The developmental origins of suicide mortality: a systematic review of longitudinal studies

Abstract

Suicide prevention efforts generally target acute precipitants of suicide, though accumulating evidence suggests that vulnerability to suicide is partly established early in life before acute precipitants can be identified. The aim of this systematic review was to synthesize evidence on early life vulnerability to suicide beginning in the prenatal period and extending through age 12. We searched PubMed, Embase, PsycNet, Web of Science, Scopus, Social Services Abstracts, and Sociological Abstracts for prospective studies published through January 2021 that investigated early life risk factors for suicide mortality. The search yielded 13,237 studies; 54 of these studies met our inclusion criteria. Evidence consistently supported the link between sociodemographic (e.g., young maternal age at birth, low parental education, and higher birth order), obstetric (e.g., low birth weight), parental (e.g., exposure to parental death by external causes), and child developmental factors (e.g., exposure to emotional adversity) and higher risk of suicide death. Among studies that also examined suicide attempt, there was a similar profile of risk factors. We discuss a range of potential pathways implicated in these associations and suggest that additional research be conducted to better understand how early life factors could interact with acute precipitants and increase vulnerability to suicide.

Keywords: Childhood; Cohort; Longitudinal; Prenatal; Suicide.

Fig 1.

PRISMA flow diagram

Fig 2.. Schematic representation of the effect of early life factors on increased vulnerability to suicide mortality.

Pregnancy-related factors, sociodemographic factors, and parental and child factors during first years of childhood are thought to influence epigenetic, neural, immune, neuroendocrine, social, and psychological changes with two potential long-term effects: 1) Increased likelihood to exposure to more proximal and precipitant factors, which in turn increase vulnerability to suicide, and 2) Increased sensitivity to stressful environments and effects of proximal factors if these occur. Genetic and environmental family factors might affect some of these effects. * Altered decision making and personality traits are listed here under proximal factors given that this review focuses on early life factors; however, they are sometimes conceptualized as distal factors in the literature.