Self-harm and violent criminality linked with parental death during childhood
Self-harm and violent criminality linked with parental death during childhood
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DOI：
10.1017/s0033291719001193
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发表时间：
2020-05-01
影响因子：
6.9
通讯作者：
Webb, R. T.
中科院分区：
文献类型：
--
作者：
Carr, M. J.;Mok, P. L. H.;Webb, R. T.
背景：众所周知，在儿童时期父母死亡后，不良健康和社会后果更频繁地发生，但缺乏证据来比较内在与外在伤害的长期风险。方法这项基于国家登记册的队列研究由1970-2000年出生的丹麦人组成。将民事登记系统和国家死亡原因登记册联系起来，以确定队列成员在15岁生日之前父母的死亡原因。从15岁开始，通过与国家患者登记册和精神病学中央研究登记册的联系确定医院治疗的自我伤害事件，并通过与国家犯罪登记册的联系确定暴力犯罪。估计了风险比和累积发生率值。结果儿童期父母死亡后，自我伤害和暴力犯罪的风险升高。协变量调整性别，出生年份和一级亲属的精神疾病减弱了这些关联，尽管显着增加的风险仍然存在。估计的风险比并没有很大的差异，根据父母死亡，但失去父母双方赋予特别大的风险增加。父母非自然死亡与父母自然死亡的风险更高;在因非自然原因而非自杀导致父母死亡的个体中，暴力犯罪风险尤其高。当学龄前儿童经历父母死亡时，这种联系最强。结论需要有效的早期干预来帮助经历过父母一方或双方死亡的青少年制定即时和持续的应对策略。加强卫生和社会服务部门与刑事司法机构之间的合作，可减轻这两种破坏性行为的风险。
Background Adverse health and social outcomes are known to occur more frequently following parental death during childhood, but evidence is lacking for comparing long-term risks of internalised v. externalised harm. Methods This national register-based cohort study consisted of Danish persons born 1970-2000. The Civil Registration System and National Causes of Death Register were linked to ascertain parental deaths by cause before cohort members' 15(th) birthdays. From age 15 years, hospital-treated self-harm episodes were ascertained through linkage to the National Patient Register and the Psychiatric Central Research Register, and violent crimes were identified via linkage to the National Crime Register. Hazard ratio and cumulative incidence values were estimated. Results Self-harm and violent criminality risks were elevated following parental death during childhood. Covariate adjustment for gender, birth year and first-degree relatives' mental illnesses attenuated these associations, although significantly heightened risks persisted. The estimated hazard ratios did not differ greatly according to which parent died, but losing both parents conferred particularly large risk increases. Risks for both adverse outcomes were higher in relation to unnatural v. natural parental death; violent criminality risk was especially raised among individuals exposed to parental death by unnatural causes other than suicide. The association was strongest when pre-school age children experienced parental death. Conclusions Effective early intervention is needed to help youngsters who have experienced the death of one or both parents to develop immediate and sustained coping strategies. Enhanced cooperation between health and social services and criminal justice agencies may mitigate risks for these two destructive behaviours.