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Background: Most developmental studies on suicide do not take into account individual variations in suicide trajectories., Aims: Using a life course approach, this study explores developmental models of suicide trajectories., Method: Two hundred and fourteen suicides were assessed with mixed methods. Statistical analysis using combined discrete-time survival (DTS) and growth mixture modelling (GMM) generated various trajectories, and path analysis (Mplus) identified exogenous and mediating variables associated with these trajectories., Results: Two groups share common risk factors, and independently of these major risk factors, they have different developmental trajectories: the first group experienced a high burden of adversity and died by suicide in their early 20s; and the second group experienced a somewhat moderate or low burden of adversity before they took their own life. Structural equation modelling identified variables specific to the early suicide trajectory: conduct and behavioural difficulties, social isolation/conflicts mediated by school-related difficulties, the end of a love relationship, and previous suicide attempts., Conclusions: Psychosocial adversity between 10 and 20 years of age may warrant key periods of intervention., (Royal College of Psychiatrists.)

Objective: To study alcohol and drug addiction incidence in students exposed to the Dawson College shooting within the 18 months following the event, to identify the precursors of a psychoactive substance addiction development while considering the severity of event exposure, and to examine whether alcohol use, 18 months after the event, is related to any of the various posttraumatic stress disorder (PTSD) symptom groups., Method: The population of this study was comprised of all the Dawson College students at the time of the event. Analyses were conducted with 854 students enrolled in the college at the time of the shooting., Results: Five per cent of women and 7% of men showed, for the first time in their life, a problem with substance addiction following the shooting. In men, young age, lifetime suicidal ideation, and having seen the killer during the shooting are the main precursors of incident accident cases. None of the studied precursors were significant in women. Men and women were also different in terms of PTSD symptoms predicting alcohol use 18 months after the shooting., Conclusion: The study highlights the importance of considering a person's sex when studying their psychoactive substance use following a trauma.

Objectives: Explore the unique developmental challenges and early adversity faced by youth and young adult who died of suicide., Method: Sixty-seven suicide victims (SG) were compared with 56 living control with no suicidal ideations in the last year, matched for age, gender, and geographical region. Mixed methods were used: consensus DSM-IV diagnoses were formulated based on Structured Clinical Interview for DSM-IV (SCID)-I and -II interviews complemented by medical charts. Life calendar method was conducted with closest third party informant. Life-history calendar served to measure life events and adversity throughout the life course and were analyzed by attributing burden of adversity score per five-year segment, which was then cluster-analyzed to define suicide victim profiles., Results: During the last year, mood disorders, abuse and dependence disorders, and anxiety disorder were between 8 and 63 times more likely to be present in the suicide group. Between 0 and 4 years old, 50% of children in the SG were exposed to abuse, physical and/or sexual violence; 60% between 5 and 9 years old; and by the time they were 10-14 years old, 77% were exposed to these forms of violence. In the control group, the respective figures were 14%, 18% and 34%. In the suicide group, the trajectories leading to suicide are different as we observe two different subgroups, one with early-onset and one with later-onset of adversity. To a large extent, people in the suicide group were exposed to major adversity and they were more likely to present cumulative comorbid disorders., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Little is known about differential suicide profiles across the life trajectory. This study introduces the life-course method in suicide research with the aim of refining the longitudinal and cumulative assessment of psychosocial factors by quantifying accumulation of burden over time in order to delineate distinctive pathways of completed suicide., Method: The psychological autopsy method was used to obtain third-party information on consecutive suicides. Life-history calendar analysis served to arrive at an adversity score per 5-year segment that was then cluster-analysed and correlated to define victim profiles., Results: Two distinct life trajectories emerged: (1) individuals who experienced childhood traumas, developmental adversity and little protection were more likely to present concurrent psychiatric and Axis II disorders; and (2) individuals who experienced less adversity but seemed more reactive to later major difficulties., Conclusions: The life calendar approach presented here in suicide research adds to the identification of life events, distal and recent, previously associated with suicide. It also quantifies the burden of adversity over the life course, defining two distinct profiles that could benefit from distinct targeted preventive intervention.