Associations of adverse childhood experiences and suicidal behaviors in adulthood in a US nationally representative sample
Associations of adverse childhood experiences and suicidal behaviors in adulthood in a US nationally representative sample
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DOI：
10.1111/cch.12617
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发表时间：
2019-01-01
影响因子：
1.9
通讯作者：
Lamis, Dorian
中科院分区：
文献类型：
--
作者：
Thompson, Martie P.;Kingree, J. B.;Lamis, Dorian
背景
自杀是青少年和年轻成年人死亡的主要原因。当前的研究通过使用具有全国代表性的样本测试这些关联、评估成年期的自杀意念和自杀未遂情况、控制已确定的自杀风险因素以及测量多种不良童年经历（ACEs），扩展了将不良童年经历与自杀行为相关联的研究。
方法
样本包括来自全国青少年健康纵向研究的9421名参与者，他们参与了跨越13年的四轮评估。我们研究了八种不同的不良童年经历（身体虐待、性虐待、情感虐待、忽视、父母死亡、父母监禁、酗酒以及家庭自杀情况）与成年期自杀意念和自杀未遂之间的纵向关联，同时控制了抑郁、酗酒问题、吸毒、犯罪、冲动、性别、种族、年龄和城市化程度。我们还测试了不良童年经历与自杀意念和自杀未遂的累积关联。
结果
逻辑回归分析表明，身体虐待、性虐待、情感虐待、父母监禁以及家庭自杀史各自使成年期自杀意念和自杀未遂的风险增加1.4到2.7倍。不良童年经历的累积增加了自杀意念和自杀未遂的几率。与没有不良童年经历的人相比，有三种或更多不良童年经历的人在成年期认真考虑自杀或尝试自杀的几率增加了三倍多。
结论
干预策略需要防止不良童年经历的发生，如果它们确实发生了，应该考虑到不良童年经历的累积对自杀风险的影响。未来的研究应该侧重于使用纵向研究设计确定不良童年经历与自杀关联的中介机制，并确定哪些不良童年经历在累积不良童年经历测量中是最重要的。
Background Suicide is a leading cause of death among adolescents and young adults. The current study extends the research linking adverse childhood experiences (ACEs) to suicidal behaviors by testing these associations using a nationally representative sample, assessing for suicide ideation and attempts in adulthood, controlling for established risk factors for suicidality, and measuring a broad array of ACEs. Methods The sample included 9,421 participants from the National Longitudinal Study of Adolescent Health who participated in four waves of assessments spanning 13 years. We examined longitudinal associations between eight different ACEs (physical, sexual, and emotional abuse, neglect, parental death, incarceration, alcoholism, and family suicidality) with suicidal ideation and suicide attempts in adulthood, while controlling for depression, problem alcohol use, drug use, delinquency, impulsivity, gender, race, age, and urbanicity. We also tested for cumulative associations of ACEs with suicide ideation and attempts. Results Logistic regression analyses indicated that physical, sexual, and emotional abuse, parental incarceration, and family history of suicidality each increased the risk by 1.4 to 2.7 times for suicidal ideation and suicide attempts in adulthood. The accumulation of ACEs increased the odds of suicide ideation and attempts. Compared with those with no ACEs, the odds of seriously considering suicide or attempting suicide in adulthood increased more than threefold among those with three or more ACEs. Conclusions Intervention strategies need to prevent ACEs from occurring and, if they do occur, should take into account the impact of cumulative ACEs on suicide risk. Future research should focus on identifying mediating mechanisms for the ACEs-suicidality association using longitudinal research designs and determine which ACEs are most important to include in a cumulative ACE measure.