Risk and protective factors for childhood suicidality: a US population-based study
Risk and protective factors for childhood suicidality: a US population-based study
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DOI：
10.1016/s2215-0366(20)30049-3
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发表时间：
2020-04-01
影响因子：
64.3
通讯作者：
Frangou, Sophia
中科院分区：
文献类型：
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作者：
Janiri, Delfina;Doucet, Gaelle E.;Frangou, Sophia
背景儿童时期的自杀念头和行为鲜为人知。我们在参加青少年大脑和认知发展(ABCD)研究的美国人群样本中检验了自杀的相关性。ABCD研究旨在研究从儿童到成年的心理健康轨迹，并收集多个领域的信息，包括心理和身体健康、脑成像、行为和认知特征以及社会和家庭环境。我们试图在这多个领域中识别和排序儿童自杀想法和行为的风险和保护因素，并评估它们与报告自杀行为的自我和谐和照顾者同意的相关性。方法ABCD样本包括11,875名9-10岁儿童的队列。招募样本的社会人口学因素包括年龄、性别、种族、社会经济地位和都市性。参与者在22个地点登记，这些地点的集水区覆盖了这个年龄段美国总人口的20%以上。多阶段抽样被用来确保ABCD样本的局部随机性和社会人口学变异的代表性。本研究中使用的数据来自ABCD研究策划的年度版本2.0。根据DSM-5儿童情感障碍和精神分裂症计算机化量表(KSADS-5)，通过独立的儿童和照顾者报告对每个儿童的自杀想法和行为(自杀倾向)进行评估。在ABCD研究的参与者中，我们使用自助式Logistic回归来量化自杀意念和行为之间的联系，以及精神和身体健康、行为、认知以及社会和家庭环境的测量。发现我们的研究样本包括7994名无关的儿童(平均年龄9.9岁[SD 0.5]；4234[53%]男性参与者)，他们有关于儿童报告和照顾者报告的自杀想法和行为的完整数据。总体而言，673名(8.4%)儿童报告了过去或现在的自杀想法，75名(0.9%)有过过去或现在的自杀计划，107名(1.3%)有过过去或现在的自杀企图。根据照顾者的说法，650名(8.1%)儿童报告了过去或现在的自杀想法，46名(0.6%)报告了过去或现在的自杀计划，39名(0.5%)报告了过去或现在的自杀企图。然而，信息者之间的一致性很低(Cohen的范围为0.0-0.2)。无论报案人是谁，儿童精神疾病(优势比[OR]1.7~4.8，95%可信区间1.5~7.4)和儿童报告的家庭冲突(OR 1.4~1.8，95%可信区间1.1~2.5)是自杀的最主要危险因素。儿童报告自杀的风险随着周末屏幕使用时间的增加而增加(OR 1.3，95%CI 1.2-1.7)，随着父母更多的监督和积极的学校参与而降低(OR 0.8，95%CI 0.7-0.9)。此外，照顾者报告的自杀倾向与照顾者教育水平(OR 1.3，95%CI 1.1-1.5)和儿童男性性别(1.5，1.1-2.0)正相关，与家庭同居人数(0.8，0.7-1.0)负相关。这些因素为优化预防和干预战略提供了可行的目标，支持了识别和治疗学龄儿童精神病理学的需要，并强调了学校和家庭干预对儿童自杀的重要性。
Background Childhood suicidal ideation and behaviours are poorly understood. We examined correlates of suicidality in a US population-based sample of children participating in the Adolescent Brain and Cognitive Development (ABCD) study. The ABCD study aims to examine trajectories of mental health from childhood to adulthood and collects information on multiple domains, including mental and physical wellbeing, brain imaging, behavioural and cognitive characteristics, and social and family environment. We sought to identify and rank risk and protective factors for childhood suicidal thoughts and behaviours across these multiple domains and evaluate their association with self-agreement and caregiver agreement in reporting suicidality.Methods The ABCD sample comprises a cohort of 11 875 children aged 9-10 years. The sociodemographic factors on which the sample was recruited were age, sex, race, socioeconomic status, and urbanicity. Participants were enrolled at 22 sites, the catchment area of which encompassed over 20% of the entire US population in this age group. Multistage sampling was used to ensure both local randomisation and representativeness of sociodemographic variation of the ABCD sample. The data used in this study were accessed from the ABCD Study Curated Annual Release 2.0. Suicidal thoughts and behaviours (suicidality) in each child were evaluated through independent child and caregiver reports based on the computerized Kiddie Schedule for Affective Disorders and Schizophrenia for DSM-5 (KSADS-5). We used bootstrapped logistic regression to quantify the association between suicidal ideation and behaviours, with measures of mental and physical wellbeing, behaviour, cognition, and social and family environment in participants from the ABCD study.Findings Our study sample comprised 7994 unrelated children (mean age 9.9 years [SD 0.5]; 4234 [53%] male participants) with complete data on child-reported and caregiver-reported suicidal ideas and behaviours. Overall, 673 (8.4%) children reported any past or current suicidal ideation, 75 (0.9%) had any past or current suicidal plans, and 107 (1.3%) had any past or current suicidal attempts. According to caregivers, 650 (8.1%) of the children reported any past or current suicidal ideation, 46 (0.6%) reported any past or current suicidal plans, and 39 (0.5%) reported past or current suicidal attempts. However, inter-informant agreement was low (Cohen's. range 0.0-0.2). Regardless of informant, child psychopathology (odds ratio [OR] 1.7-4.8, 95% CI 1.5-7.4) and child-reported family conflict (OR 1.4-1.8, 95% CI 1.1-2.5) were the most robust risk factors for suicidality. The risk of child-reported suicidality increased with higher weekend screen use time (OR 1.3, 95% CI 1.2-1.7) and reduced with greater parental supervision and positive school involvement (for both OR 0.8, 95% CI 0.7-0.9). Additionally, caregiver-reported suicidality was positively associated with caregiver educational level (OR 1.3, 95% CI 1.1-1.5) and male sex in children (1.5, 1.1-2.0), and inversely associated with the number of household cohabitants (0.8, 0.7-1.0).Interpretation We identified risk and protective factors that show robust and generalisable associations with childhood suicidality. These factors provide actionable targets for optimising prevention and intervention strategies, support the need to identify and treat psychopathology in school-age children, and underscore the importance of school and family interventions for childhood suicidality.