Association of Cumulative Childhood Adversity and Adolescent Violent Offending With Suicide in Early Adulthood
Association of Cumulative Childhood Adversity and Adolescent Violent Offending With Suicide in Early Adulthood
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DOI：
10.1001/jamapsychiatry.2017.3788
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发表时间：
2018-02-01
期刊：
影响因子：
25.8
通讯作者：
Kosidou, Kyriaki
中科院分区：
文献类型：
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作者：
Bjorkenstam, Emma;Hjern, Anders;Kosidou, Kyriaki
重要性 童年逆境 (CA) 与成年早期自杀风险增加有关，这可能是由于青春期适应不良的轨迹所致。尽管青少年暴力犯罪与自杀有关，但对其在 CA 与自杀之间的关联中所起的作用知之甚少。 目的 研究青少年暴力犯罪是否介导 CA 与成年早期自杀之间的关联。 设计、设置和参与者 这项基于人群的纵向队列研究，随访时间跨度为 5 至 9 年，纳入了 1984 年至 1988 年间出生于瑞典的 476 103 名个体。对研究人群进行了前瞻性随访。从20岁到2013年12月31日，关于自杀。数据分析的时间为1984年1月1日至2013年12月31日。暴露基于登记的CA包括父母死亡、父母药物滥用和精神疾病、父母犯罪、父母分居、公共援助接受、儿童福利干预和居住不稳定。青少年暴力犯罪被定义为在 15 岁至 19 岁之间犯有暴力犯罪。 主要结果和措施 20 岁以后（1984 年出生的从 2004 年起，1988 年出生的从 2008 年起）到 2013 年底的自杀风险估计，采用 95% CI 的发病率比（IRR）计算泊松回归分析。针对人口统计和精神疾病进行了调整。此外，还使用了逻辑回归的二元中介分析。 结果 本研究总共纳入了 476 103 名个体（231 699 [48.7%] 女性）。那些因暴力犯罪被定罪的人比那些没有暴力犯罪的人更多地接触到所有 CA。累积 CA 与未定罪青少年（调整后 IRR，2.4；95% CI，1.5-3.9）和已定罪青少年的自杀风险相关，后者自杀风险较高（调整后 IRR，8.5；95% CI，4.6-15.7）。青少年暴力犯罪在一定程度上介导了 CA 与自杀之间的关联。结论和相关性 有 CA 病史且在青春期也参与过暴力犯罪的个体自杀风险较高。预防儿童时期外化行为的干预措施以及增加对有犯罪行为的青少年的支持可能有可能预防与 CA 相关的自杀。
IMPORTANCE Childhood adversity (CA) is associated with an increased risk of suicide in young adulthood that might be explained by maladaptive trajectories during adolescence. Although adolescent violent offending is linked with suicide, little is known about its role in the association between CA and suicide.OBJECTIVE To examine whether adolescent violent offending mediates the association between CA and suicide in early adulthood.DESIGN, SETTING, AND PARTICIPANTS This population-based, longitudinal cohort study with a follow-up time spanning 5 to 9 years included 476 103 individuals born in Sweden between 1984 and 1988. The study population was prospectively followed up from 20 years of age until December 31, 2013, with respect to suicide. Data analysis was performed from January 1, 1984, to December 31, 2013.EXPOSURES Register-based CAs included parental death, parental substance abuse and psychiatric disorder, parental criminal offending, parental separation, public assistance recipiency, child welfare intervention, and residential instability. Adolescent violent offending was defined as being convicted of a violent crime between the ages of 15 and 19 years.MAIN OUTCOMES AND MEASURES Estimates of risk of suicide after 20 years of age (from 2004 if born in 1984 and from 2008 if born in 1988) until the end of 2013 were calculated as incidence rate ratios (IRRs) with 95% CIs using Poisson regression analysis. Adjustments were made for demographics and psychiatric disorder. In addition, binary mediation analysis with logistic regression was used.RESULTS A total of 476 103 individuals (231 699 [48.7%] female) were included in the study. Those with a conviction for violent offending had been exposed to all CAs to a greater extent than those with no violent offending. Cumulative CA was associated with risk of suicide in nonconvicted (adjusted IRR, 2.4; 95% CI, 1.5-3.9) and convicted youths, who had a higher risk of suicide (adjusted IRR, 8.5; 95% CI, 4.6-15.7). Adolescent violent offending partly mediated the association between CA and suicide.CONCLUSIONS AND RELEVANCE Individuals with a history of CA who also engage in violent offending in adolescence have a high risk of suicide. Interventions to prevent externalizing behavior during childhood and increased support to youths with delinquent behavior may have the potential to prevent suicide related to CA.