and its incidence rate is increasing (1-5). Therefore, it is important to identify corresponding risk factors for future intervention.
Recently, Björkenstam et al. (6) reported a retrospective cohort study, to investigate the association between different indicators of childhood adversity and suicide among 15–24 years old adolescents and young adults.
In this study, the authors enrolled a large population of 548,721 adolescents and young adults according to the database of various Swedish registers. To categorize childhood adversity, they used seven indicators: death in family (suicide in family was analyzed separately), parental substance abuse, parental psychiatric disorder, parental criminality, parental separation/single parent household, household receiving public assistance, and residential instability. Analyses were adjusted by different potential confounders, including year of birth, foreign born parent, parental education, school performance grade, and childhood psychopathology.
Youngsters with at least one indicator of childhood adversity accounted for 42% proportion of the whole study population; among them, there were a total of 256 suicide cases. Compared with youngsters without indicators of childhood adversity youngsters with the indicators had at least a 1.4 times higher incidence rate of suicide. The corresponding rate was 1.9 (95% CI: 1.3–2.8) in death in family, 2.9 (1.4–5.9) in suicide in family, 1.9 (1.4–2.4) in parental substance abuse, 2.0 (1.5–2.8) in parental psychiatric disorder, 2.3 (1.7–3.0) in parental criminality, 1.4 (1.2–1.7) in parental separation/single parent household, 1.6 (1.3–2.0) in household receiving public assistance, and 1.6 (1.1–2.4) in residential instability, respectively (Table 1). More importantly, a dose-response effect existed for the above comparison [one indicator: 1.1 (0.9–1.4); two indicators: 1.9 (1.4–2.5); at least three indicators: 2.6 (1.9–3.41)] (Table 1).
According to the study, it is also interesting to know, for youngsters with poorer grade performance in school, the suicide risk increased [poorest versus highest: 2.0 (1.4–2.8)]. This result is related to other research showing that the rate of incident suicide among youngsters with the lowest performance in schools was 4.57 times higher than the suicide rate among youngsters with the highest performance (7). Data indicate that, intervention may be considered to be implemented in school period, in order to prevent future suicide.
From this study, a challenge is, even though a higher rate of suicide was found in childhood adversity, it is also important to know that a large proportion of this study population (58%) did not suffer from childhood adversity, but the number of suicides among these youngsters accounted for 41% (175/431) of suicide cases in all population. Namely, despite all relevant indicators of childhood adversity investigated in this study, perhaps there were other risk factors influencing those youngsters who finally decided to end their lives. Further investigation is warranted.
In summary, this study is the first to comprehensively investigate cumulative risk effect of different indicators of childhood adversity on suicide among youngsters. It found that, with more indicators of childhood adversity, youngsters have a higher risk of committing suicide. In addition, it is also the first to separately investigate these many relevant indicators of childhood adversity for suicide with large population size. Based on the research finding, youngsters who exposed with suicide in the family, parental criminality, and parental psychiatric disorder, potentially have higher risk of committing suicide. This study demonstrated potential social patterns behind suicide behavior, which is worthy for improving public awareness and preventing suicide in real practice.
This editorial is written for my dear nephew who recently left, as well as considerable children who were or who are suffering from adversity, even tribulation. Life still could be full of love and joy, deserving continuous involvement. More importantly, our society would like to care, accompany, and help. We all share bright future. I sincerely thank my family (especially my grandma Ermei Gu), and all friends for supporting me, especially during my childhood. I also sincerely thank Dr. Jieyu Wu (First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China), Prof. Kimberly Johnson, Ms. Elizabeth Burke, and Ms. Xinli Wang (Washington University in St. Louis, St. Louis, USA) for providing suggestion on revising this Editorial.
Conflicts of Interest: The author has no conflicts of interest to declare.
- World Health Organization. Available online: http://www.who.int/mediacentre/factsheets/fs398/en/
- Turecki G, Brent DA. Suicide and suicidal behaviour. Lancet 2016;387:1227-39. [Crossref] [PubMed]
- World Health Organization. Preventing suicide: A global imperative. WHO, 2014.
- Cash SJ, Bridge JA. Epidemiology of youth suicide and suicidal behavior. Curr Opin Pediatr 2009;21:613-9. [Crossref] [PubMed]
- Wasserman D, Cheng Q, Jiang GX. Global suicide rates among young people aged 15-19. World Psychiatry 2005;4:114-20. [PubMed]
- Björkenstam C, Kosidou K, Björkenstam E. Childhood adversity and risk of suicide: cohort study of 548,721 adolescents and young adults in Sweden. BMJ 2017 19;357:j1334.
- Björkenstam C, Weitoft GR, Hjern A, et al. School grades, parental education and suicide--a national register-based cohort study. J Epidemiol Community Health 2011;65:993-8. [Crossref] [PubMed]