Suicidal behavior from childhood to youth: trajectories and among attachment, family, and violence: a study based on the Violence and Children's Mental Health Cohort of São Gonçalo/RJ

Abstract

The objective of this thesis was to investigate suicidal behavior and non-suicidal selfinjury in childhood, adolescence, and youth based on data from an epidemiological study with five waves, the "São Gonçalo/RJ Violence and Mental Health Cohort" (2005 to 2022). This thesis prioritizes the role of attachment, family, and violence from a longitudinal and developmental perspective. Using a triangulation of methods and theoretical frameworks related to Child and Adolescent Psychiatry, Pediatrics, Mental Health, and Public Health, the results and discussions of this research are presented in five products (scientific articles and a book chapter), addressing specific objectives. 1) Out of the 500 schoolchildren (average age of eight years) who constituted the sample in 2005, 316 were followed until the third wave of the cohort (2012), with the assessment of the outcome of interest "suicidal behavior and nonsuicidal self-injury." There was a 15% increase in the likelihood of this behavior (OR 1.15; p=0.069) in the presence of non-secure attachment mental representation, measured through the Family Drawing Global Scale, compared to the control group (secure attachment mental representation). This finding corroborates the first thousand days of life as a critical period for promoting mental health and preventing self-inflicted violence. 2) 129 young people were followed until the fifth wave (2022); of these, 27% presented suicidal behavior and non-suicidal self-injury in one or more waves of the study. An essayistic look at the two decades of the cohort recognized the second half of adolescence and youth as the phases with the highest occurrence of self-inflicted violence, in addition to the fluctuation of this outcome in the participants' trajectories, reflecting the uncertainties and fears of families regarding their children's future. 3) The investigation of three forms of violence in the lives of the 129 participants, considering the phases of childhood, adolescence, and youth (nine independent variables), indicated: a high occurrence of family violence in childhood (84.5% physical violence and 76.7% psychological violence); greater experience and/or perception of community violence in youth (40.3% vs. 18.6% in childhood and 12.4% in adolescence); and the magnitude of psychological violence: from childhood to adolescence (p<0.001) and from adolescence to youth (p=0.063). The structural equation model between these nine independent variables and the outcome pointed out the most significant ones: community violence in adolescence (0,517; p<0.001), family psychological violence in youth (0,398; p<0.001), and family psychological violence in childhood (0,656; p=0.006). 4) The content analysis of nine interviews with peripheral young participants from the fifth wave of the cohort (2022) allowed for a discussion about the everyday horizons that kept them away from suicide, protecting them despite suffering and violence. "Spirituality," "occupation," and "motherhood" were the main turning points in their lives, indicating that protective trajectories and prevention of suicidal behavior need to advance through decolonial, intersectional, and socially relevant approaches. 5) Highlighting the urgency of dialogue between academia and society, with an emphasis on suicide prevention, a review was produced representing the important role of scientific dissemination and encouraging the engagement of all professionals who assist children and adolescents with this issue. This research reflected on how attachment and different forms of violence can influence the developmental trajectories of children and adolescents, bringing them closer to a selfinjurious outcome. Its findings are intended to add to the body of discussions on the prevention of suicidal behaviour and non-suicidal self-injury, broadening the universalization and awareness of this debate.