Life-Time Adversities, Reported Thirteen Years After a Suicide Attempt: Relationship to Recovery, 5HTTLPR Genotype, and Past and Present Morbidity

Abstract

In this study, we investigated how adversities related to past and present morbidity, and genotype. Forty-two, suicide attempters and 22 matched control patients were followed-up after 13 years. Life-time adversities were explored in an interview, and the patients were reassessed psychiatrically. The serotonin-transporter-linked promotor region (5-HTTLPR) was typed. More adversities were reported by suicide attempters than controls, and by still-ill than recovered suicide attempters. Adversities reported at follow-up were related to psychiatric morbidity at follow-up, but not to morbidity 13 years earlier. The 5-HTTLPR, genotype was associated with reported adversities, but not chances of recovery. Adversities potentially affected chronic morbidity. 5-HTTLPR genotype did not affect long-term recovery.

Keywords:

• follow-up
• gene
• life-events
• outcome
• self-harm
• suicide

We would like to acknowledge the efforts of the following persons: Anders Nimeus and Goran Regnell for performing psychiatric evaluations; Margot Alsén; Aleksandra Wojcik for an early draft article that inspired this one. Funded by: Swedish Research Council grant no. 14548; Söderström-König foundation; Sjöbring foundation; and Skåne ALF. We are aware of no competing interests.

Notes

Note. Background variables of controls, all suicide attempters, and matched suicide attempters (the 22 of 42, who had been matched to controls by age, sex and diagnosis). No significant differences between all suicide attempters and controls, or matched suicide attempters and controls, found, using (†) the Wilcoxon two-sample test, (††) Students's t-test and (‡) χ²-test.

Note. Overview of life events across different ages, considered in the analysis. Counts of “yes” and “no” responses (“yes”:“no”) for all suicide attempters (Suic.) and all controls (Cntl.). All adversities allegedly happened before index, but were reported at follow-up.

(†) Odds ratios (OR) based on all 64 participants.

(∗)Significant χ²-test (P < 0.05), not adjusting for multiple comparisons.

Note. “Yes” and “No” responses for suicide attempters (Suic.) and controls (Cntl.). All 34 life-events before index were tested, but only life-events where the χ²-test was significant (P < 0.05) are shown in the table.

(†) The corrected P value (Corr. P) controls for 34 multiple comparisons.

(‡) 95% CI not adjusted for multiple comparisions.

(∗) Corrected P-value significant at P < 0.05.

Note. Some particular adversities are associated with high or extremes exposure to adversities in general, affecting the interpretation of our results, and what it means to have a high burden of life-time adversities. The table shows the top-five predictive questions that are indicative of a suicide attempter reporting greater than normal of adversities (above the 50% percentile) or exceptionally high number of adversities (above the 90% percentile). κ measures the agreement between the item (e.g., bullied, “yes” or “no”) and the number of adversities (e.g., >50% percentile, “yes” or “no”).

Note. Fewer adversities would be expected to preceed mental illness amonst patients at high risk (SS genotype) than those at low risk (LL genotype). Results using linear models confirm a linear trend, with more adversitites reported before the initial suicide attempt for each additional long allele. The higher number of adversities that we know are reported by recovered than still-ill suicide attempters, is only detectable in the SL-group. (See also Figure 2A for a graphical representation.)

(∗) Significant at P < 0.05.