Background: Nocturnal enuresis and delayed attainment of nocturnal bladder control are associated with increased risk for psychopathology in children and adolescents. It has long been known that psychopathology is a major risk factor for youth suicide. However, no studies have examined the association between the age of attainment of nocturnal bladder control and adolescent suicidal behavior.
Methods: A community sample of 1920 adolescents aged 11-16 years from one prefecture of mainland China participated in the study. Parents completed a structured questionnaire including adolescents' developmental history, suicidal behavior, depressive symptoms, aggressive behavior, and family environment.
Results: Multivariate logistic regression models indicated that attaining nocturnal bladder control after 3 years was significantly associated with increased risk for adolescent suicidal behavior, after controlling for a number of child and family covariates. A dose-response relationship between the age of attaining nocturnal bladder control and suicidal behavior was observed (OR=2.1 for children attaining bladder control at 3-4 years and OR=3.6 for children attaining bladder control at 5 years or later). Mediating models indicated that depression and aggressive behavior mediated, at least in part, the effect of delayed nocturnal bladder control on suicidal behavior.
Limitations: This is retrospective study. Suicidal behaviors were reported by parents.
Conclusions: Delayed nocturnal bladder control may be an earlier neurodevelopmental predictor of youth suicidal behavior. Further research is suggested to explore earlier neurodevelopmental risk factors and potential mechanisms of youth suicidal behavior.