Association of Cumulative Childhood Adversity and Adolescent Violent Offending With Suicide in Early Adulthood

Abstract

Importance: Childhood adversity (CA) is associated with an increased risk of suicide in young adulthood that might be explained by maladaptive trajectories during adolescence. Although adolescent violent offending is linked with suicide, little is known about its role in the association between CA and suicide.

Objective: To examine whether adolescent violent offending mediates the association between CA and suicide in early adulthood.

Design, setting, and participants: This population-based, longitudinal cohort study with a follow-up time spanning 5 to 9 years included 476 103 individuals born in Sweden between 1984 and 1988. The study population was prospectively followed up from 20 years of age until December 31, 2013, with respect to suicide. Data analysis was performed from January 1, 1984, to December 31, 2013.

Exposures: Register-based CAs included parental death, parental substance abuse and psychiatric disorder, parental criminal offending, parental separation, public assistance recipiency, child welfare intervention, and residential instability. Adolescent violent offending was defined as being convicted of a violent crime between the ages of 15 and 19 years.

Main outcomes and measures: Estimates of risk of suicide after 20 years of age (from 2004 if born in 1984 and from 2008 if born in 1988) until the end of 2013 were calculated as incidence rate ratios (IRRs) with 95% CIs using Poisson regression analysis. Adjustments were made for demographics and psychiatric disorder. In addition, binary mediation analysis with logistic regression was used.

Results: A total of 476 103 individuals (231 699 [48.7%] female) were included in the study. Those with a conviction for violent offending had been exposed to all CAs to a greater extent than those with no violent offending. Cumulative CA was associated with risk of suicide in nonconvicted (adjusted IRR, 2.4; 95% CI, 1.5-3.9) and convicted youths, who had a higher risk of suicide (adjusted IRR, 8.5; 95% CI, 4.6-15.7). Adolescent violent offending partly mediated the association between CA and suicide.

Conclusions and relevance: Individuals with a history of CA who also engage in violent offending in adolescence have a high risk of suicide. Interventions to prevent externalizing behavior during childhood and increased support to youths with delinquent behavior may have the potential to prevent suicide related to CA.

Figure.. Model of the Association Among Childhood Adversity (CA), Violent Offending, and Suicide

Logistic regression coefficients are as follows: β₀ = −4.32, β₁ = 0.55 × cumulative CA, for the association of cumulative CA with adolescent violent offending; β₀ = −6.77, β₁ = 2.04 × adolescent violent offending, for the association of adolescent violent offending with suicide; β₀ = −6.89, β₁ = 0.39 × cumulative CA, for total effect (association of cumulative CA with suicide); and β₀ = −6.94, β₁ = 0.32 × cumulative CA for direct effect (association of cumulative CA with suicide). The value in parentheses is the coefficient for the direct (ie, unmediated) path. P < .001 for all associations.