Mediators of increased self-harm and suicidal ideation in sexual minority youth: a longitudinal study
Mediators of increased self-harm and suicidal ideation in sexual minority youth: a longitudinal study
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DOI：
10.1017/s003329171800346x
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发表时间：
2019-11-01
影响因子：
6.9
通讯作者：
Rimes, K. A.
中科院分区：
文献类型：
--
作者：
Oginni, O. A.;Robinson, E. J.;Rimes, K. A.
背景与异性恋青年相比，性少数青年的自杀意念和自我伤害有所增加;然而，中介机制的证据主要是横断面的。采用纵向设计，我们调查了自尊和抑郁症状作为性少数青少年自杀意念或自我伤害（SISH）发生率增加的中介，以及儿童期性别不一致（CGN）和性别作为这些关系的调节因子。共有4274名来自雅芳父母和儿童纵向研究（ALSPAC）队列的青少年在15岁时报告了性取向，并在20岁时报告了去年的SISH。自尊和抑郁症状分别在17岁和18岁时进行评估。CGN在30 - 57个月时测量。协变量包括社会人口统计学变量和早期测量的中介变量和结果变量。使用结构方程模型评估调解途径。在20岁时，性少数青年（几乎占样本的12%）报告去年SISH的可能性是异性恋青年的三倍（95%置信区间2.43 - 3.64）。两个调解途径：一个单一的调解途径涉及自尊和多重介导的途径，涉及自尊和抑郁症状。虽然CGN与过去一年的SISH相关，但它并没有调节任何中介途径，也没有证据表明性别的调节作用。较低的自尊和抑郁症状的增加部分解释了性少数青年后来自杀意念和自我伤害的风险增加。预防战略可包括采取增强或保护自尊的干预措施，特别是在性少数青年女性中，以及治疗抑郁症。
Background. Sexual minority youth have elevated suicidal ideation and self-harm compared with heterosexual young people; however, evidence for mediating mechanisms is predominantly cross-sectional. Using a longitudinal design, we investigated self-esteem and depressive symptoms as mediators of increased rates of suicidal ideation or self-harm (SISH) among sexual minority youth, and the roles of childhood gender nonconformity (CGN) and sex as moderators of these relationships.Method. In total, 4274 youth from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort reported sexual orientation at age 15 years, and past-year SISH at age 20 years. Self-esteem and depressive symptoms were assessed at ages 17 and 18 years, respectively. CGN was measured at 30-57 months. Covariates included sociodemographic variables and earlier measures of mediator and outcome variables. Mediation pathways were assessed using structural equation modelling.Results. Sexual minority youth (almost 12% of the sample) were three times more likely than heterosexual youth to report past-year SISH (95% confidence interval 2.43-3.64) at 20 years. Two mediation pathways were identified: a single mediator pathway involving self-esteem and a multiple-mediated pathway involving self-esteem and depressive symptoms. Although CGN was associated with past-year SISH, it did not moderate any mediation pathways and there was no evidence for moderation by sex.Conclusions. Lower self-esteem and increased depressive symptoms partly explain the increased risk for later suicidal ideation and self-harm in sexual minority youth. Preventive strategies could include self-esteem-enhancing or protecting interventions, especially in female sexual minority youth, and treatment of depression.