Incidence of Suicide Among Persons Who Had a Parent Who Died During Their Childhood A Population-Based Cohort Study
Incidence of Suicide Among Persons Who Had a Parent Who Died During Their Childhood A Population-Based Cohort Study
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DOI：
10.1001/jamapsychiatry.2015.2094
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发表时间：
2015-12-01
期刊：
影响因子：
25.8
通讯作者：
Vestergaard, Mogens
中科院分区：
文献类型：
--
作者：
Guldin, Mai-Britt;Li, Jiong;Vestergaard, Mogens
父母自杀死亡与失去亲人的孩子自杀的风险增加有关，但对父母因其他原因死亡后自杀的长期风险知之甚少。更好地了解这种关联可能会提高自杀预防efforts.OBJECTIVE研究父母死亡后自杀的长期风险，以及父母死亡原因的风险轨迹如何不同，同时考虑主要的潜在混杂变量。一项基于人群的匹配队列研究使用来自全国登记的信息（1968年至2008年的数据）在3个斯堪的纳维亚国家（共7 302 033人）。我们确定了189094名儿童（2.6%），他们的父母在孩子年满18岁之前死亡（即丧亲队列）。每个失去亲人的孩子与10个没有父母在18岁之前死亡的孩子（共1890940名儿童）（即参考队列）在性别和年龄上相匹配。两个队列随访长达40年。Poisson回归用于计算发病率比（IRR），同时考虑父母死亡时的年龄、性别、丧亲时间、母亲/父亲死亡、出生顺序、精神疾病家族史和社会经济状况。数据分析于2015年6月24日完成。暴露主要暴露是父母一方在生命的前18年内死亡。主要结局和指标父母一方在儿童时期死亡的人的自杀发生率。265名死者家属（0.14%）和1342名无家属者0.07%死于自杀（IRR = 2.02 [95% CI，1.75-2.34]）;父母一方死于自杀的儿童IRR = 3.44（95% CI，2.61-4.52），父母一方死于其他原因的儿童IRR = 1.76（95% CI，1.49-2.09）。对于父母在6岁前死亡的儿童，IRR往往更高，并且IRR至少在25年内保持较高水平。在25年的后续行动中，自杀的绝对风险是4在1000人的男孩经历了父母死亡和2在1000人的女孩经历了父母death.CONCLUSIONS和相关性父母在童年死亡，无论原因如何，与长期自杀风险增加。童年时期父母死亡的后果是深远的，自杀风险轨迹可能会受到早期生活条件的影响。未来的公共卫生工作应考虑帮助高度痛苦的儿童科普丧亲之痛。
IMPORTANCE Parental death from suicide is associated with increased risk of suicide in the bereaved child, but little is known about the long-term risks of suicide after parental death from other causes. A better understanding of this association may improve suicide prevention efforts.OBJECTIVE To examine the long-term risks of suicide after parental death and how the risk trajectories differed by cause of parental death while accounting for major potential confounding variables.DESIGN, SETTING, AND PARTICIPANTS A population-based matched cohort study was performed using information from nationwide registers (data from 1968 to 2008) in 3 Scandinavian countries (for a total of 7 302 033 persons). We identified 189 094 children (2.6%) who had a parent who died before the child reached 18 years of age (ie, the bereaved cohort). Each bereaved child was matched by sex and age to 10 children who did not have a parent who died before they reached 18 years of age (for a total of 1 890 940 children) (ie, the reference cohort). Both cohorts were followed for up to 40 years. Poisson regression was used to calculate the incidence rate ratio (IRR), while accounting for age at parental death, sex, time since bereavement, maternal/paternal death, birth order, family history of psychiatric illness, and socioeconomic status. Data analyses were finalized June 24, 2015.EXPOSURE The main exposure was death of a parent within the first 18 years of life.MAIN OUTCOMES AND MEASURES Incidence of suicide among persons who had a parent who died during their childhood.RESULTS During follow-up, 265 bereaved persons (0.14%) and 1342 nonbereaved persons (0.07%) died of suicide (IRR = 2.02 [95% CI, 1.75-2.34]); IRR = 3.44 (95% CI, 2.61-4.52) for children who had a parent who died of suicide, and IRR = 1.76 (95% CI, 1.49-2.09) for children who had a parent who died of other causes. The IRR tended to be higher for children who had a parent who died before they reached 6 years of age, and the IRR remained high for at least 25 years. During 25 years of follow-up, the absolute risk of suicide was 4 in 1000 persons for boys who experienced parental death and 2 in 1000 persons for girls who experienced parental death.CONCLUSIONS AND RELEVANCE Parental death in childhood is, irrespective of cause, associated with an increased long-term risk of suicide. The consequences of parental death in childhood are far-reaching, and suicide risk trajectories may be influenced by early-life conditions. Future public health efforts should consider helping highly distressed children to cope with bereavement.