Suicide attempt in young people: a signal for long-term health care and social needs

Abstract

Importance: Suicidal behavior has increased since the onset of the global recession, a trend that may have long-term health and social implications.

Objective: To test whether suicide attempts among young people signal increased risk for later poor health and social functioning above and beyond a preexisting psychiatric disorder.

Design: We followed up a cohort of young people and assessed multiple aspects of their health and social functioning as they approached midlife. Outcomes among individuals who had self-reported a suicide attempt up through age 24 years (young suicide attempters) were compared with those who reported no attempt through age 24 years (nonattempters). Psychiatric history and social class were controlled for.

Setting and participants: The population-representative Dunedin Multidisciplinary Health and Development Study, which involved 1037 birth cohort members comprising 91 young suicide attempters and 946 nonattempters, 95% of whom were followed up to age 38 years.

Main outcomes and measures: Outcomes were selected to represent significant individual and societal costs: mental health, physical health, harm toward others, and need for support.

Results: As adults approaching midlife, young suicide attempters were significantly more likely to have persistent mental health problems (eg, depression, substance dependence, and additional suicide attempts) compared with nonattempters. They were also more likely to have physical health problems (eg, metabolic syndrome and elevated inflammation). They engaged in more violence (eg, violent crime and intimate partner abuse) and needed more social support (eg, long-term welfare receipt and unemployment). Furthermore, they reported being lonelier and less satisfied with their lives. These associations remained after adjustment for youth psychiatric diagnoses and social class.

Conclusions and relevance: Many young suicide attempters remain vulnerable to costly health and social problems into midlife. As rates of suicidal behavior rise with the continuing global recession, additional suicide prevention efforts and long-term monitoring and after-care services are needed.

Figure 1

More than their share: Selected outcomes in midlife, for young suicide attempters and non-attempters. Left bar shows the proportion of the entire Dunedin cohort that made a suicide attempt up through age 24 years. Right bars show, of the cohort members with each outcome, what proportion were young suicide attempters. Note: “Persistent psychiatric problem” indicates 2+ diagnoses with depression, generalized anxiety disorder, or substance dependence between ages 26 and 38. All other outcomes are as described in eTable 1.