Suicide represents a major public health concern, and its burden is particularly felt among adolescents and young adults. Although low- and middle-income countries account for 75% of the global suicide burden, there is a lack of data to allow for high quality research examining risk and protective factors for suicidality in this context. One notable exception is a large cohort of Brazilians born in the city of Pelotas in 1993, and followed since their birth.
The aim of the proposed project is to investigate childhood and adolescent risk and protective factors for suicidality in a prospective cohort of Brazilians followed since their birth in 1993. Specifically, this project will address 3 objectives:
1) To investigate whether the association between adolescent adversity and suicide attempt is stronger among those who experience early life adversity
2) To investigate whether there are modifiable factors that may reduce the likelihood of suicide attempt after experiencing adversity
3) To investigate sex differences in the associations above
The proposed project will use data from the 1993 Pelotas Birth Cohort Study, which has followed more than 5,000 children since their birth in the city of Pelotas, Brazil, in 1993. Early-life measures include sociodemographic factors and prenatal smoking and alcohol use. Childhood and adolescent measures include maternal mental health, exposure to violence and other stressful life events, nutrition, physical activity, relationship with parents, substance use, and symptoms of depression/anxiety, conduct problems, and hyperactivity. At ages 18 and 22, participants were asked if they had ever attempted suicide.
This cohort provides an excellent opportunity to study risk and protective factors for suicide attempt in a middle-income community sample, due to the inclusion of assessments of mental health and suicidal behaviours in adolescence and early adulthood, and rich information on numerous potential risk and protective factors in early life, late childhood, and adolescence. Virtually no longitudinal birth cohort studies that could investigate early life risks for suicidal behaviour exist outside of high-income countries, apart from the 1993 Pelotas Birth Cohort Study. The use of previously collected longitudinal data makes this project highly resource and time efficient. This study will provide evidence on the modifying role of lifestyle factors and early life stress in the association between stressful life events and suicide attempts outside of a high-income setting. The study will be led by a team that is embedded in the local community, and is consequently well placed to help guide local prevention and intervention efforts and influence national strategies for suicide prevention.
