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Jelena Brezo, PhD; Edward D. Barker, PhD; Joel Paris, MD; Martine Hébert, PhD; Frank Vitaro, PhD; Richard E. Tremblay, PhD; Gustavo Turecki, MD, PhD

Arch Pediatr Adolesc Med. 2008;162(11):1015-1021.

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 co-occurrence 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 ² = 10.93; P < .001) but not men (OR = 0.80; Wald 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.

Author Affiliations: McGill Group for Suicide Studies, Douglas Hospital Research Center (Drs Brezo and Turecki), Research Unit on Children's Psychosocial Maladjustment, University of Montreal (Drs Barker, Vitaro, Tremblay, and Turecki), Department of Psychiatry, McGill University (Drs Paris), and Department of Sexology, University of Quebec (Dr Hébert), Montreal, Quebec, Canada; and King's College London, Institute of Psychiatry, MRC Social, Genetic and Developmental Psychiatry Centre, London, England (Dr Barker).