Objective

Childhood irritability predicts suicidal ideation/attempt (suicidality), but it is unclear whether irritability is an independent and direct risk factor for suicidality or a marker of intermediate mental health symptoms associated with suicidality. This study aimed to identify developmental patterns of childhood irritability and to test whether childhood irritability is directly associated with suicidality or indirectly associated with intermediate mental health symptoms.

Method

One thousand three hundred ninety-three participants from the Québec Longitudinal Study of Child Development were followed from birth to 17 years. Teachers assessed irritability yearly (at 6–12 years) and children self-reported intermediate mental health symptoms (depression, anxiety, disruptiveness, and hyperactivity-impulsivity; at 13 years) and suicidality (at 15 and 17 years).

Results

Four irritability trajectories were identified: low (74.7%), rising (13.0%), declining (7.4%), and persistent (5.0%). Children following a rising irritability trajectory (versus a low trajectory) were at higher suicidality risk. A large proportion of this association was direct (odds ratio 2.11, 95% CI 1.30–3.43) and a small proportion was indirect by depressive symptoms (accounting for 23% of the association; odds ratio 1.17, 95% CI 1.03–1.34). Children on a persistent irritability trajectory (versus a low trajectory) were at higher risk of suicidality and this association was uniquely indirect by depressive symptoms (accounting for 73% of the association; odds ratio 1.51, 95% CI 1.16–1.97). The declining trajectory was not related to suicidality; no association with anxiety, disruptiveness, and hyperactivity-impulsivity was found.

Conclusion

Rising irritability across childhood represents a direct risk for suicidality. Persistent irritability appears to be a distal marker of suicidality acting through more proximal depressive symptoms.

中文翻译：

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童年易怒与青少年自杀倾向的关联途径

客观的

童年易怒易感会导致自杀意念/尝试（自杀），但目前尚不清楚易怒是自杀的独立且直接的危险因素，还是自杀相关的中级心理健康症状的标志。这项研究旨在确定儿童易怒的发展模式，并测试儿童易怒是直接与自杀有关，还是间接与中间心理健康症状有关。

方法

魁北克儿童发展纵向研究的1,393名参与者从出生到17岁一直受到随访。教师评估了每年（6至12岁）的易怒性，儿童自我报告了中等心理健康症状（在13岁时的抑郁，焦虑，破坏性和多动冲动；在15岁和17岁时）。

结果

确定了四个易怒轨迹：低（74.7％），上升（13.0％），下降（7.4％）和持续（5.0％）。易怒路线（相对于低轨迹）的儿童自杀倾向性较高。这种关联的很大一部分是直接的（赔率2.11，95％CI 1.30–3.43），而间接的则是抑郁症状（占关联的23％；优势比1.17，95％CI 1.03–1.34）。持续性易怒轨迹（相对于低轨迹）的儿童有自杀倾向的较高风险，这种关联是抑郁症状的唯一间接原因（占关联的73％；优势比1.51，95％CI 1.16-1.97）。下降的轨迹与自杀性无关。没有发现与焦虑，破坏性和多动冲动相关。

结论

整个儿童时期烦躁情绪的上升代表着自杀的直接风险。持久性烦躁似乎是自杀倾向的远端标志，可通过更多近端抑郁症状发挥作用。