Childhood Irritability Associated With Adolescent Suicidality

Massimiliano Orri, PhD

Researchers in Quebec found that children with high irritability and high depressive/anxious mood symptoms were 2 times more likely to think about suicide or make a suicide attempt in adolescence compared with children showing depressive/anxious mood only or low irritability and low depressive/anxious mood.

“No study to date has examined the joint association of depressive mood and irritability during childhood with later suicidality,” wrote Massimiliano Orri, PhD, Postdoctoral Research Fellow at McGill University, Montreal and associates.

Causes of adolescent suicide are a major public health concern. In 2014, suicide was the second leading cause of death for children aged 10-14 and 15-24, according to The Centers for Disease Control and Prevention (CDC).

This population-based cohort study followed 1430 children from infancy up to 17 years of age. Authors collected assessments on a yearly or bi-yearly basis between 1998 — 2015. Assessments included 5 teacher reports submitted while participants were 6-12 years of age. Adolescent participants self-reported suicidality (serious suicidal ideation or suicide attempt) at 13, 15, and 17 years of age.

Researchers identified 5 profiles from the results: no irritability and low depressive/anxious mood (465 [32.5%]), (2) low irritability and low depressive/anxious mood (366 [25.6%]), (3) moderate irritability and low depressive/anxious mood (353 [24.7%]), (4) moderate declining irritability and high depressive/anxious mood (94 [6.6%]), and (5) high irritability and depressive/anxious mood (152 [10.6%]). The first two profiles were combined and used as a reference group.

Suicidality ranged from 10.6% of adolescents of profile 4 to 16.4% of adolescents of profile 5. Researchers found that children with profile 5 had twice the odds of developing suicidality (OR, 2.22; 95% CI, 1.32-3.74), adjusted for sex and socioeconomic status.

Notably, the high depressive/anxious mood group (profile 4) had the same likelihood of suicidality as the reference group.

“[A] contribution of this study is the identification of a group of children (approximately 25%) with moderate and stable levels of irritability (but low depressive/anxious mood) who are at elevated risk of suicidality during adolescence,” said the authors. “We found that even moderate levels of irritability may contribute to suicidal risk.

Previous research by the CDC has shown that the rate of US emergency department visits due to nonfatal self-inflicted injuries has been increasing annually by 5.7% (95% CI, 3.0%-8.4%) since 2008 in patients aged 10 to 24 years old.

“Youth suicide rates in the US increased after 2006, with females ages 10 to 14 years experiencing the greatest increase,” said Melissa C. Mercado, PhD, MSc, MA, lead researcher for the CDC study.

Given the high stakes, Orri and colleagues emphasized the need for further research, “because our findings are exploratory, additional studies are needed to test the putatively causal role of irritability on suicidality.”

The study, “Association of Childhood Irritability and Depressive/Anxious Mood Profiles With Adolescent Suicidal Ideation and Attempts” was published online in the Journal of the American Medical Association.