Massimiliano Orri1, David Gunnell2, Stephane Richard-Devantoy3, Despina Bolanis3, Jill Boruff4, Gustavo Turecki3, Marie-Claude Geoffroy5. 1. McGill Group for Suicide Studies, Douglas Mental Health University Institute and Department of Psychiatry, McGill University, Montreal, QC, Canada; Bordeaux Population Health Research Centre, Inserm U1219, University of Bordeaux, Bordeaux, France. 2. Population Health Sciences, University of Bristol, Bristol, UK; National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK. 3. McGill Group for Suicide Studies, Douglas Mental Health University Institute and Department of Psychiatry, McGill University, Montreal, QC, Canada. 4. Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, QC, Canada. 5. McGill Group for Suicide Studies, Douglas Mental Health University Institute and Department of Psychiatry, McGill University, Montreal, QC, Canada; Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada. Electronic address: marie-claude.geoffroy@mcgill.ca.
Abstract
BACKGROUND: Adverse in-utero and perinatal conditions might contribute to an increased suicide risk throughout the lifespan; however, existing evidence is sparse and contradictory. We aimed to investigate in-utero and perinatal exposures associated with suicide, suicide attempt, and suicidal ideation. METHODS: We did a systematic review and meta-analysis and searched MEDLINE, Embase, and PsycINFO from inception to Jan 24, 2019, for population-based prospective studies that investigated the association between in-utero and perinatal factors and suicide, suicide attempt, and suicidal ideation. Only papers published in English in peer-reviewed journals were considered. Two researchers independently extracted formal information (eg, country, year, duration of follow-up) and number of cases and non-cases exposed and non-exposed to each risk factor. We calculated pooled odds ratios (ORs) with 95% CIs using random-effects models and used meta-regression to investigate heterogeneity. This study was registered with PROSPERO, number CRD42018091205. FINDINGS: We identified 42 eligible studies; they had a low risk of bias (median quality score 9/9 [IQR 8-9]). Family or parental characteristics, such as high birth order (eg, for fourth-born or later-born vs first-born, pooled OR 1·51 [95% CIs 1·21-1·88]), teenage mothers (1·80 [1·52-2·14]), single mothers (1·57 [1·31-1·89]); indices of socioeconomic position, such as low maternal (1·36 [1·28-1·46]) and paternal (1·38 [1·27-1·51]) education; and fetal growth (eg, low birthweight 1·30 [1·09-1·55] and small for gestational age 1·18 [1·00-1·40]) were associated with higher suicide risk. Father's age, low gestational age, obstetric characteristics (eg, caesarean section), and condition or exposure during pregnancy (eg, maternal smoking or hypertensive disease) were not associated with higher suicide risk. Similar patterns of associations were observed for suicide attempt and suicidal ideation; however, these results were based on a lower number of studies. In meta-regression, differences in length of follow-up explained most between-study heterogeneity (inital I2 ranged from 0 to 79·5). INTERPRETATION: These findings suggest that prenatal and perinatal characteristics are associated with increased suicide risk during the life course, supporting the developmental origin of health and diseases hypothesis for suicide. The low number of studies for some risk factors, especially for suicide attempt and ideation, leaves gaps in knowledge that need to be addressed. The mechanisms underlying the reported associations and their causal nature still remain unclear. FUNDING: Horizon 2020 (EU).
BACKGROUND: Adverse in-utero and perinatal conditions might contribute to an increased suicide risk throughout the lifespan; however, existing evidence is sparse and contradictory. We aimed to investigate in-utero and perinatal exposures associated with suicide, suicide attempt, and suicidal ideation. METHODS: We did a systematic review and meta-analysis and searched MEDLINE, Embase, and PsycINFO from inception to Jan 24, 2019, for population-based prospective studies that investigated the association between in-utero and perinatal factors and suicide, suicide attempt, and suicidal ideation. Only papers published in English in peer-reviewed journals were considered. Two researchers independently extracted formal information (eg, country, year, duration of follow-up) and number of cases and non-cases exposed and non-exposed to each risk factor. We calculated pooled odds ratios (ORs) with 95% CIs using random-effects models and used meta-regression to investigate heterogeneity. This study was registered with PROSPERO, number CRD42018091205. FINDINGS: We identified 42 eligible studies; they had a low risk of bias (median quality score 9/9 [IQR 8-9]). Family or parental characteristics, such as high birth order (eg, for fourth-born or later-born vs first-born, pooled OR 1·51 [95% CIs 1·21-1·88]), teenage mothers (1·80 [1·52-2·14]), single mothers (1·57 [1·31-1·89]); indices of socioeconomic position, such as low maternal (1·36 [1·28-1·46]) and paternal (1·38 [1·27-1·51]) education; and fetal growth (eg, low birthweight 1·30 [1·09-1·55] and small for gestational age 1·18 [1·00-1·40]) were associated with higher suicide risk. Father's age, low gestational age, obstetric characteristics (eg, caesarean section), and condition or exposure during pregnancy (eg, maternal smoking or hypertensive disease) were not associated with higher suicide risk. Similar patterns of associations were observed for suicide attempt and suicidal ideation; however, these results were based on a lower number of studies. In meta-regression, differences in length of follow-up explained most between-study heterogeneity (inital I2 ranged from 0 to 79·5). INTERPRETATION: These findings suggest that prenatal and perinatal characteristics are associated with increased suicide risk during the life course, supporting the developmental origin of health and diseases hypothesis for suicide. The low number of studies for some risk factors, especially for suicide attempt and ideation, leaves gaps in knowledge that need to be addressed. The mechanisms underlying the reported associations and their causal nature still remain unclear. FUNDING: Horizon 2020 (EU).
Authors: Massimiliano Orri; Michel Boivin; Chelsea Chen; Marilyn N Ahun; Marie-Claude Geoffroy; Isabelle Ouellet-Morin; Richard E Tremblay; Sylvana M Côté Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2020-11-13 Impact factor: 4.328
Authors: Marie C Navarro; Isabelle Ouellet-Morin; Marie-Claude Geoffroy; Michel Boivin; Richard E Tremblay; Sylvana M Côté; Massimiliano Orri Journal: JAMA Netw Open Date: 2021-03-01
Authors: Pablo Vidal-Ribas; Theemeshni Govender; Rajeshwari Sundaram; Roy H Perlis; Stephen E Gilman Journal: Transl Psychiatry Date: 2022-01-10 Impact factor: 6.222
Authors: Mareike Ernst; Iris Reiner; Achim Fieß; Ana N Tibubos; Andreas Schulz; Juliane Burghardt; Eva M Klein; Elmar Brähler; Philipp S Wild; Thomas Münzel; Jochem König; Karl J Lackner; Norbert Pfeiffer; Matthias Michal; Jörg Wiltink; Manfred E Beutel Journal: Sci Rep Date: 2020-07-31 Impact factor: 4.379