Perinatal risk factors for suicide in young adults in Taiwan.
BACKGROUND
We investigated the association of early life social factors-maternal age, single motherhood, socioeconomic position, birth order and family size-with future risk of suicide in Taiwan.


METHODS
Using a nested case-control design, we used linked data from Taiwan's Birth Registry (1978-93) and Taiwan's Death Registry (1993-2008) and identified 3984 suicides aged 15-30 years. For each suicide, 30 controls matched by age and sex were randomly selected, using incidence density sampling. Conditional logistic regression models were estimated to assess the association of early life risk factors with suicide.


RESULTS
Younger maternal age (<25 years), single motherhood, lower paternal educational level and higher birth order were independently associated with increased risk of suicide. Stratified analyses suggest that lower paternal educational level was associated with male, but not female suicide risk (Pinteraction=0.02). Single motherhood was a stronger risk factor for suicide in female than in male offspring [odds ratios (95% confidence interval)=2.30 (1.47, 3.58) vs. 1.50 (1.01, 2.20), Pinteraction=0.12]. There was a suggestion that in families with large sibship size (≥4 siblings), the excess in suicide risk was greater among later born daughters compared with later born sons (Pinteraction=0.05).


CONCLUSIONS
Our findings provide support for the results of European studies, suggesting that early life social circumstances influence future risk of suicide. Factors specific to Taiwanese culture, such as a preference for male offspring, may have influenced gender-specific patterns of risk.
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan, Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei, Taiwan, School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Public Health, College of Medicine, National Cheng-Kung University, Tainan, Taiwan, Department of Medical Research, Chia-Yi Christian Hospital, Chiayi City, Taiwan, Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong and Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.
Ying-Yeh
YY
Chen
David
D
Gunnell
Chin-Li
CL
Lu
Shu-Sen
SS
Chang
Tsung-Hsueh
TH
Lu
Chung-Yi
CY
Li
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001722:Birth Order; D016022:Case-Control Studies; D015331:Cohort Studies; D004522:Educational Status; D005191:Family Characteristics; D005220:Fathers / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008423:Maternal Age; D009035:Mothers / Q000706:statistics & numerical data*; D016017:Odds Ratio; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D035781:Siblings; D020954:Single-Parent Family / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
Suicide; birth order; culture; family characteristics; gender