Posted by Phillipa on April 10, 2009, at 19:46:50
Do not read if prome to suicide about adolescent boys. Phillipa Reason for posting my Grandson has conduct disorder.
Early Conduct and Emotional Problems Predict Suicidal Behavior in Males
April 9, 2009 Impulsive or aggressive behavior combined with emotional problems in young boys is a strong predictor of later suicidal behavior, according to a new study.The study found that 1 in 20 boys with comorbid conduct and emotional problems at the age of 8 years killed themselves or seriously attempted to, whereas only 1 in 250 males who did not exhibit these early psychiatric problems did.
As well, the study showed that almost 80% of males demonstrating suicidal behavior exhibited signs of psychiatric illness early in life.
The study was published in the April issue of Archives of General Psychiatry.
This research shows that for males, the pathway from mental-health problems to suicidal behavior starts in early childhood. "It's tragic that 4 out of 5 of those who either completed suicide or had a serious attempt that required hospital treatment had a high level of psychiatric problems as early as age 8," lead author, Andre Sourander, MD, from Turku University Hospital, in Finland, told Medscape Psychiatry.
Need to Make Childhood Mental Health a Priority
The findings highlight the need to make childhood mental-health services a priority and to view psychiatric problems from a developmental perspective, said Dr. Sourander.
The study consisted of 5302 subjects (2700 males and 2602 females), representing 88.1% of the original nationwide Finnish 1981 Birth Cohort Study and 91.2% of those who participated in a study of this population in 1989.
In the 1989 study, when the subjects were 8 years old, researchers assessed behavior using a variety of tools, including Rutter Scale questionnaires filled out by teachers and parents that evaluated conduct, and hyperkinetic (attention span, restlessness) and emotional (shyness, anxiety) elements. The children also rated themselves on depressive symptoms.
To study comorbid psychopathology, researchers created 6 groups:
children who screened negative on all assessment scales (reference group)
children with conduct and emotional problems
children with only conduct issues
children with hyperactivity problems but no conduct problems
children with only emotional problems
children who reported high depressive symptoms but who screened negative on the other 3 scales.Data were also available on family structure, parental education levels, and school performance.
To gather information on suicide attempts and completed suicides to the end of 2005, researchers used death certificates and other sources. Each resident of Finland has a personal identification number that makes the tracking of patient health history relatively easy.
Conduct Disorder Strongly Predictive
Of the 24 deaths among males, 13 (54%) were suicides. Of the 16 deaths among females, only 2 (13%) were suicides. The mean age of males who completed suicide was 21.3 years; the 2 females who committed suicide were 14 and 16 years old.
Also during the study period, 42 patients (17 males and 25 females) were admitted to hospital after a suicide attempt. Three of the males later committed suicide. As well, 2 of the males and 5 of the females were admitted to hospital twice for suicide attempts.
Methods of completed suicide or attempted suicide included hanging, shooting, drowning, deliberate traffic accidents, jumping from a high place, and drug overdose (or poisoning). About 85% of females and 50% of males used the last method.
Researchers pooled these attempted and completed suicides, resulting in a total of 54 individuals (27 males and 27 females), or 1% of the sample group.
Of the 27 males who completed or attempted suicide, 21 screened positive on either the parent or teacher Rutter Scale, compared with 3 of the 27 females.
Looking at psychopathology domains as linear variables, researchers found that conduct disorder strongly predicted suicide outcome among males (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.52.5 for 1 standard deviation change; P < .001), as did hyperkinetic (OR, 1.8; 95% CI, 1.42.4; P < .001) and emotional (OR, 1.7; 95% CI, 1.32.3; P < .001) scores.
When the researchers investigated comorbid groups, they found that the strongest predictor of suicide outcome among males was conduct-emotional status (i.e., children who are impulsive and aggressive and at the same time have emotional problems).
Although not living with 2 biological parents also predicted suicide outcome among males, other factors associated with divorce, such as family violence and substance abuse, might explain this link.
As for females, family structure and psychopathology score predicted suicide status, but since there were only 2 female suicides, the results apply only to suicide attempts.
The authors commented that suicide-spectrum problems among girls are strongly associated with affective disorders that don't manifest significantly until after puberty.
First Study of Its Kind
This was the first prospective population-based study to examine predictive associations between early childhood psychopathology and later completed suicides and serious suicide attempts.
Previous research relied almost exclusively on retrospective analyses that were largely incomplete or had outcomes that were based on information about suicidal ideation or less severe suicidal acts.
Although this current study used questionnaires to gather information, Dr. Sourander said that these symptom checklists correlate "very strongly" with psychiatric interviews.
The study results underline the need to view pediatric mental health as a priority, said Dr. Sourander, adding that almost none of the males in the study who were at high risk for severe suicide outcome had used psychiatric medical services during adolescence. "Early interventions could possibly prevent suicide behavior," he said.
The study could have important implications for primary care. General practitioners and nurses are trained to check mostly for physical problems, even though many of the most chronic health issues in developing countries are psychiatric in nature, said Dr. Sourander.
"The thinking is that if it's something that sounds like it's a mental problem, it belongs to psychiatric professionals or psychosocial people, but I think this is an opportunity to see health, especially among children, from both a physical and psychological point of view."
Dr. Sourander noted that only 1 of the 24 boys who died in this study died of a physical illness. "All the others were accidents or suicides or were killed."
Shift in Thinking Required
Considering child mental health in the context of later health outcomes requires a significant "shift in thinking" on the part of health professionals, said Dr. Sourander. "Today, adult psychiatry, adolescent psychiatry, and child psychiatry are all still separate fields." He added that the shift has already begun, thanks in large part to longitudinal studies, such as this one, that show "a strong continuity between childhood factors and adult problems."
The study also offers an opportunity to encourage interventions on the part of teachers, whom Dr. Sourander called "gatekeepers". "Mental-health services for kids have to be developed in the context of where kids are. They have to be developed in collaboration with other health services and with a strong link to school services."
Dr. Sourander and his colleagues are now looking at outcomes such as criminality and the use of psychopharmacology in the same study sample.
The researchers have disclosed no relevant financial relationships.
Arch Gen Psychiatry. 2009;66:398-406. Abstract
poster:Phillipa
thread:889863
URL: http://www.dr-bob.org/babble/20090408/msgs/889863.html