THE ASSOCIATION BETWEEN EXPOSURE TO SUICIDE AND SUICIDALITY OUTCOMES IN A NATIONALLY-REPRESENTATIVE PROSPECTIVE COHORT OF CANADIAN YOUTH Sonja A. Swanson, Sc.M. 1 ; Ian Colman, Ph.D. 2, 3 1 Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA 2 Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada 3 School of Public Health, University of Alberta, Edmonton, AB, Canada Corresponding Author: Dr. Ian Colman, Assistant Professor, Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Road, Room 3230C, Ottawa, ON, K1H 8M5, CANADA Email: [email protected]Tel: +1 613 562 5800 ext. 8715
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THE ASSOCIATION BETWEEN EXPOSURE TO SUICIDE AND SUICIDALITY
OUTCOMES IN A NATIONALLY-REPRESENTATIVE PROSPECTIVE COHORT
OF CANADIAN YOUTH
Sonja A. Swanson, Sc.M.1; Ian Colman, Ph.D.2, 3
1Department of Epidemiology, Harvard School of Public
Health, Boston, MA, USA
2Department of Epidemiology and Community Medicine,
University of Ottawa, Ottawa, ON, Canada
3School of Public Health, University of Alberta, Edmonton,
AB, Canada
Corresponding Author: Dr. Ian Colman, Assistant Professor,
Department of Epidemiology and Community Medicine,
University of Ottawa, 451 Smyth Road, Room 3230C, Ottawa,
Yes NA 0.6 (0.2) 9.1 (0.7) No NA 99.4 (0.2) 90.9 (0.7)Prior Drug Use2
Yes NA 5.2 (0.4) 22.5 (0.9) No NA 94.8 (0.4) 77.5 (0.9)Prior Suicide Attempt2
Yes NA 2.9 (0.3) 4.7 (0.4) No NA 97.1 (0.3) 95.3 (0.4)
1. Prior stressful life events reported at previous assessment two years earlier (e.g., ages 10-11 for those ages 12-13 at baseline).2. Prior drinking, drug use, and suicide attempts reported at previous assessment two years earlier (e.g., ages 12-13 for those ages 14-15 at baseline). These measures were not assessed prior to
age 12 and thus are not available for those ages 12-13 at baseline. Previous suicide attempts were only assessed in the subset of respondents with baseline information from Cycles 4-7 (not 3-7) due to availability of the assessment.
Table 2. Cross-sectional association between suicide by a schoolmate and suicidality outcomes in youth, OR (95% CI)
Unadjusted Partially Adjusted* Fully Adjusted*Ages 12-13Ideation Exposure in Past Year 5.06 (3.04-8.40) 5.09 (3.03-8.57) 6.46 (3.56-11.72) Exposure > Year Ago 4.57 (2.87-7.29) 4.58 (2.87-7.32) 4.08 (2.43-6.86) No Exposure Reference Reference ReferenceAttempt Exposure in Past Year 4.57 (2.39-8.71) 4.68 (2.37-9.24) 5.93 (2.67-13.20) Exposure > Year Ago 5.80 (3.07-10.97) 5.65 (2.98-10.70) 5.05 (2.50-10.19) No Exposure Reference Reference ReferenceAges 14-15Ideation Exposure in Past Year 2.93 (2.02-4.24) 2.78 (1.91-4.04) 2.85 (1.85-4.41) Exposure > Year Ago 2.89 (2.01-4.15) 2.66 (1.84-3.84) 2.35 (1.55-3.54) No Exposure Reference Reference ReferenceAttempt Exposure in Past Year 3.99 (2.46-6.45) 3.62 (2.21-5.94) 3.41 (1.93-6.04) Exposure > Year Ago 3.88 (2.40-6.27) 3.38 (2.07-5.52) 2.98 (1.70-5.22) No Exposure Reference Reference ReferenceAges 16-17Ideation Exposure in Past Year 2.23 (1.43-3.48) 2.21 (1.40-3.47) 1.83 (1.04-3.21) Exposure > Year Ago 1.86 (1.18-2.93) 1.79 (1.13-2.84) 1.97 (1.14-3.41) No Exposure Reference Reference ReferenceAttempt Exposure in Past Year 3.22 (1.62-6.41) 3.13 (1.53-6.43) 3.26 (1.35-7.89) Exposure > Year Ago 2.33 (1.17-4.61) 2.18 (1.08-4.40) 2.04 (0.84-4.96) No Exposure Reference Reference Reference*Partially adjusted models account for gender and socioeconomic status. For ages 14-15 and 16-17, fully adjusted models account for gender, socioeconomic status, prior depression/anxiety, prior monthly drinking episodes, and prior drug use. For ages 12-13, fully adjusted models account for gender, socioeconomic status, and prior depression/anxiety.
Table 3. Cross-sectional association between suicide by someone personally known and suicidality outcomes in youth, OR (95% CI)
Unadjusted Partially Adjusted* Fully Adjusted*Ages 12-13Ideation Exposure in Past Year 3.28 (1.98-5.43) 3.35 (2.00-5.62) 4.02 (2.22-7.27) Exposure > Year Ago 1.87 (1.26-2.76) 1.91 (1.29-2.83) 1.75 (1.10-2.79) No Exposure Reference Reference ReferenceAttempt Exposure in Past Year 2.57 (1.31-5.04) 2.53 (1.26-5.07) 3.20 (1.48-6.90) Exposure > Year Ago 2.77 (1.66-4.62) 2.80 (1.68-4.68) 2.74 (1.48-5.08) No Exposure Reference Reference ReferenceAges 14-15Ideation Exposure in Past Year 2.74 (1.86-4.04) 2.56 (1.73-3.77) 2.84 (1.79-4.49) Exposure > Year Ago 2.42 (1.77-3.30) 2.21 (1.61-3.03) 2.28 (1.57-3.31) No Exposure Reference Reference ReferenceAttempt Exposure in Past Year 3.82 (2.43-6.01) 3.47 (2.19-5.50) 3.59 (2.06-6.26) Exposure > Year Ago 2.51 (1.69-3.73) 2.23 (1.48-3.37) 2.07 (1.27-3.39) No Exposure Reference Reference ReferenceAges 16-17Ideation Exposure in Past Year 1.86 (1.20-2.88) 1.86 (1.20-2.90) 1.85 (1.12-3.05) Exposure > Year Ago 2.11 (1.51-2.96) 1.92 (1.36-2.70) 1.80 (1.18-2.76) No Exposure Reference Reference ReferenceAttempt Exposure in Past Year 2.80 (1.57-4.97) 2.83 (1.57-5.11) 3.14 (1.53-6.44) Exposure > Year Ago 2.68 (1.69-4.24) 2.30 (1.41-3.74) 2.25 (1.19-4.25) No Exposure Reference Reference Reference*Partially adjusted models account for gender and socioeconomic status. For ages 14-15 and 16-17, fully adjusted models account for gender, socioeconomic status, prior depression/anxiety, prior monthly drinking episodes, and prior drug use. For ages 12-13, fully adjusted models account for gender, socioeconomic status, and prior depression/anxiety.
Table 4. Prospective association between proximity to suicide and suicidality outcomes two years later, OR (95% CI)
Unadjusted Partially Adjusted* Fully Adjusted*Exposure to school suicideAges 12-13Ideation 1.61 (0.71-3.67) 1.77 (0.78-4.04) 0.93 (0.32-2.72)Attempt 3.07 (1.05-8.96) 3.52 (1.20-10.33) 1.46 (0.28-7.56)Ages 14-15Ideation 1.65 (1.06-2.55) 1.65 (1.06-2.55) 1.82 (1.13-2.94)Attempt 2.72 (1.47-5.04) 2.62 (1.41-4.86) 2.68 (1.34-5.34)Exposure to a personally-known suicideAges 12-13Ideation 1.30 (0.65-2.60) 1.39 (0.69-2.78) 1.41 (0.67-2.97)Attempt 1.55 (0.63-3.81) 1.67 (0.66-4.18) 1.85 (0.64-5.35)Ages 14-15Ideation 1.56 (0.97-2.49) 1.50 (0.95-2.38) 1.46 (0.86-2.48)Attempt 2.13 (1.10-4.13) 1.98 (1.03-3.81) 1.83 (0.82-4.09)*Partially adjusted models account for gender and socioeconomic status. For ages 14-15 and 16-17, fully adjusted models account for gender, socioeconomic status, prior depression/anxiety, prior monthly drinking episodes, and prior drug use. For ages 12-13, fully adjusted models account for gender, socioeconomic status, and prior depression/anxiety.
eTable 1. Cross-sectional association between suicide by a schoolmate and suicidality outcomes in youth, assuming those who reported “I don’t know” regarding exposure to suicide were not exposed, OR (95% CI)
Unadjusted Partially Adjusted Fully AdjustedAges 12-13Ideation Exposure in Past Year 3.39 (2.09-5.50) 3.53 (2.15-5.81) 4.24 (2.37-7.58) Exposure > Year Ago 3.06 (1.98-4.74) 3.05 (1.97-4.73) 2.62 (1.62-4.25) No Exposure Reference Reference ReferenceAttempt Exposure in Past Year 3.14 (1.72-5.71) 3.18 (1.70-5.96) 3.74 (1.78-7.85) Exposure > Year Ago 3.98 (2.24-7.09) 3.91 (2.20-6.94) 3.34 (1.79-6.23) No Exposure Reference Reference ReferenceAges 14-15Ideation Exposure in Past Year 1.74 (1.24-2.46) 1.73 (1.23-2.44) 1.89 (1.28-2.79) Exposure > Year Ago 1.72 (1.25-2.37) 3 1.66 (1.21-2.29) 1.55 (1.09-2.22) No Exposure Reference Reference ReferenceAttempt Exposure in Past Year 2.40 (1.56-3.70) 2.32 (1.51-3.56) 2.44 (1.49-3.98) Exposure > Year Ago 2.34 (1.54-3.54) 2.18 (1.44-3.29) 2.12 (1.32-3.41) No Exposure Reference Reference ReferenceAges 16-17Ideation Exposure in Past Year 1.88 (1.29-2.74) 1.90 (1.30-2.78) 1.70 (1.07-2.71) Exposure > Year Ago 1.57 (1.07-2.31) 1.54 (1.04-2.27) 1.80 (1.13-2.86) No Exposure Reference Reference ReferenceAttempt Exposure in Past Year 2.27 (1.34-3.84) 2.31 (1.33-4.04) 2.66 (1.35-5.23) Exposure > Year Ago 1.64 (0.95-2.82) 1.58 (0.91-2.77) 1.60 (0.78-3.27) No Exposure Reference Reference Reference*Partially adjusted models account for gender and socioeconomic status. For ages 14-15 and 16-17, fully adjusted models account for gender, socioeconomic status, prior depression/anxiety, prior monthly drinking episodes, and prior drug use. For ages 12-13, fully adjusted models account for gender, SES, and prior depression/anxiety.
eTable 2. Cross-sectional association between suicide by someone personally known and suicidality outcomes in youth, assuming those who reported “I don’t know” regarding exposure to suicide were not exposed, OR (95% CI)
Unadjusted Partially Adjusted Fully AdjustedAges 12-13Ideation Exposure in Past Year 2.88 (1.75-4.75) 2.92 (1.75-4.88) 3.58 (1.99-6.47) Exposure > Year Ago 1.64 (1.12-2.42) 1.66 (1.13-2.44) 1.56 (0.99-2.45) No Exposure Reference Reference ReferenceAttempt Exposure in Past Year 2.20 (1.14-4.24) 2.14 (1.09-4.22) 2.70 (1.28-5.70) Exposure > Year Ago 2.38 (1.45-3.90) 2.37 (1.44-3.90) 2.33 (1.29-4.20) No Exposure Reference Reference ReferenceAges 14-15Ideation Exposure in Past Year 2.45 (1.67-3.59) 2.26 (1.54-3.31) 2.46 (1.56 – 3.88) Exposure > Year Ago 2.16 (1.59-2.94) 1.95 (1.43-2.67) 1.96 (1.36 – 2.84) No Exposure Reference Reference ReferenceAttempt Exposure in Past Year 3.64 (2.33-5.68) 3.26 (2.08 – 5.11) 3.36 (1.96 – 5.76) Exposure > Year Ago 2.39 (1.63-3.51) 2.10 (1.41 – 3.12) 1.94 (1.21 – 3.11) No Exposure Reference Reference ReferenceAges 16-17Ideation Exposure in Past Year 1.75 (1.14 - 2.70) 1.74 (1.13-2.69) 1.73 (1.05-2.83) Exposure > Year Ago 1.99 (1.43 - 2.77) 1.80 (1.28- 2.52) 1.69 (1.12-2.56) No Exposure Reference Reference ReferenceAttempt Exposure in Past Year 2.46 (1.41-4.31) 2.44 (1.37-4.34) 2.69 (1.35-5.36) Exposure > Year Ago 2.36 (1.50-3.71) 1.99 (1.23 - 3.22) 1.96 (1.07 – 3.59) No Exposure Reference Reference Reference*Partially adjusted models account for gender and socioeconomic status. For ages 14-15 and 16-17, fully adjusted models account for gender, socioeconomic status, prior depression/anxiety, prior monthly drinking episodes, and prior drug use. For ages 12-13, fully adjusted models account for gender, socioeconomic status, and prior depression/anxiety.
eTable 3. Prospective association between proximity to suicide and suicidality outcomes two years later, assuming those who reported “I don’t know” regarding exposure to suicide were not exposed, OR (95% CI)
Unadjusted Partially Adjusted Fully AdjustedExposure to school suicideAges 12-13Ideation 1.09 (0.48-2.47) 1.22 (0.54-2.75) 0.65 (0.22-1.91)Attempt 1.87 (0.64-5.45) 2.15 (0.74-6.28) 0.95 (0.18-4.97)Ages 14-15Ideation 1.32 (0.86-2.01) 1.31 (0.86-2.00) 1.44 (0.91-2.30)Attempt 1.74 (0.98-3.06) 1.70 (0.96-3.01) 1.80 (0.94-3.46)Exposure to a personally-known suicideAges 12-13Ideation 1.20 (0.60-2.38) 1.26 (0.63-2.52) 1.24 (0.59-2.62)Attempt 1.42 (0.58-3.50) 1.51 (0.60-3.76) 1.62 (0.57-4.61)Ages 14-15Ideation 1.48 (0.93-2.36) 1.42 (0.90-2.24) 1.39 (0.82-2.35)Attempt 2.03 (1.06-3.90) 1.87 (0.98-3.57) 1.77 (0.83-3.80)*Partially adjusted models account for gender and socioeconomic status. For ages 14-15 and 16-17, fully adjusted models account for gender, socioeconomic status, prior depression/anxiety, prior monthly drinking episodes, and prior drug use. For ages 12-13, fully adjusted models account for gender, socioeconomic status, and prior depression/anxiety.