Childhood household dysfunction, school performance and psychiatric care utilisation in young adults: a register study of 96 399 individuals in Stockholm County
Childhood household dysfunction, school performance and psychiatric care utilisation in young adults: a register study of 96 399 individuals in Stockholm County
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DOI：
10.1136/jech-2015-206329
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发表时间：
2016-05-01
影响因子：
6.3
通讯作者：
Burstrom, Bo
中科院分区：
文献类型：
--
作者：
Bjorkenstam, Emma;Dalman, Christina;Burstrom, Bo
背景 童年时期家庭功能失调会增加精神疾病发病的风险。尽管学校表现也与精神疾病发病率有关，但有限的研究认为学校表现是一个中介因素。为了解决文献中的这一空白，当前的注册研究调查了学校表现是否介导了童年家庭功能障碍（出生至 14 岁之间经历的）与成年早期精神科护理利用之间的关联。方法我们使用了瑞典队列，该队列由 1987 年至 1991 年出生的 96 399 名个体组成。儿童家庭功能障碍的指标包括家庭死亡、父母药物滥用和精神疾病、父母躯体疾病、父母犯罪、父母分居/单亲家庭、公共援助接受情况和居住不稳定。义务教育九年的最终成绩被用来创建五个类别。 18 岁后使用精神科护理的风险估计（以住院患者、门诊患者和初级护理为衡量标准）计算为 HR，置信区间为 95%。使用引导方法对中介进行了测试。结果 儿童时期家庭功能障碍的累积暴露与精神科护理的利用呈正相关。具体而言，与没有接触到最高成绩指标的个人相比，接触到三个或更多学校成绩不完整指标的个人风险最高（根据人口统计数据调整后，HR=3.7（95% CI 3.3 至 4.1））。研究发现学校表现可以调节这种关系。结论我们的研究结果表明，未来预防或减轻儿童家庭功能障碍对精神疾病发病率的负面影响的努力可能会受益于改善弱势青少年学校表现的策略的整合。
Background Exposure to childhood household dysfunction increases the risk of psychiatric morbidity. Although school performance also has been linked with psychiatric morbidity, limited research has considered school performance as a mediating factor. To address this gap in the literature, the current register study examined whether school performance mediates the association between childhood household dysfunction (experienced between birth and age 14 years) and psychiatric care utilisation in young adulthood.Methods We used a Swedish cohort of 96 399 individuals born during 1987-1991. Indicators of childhood household dysfunction were familial death, parental substance abuse and psychiatric morbidity, parental somatic disease, parental criminality, parental separation/single-parent household, public assistance recipiency and residential instability. Final school grades from the 9th year of compulsory school were used to create five categories. Estimates of risk of psychiatric care utilisation (measured as inpatient, outpatient and primary care) after the age of 18 years were calculated as HRs with 95% CIs. Mediation was tested with the bootstrap approach.Results Cumulative exposure to childhood household dysfunction was positively associated with psychiatric care utilisation. Specifically, individuals exposed to three or more indicators with incomplete school grades had the highest risk (HR=3.7 (95% CI 3.3 to 4.1) after adjusting for demographics), compared to individuals exposed to no indicators with highest grades. School performance was found to mediate the relationship.Conclusions Our findings suggest that future efforts to prevent or mitigate the negative effects of childhood household dysfunction on psychiatric morbidity may benefit from integration of strategies that improve school performance among vulnerable youth.