Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: a population-based birth cohort study
Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: a population-based birth cohort study
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DOI：
10.1016/s2215-0366(19)30030-6
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发表时间：
2019-04-01
影响因子：
64.3
通讯作者：
Gunnell, David
中科院分区：
文献类型：
--
作者：
Mars, Becky;Heron, Jon;Gunnell, David
背景自杀念头和非自杀性自残在青少年中很常见，并且与自杀企图密切相关。我们的目的是确定这些高危人群未来自杀企图的预测因素。方法参与者来自英国的一项以人口为基础的出生队列研究——雅芳父母与儿童纵向研究。样本包括456名报告有自杀念头的青少年和569名报告在16岁时有非自杀性自残行为的青少年。Logistic回归分析用于探索广泛的前瞻性记录的风险因素与未来自杀企图之间的关联，并在21岁时进行评估。310名有自杀念头的参与者中有38人（12%），380名有非自杀性自残行为的参与者中有46人（12%）报告在21岁时第一次试图自杀。在有自杀念头的参与者中，向企图过渡的最强预测因子是非自杀性自残（比值比[OR] 2.78, 95% CI 1.35-5.74; p=0.0059）、大麻使用（比值比[OR] 2.61, 1.11-6.14; p=0.029）、其他非法药物使用（比值比[OR] 2.47, 1.02-5.96; p=0.045）、自残暴露（家庭2.03,0.93-4.44,p=0.076；朋友1.85,0.93-3.69,p=0.081）和较高水平的人格类型智力/开放性（比值比1.62,1.06-2.46,p=0.025）。在基线时有非自杀性自我伤害的参与者中，最强的预测因子是大麻使用（OR 2.14, 95% CI 1.04-4.41; p=0.038）、其他非法药物使用（2.17,1.10-4.27;p=0.025）、睡眠问题（夜间醒来1.91,0.95-3.84,p=0.069；睡眠不足1.97,1.02-3.81,p=0.043）和较低水平的人格类型外向性（0.71,0.49-1.03,p=0.068）。大多数考虑过自杀或从事非自杀性自残行为的青少年不会尝试自杀。在这些高危人群中，许多被普遍引用的风险因素与向自杀企图的转变无关。我们的研究结果表明，询问药物使用、非自杀性自残、睡眠、人格特征和自残经历可以为风险评估提供信息，并可能帮助临床医生确定哪些青少年未来最有可能尝试自杀。资助美国预防自杀基金会、国立健康研究所布里斯托尔大学医院生物医学研究中心、布里斯托尔国家卫生服务基金会信托基金和布里斯托尔大学。版权(c)作者。Elsevier Ltd.出版。这是一篇基于CC BY 4.0许可的开放获取文章。
Background Suicidal thoughts and non-suicidal self-harm are common in adolescents and are strongly associated with suicide attempts. We aimed to identify predictors of future suicide attempts in these high-risk groups.Methods Participants were from the Avon Longitudinal Study of Parents and Children, a population-based birth cohort study in the UK. The sample included 456 adolescents who reported suicidal thoughts and 569 who reported non-suicidal self-harm at 16 years of age. Logistic regression analyses were used to explore associations between a wide range of prospectively recorded risk factors and future suicide attempts, assessed at the age of 21 years.Findings 38 (12%) of 310 participants with suicidal thoughts and 46 (12%) of 380 participants who had engaged in non-suicidal self-harm reported having attempted suicide for the first time by the follow-up at 21 years of age. Among participants with suicidal thoughts, the strongest predictors of transition to attempts were non-suicidal self-harm (odds ratio [OR] 2.78, 95% CI 1.35-5.74; p=0.0059), cannabis use (2.61, 1.11-6.14; p=0.029), other illicit drug use (2.47, 1.02-5.96; p=0.045), exposure to self-harm (family 2.03, 0.93-4.44, p=0.076; friend 1.85, 0.93-3.69, p=0.081), and higher levels of the personality type intellect/openness (1.62, 1.06-2.46; p=0.025). Among participants with non-suicidal self-harm at baseline, the strongest predictors were cannabis use (OR 2.14, 95% CI 1.04-4.41; p=0.038), other illicit drug use (2.17, 1.10-4.27; p=0.025), sleep problems (waking in the night 1.91, 0.95-3.84, p=0.069; insufficient sleep 1.97, 1.02-3.81, p=0.043), and lower levels of the personality type extraversion (0.71, 0.49-1.03; p=0.068).Interpretation Most adolescents who think about suicide or engage in non-suicidal self-harm will not make an attempt on their life. Many commonly cited risk factors were not associated with transition to suicide attempt among these high-risk groups. Our findings suggest that asking about substance use, non-suicidal self-harm, sleep, personality traits, and exposure to self-harm could inform risk assessments, and might help clinicians to identify which adolescents are at greatest risk of attempting suicide in the future.Funding American Foundation for Suicide Prevention, National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol National Health Service Foundation Trust, and the University of Bristol. Copyright (c) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.