Childhood adversity and self-poisoning: A hospital case control study in Sri Lanka.
Childhood adversity and self-poisoning: A hospital case control study in Sri Lanka.
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DOI：
10.1371/journal.pone.0242437
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Knipe D
中科院分区：
文献类型：
--
作者：
Rajapakse T;Russell AE;Kidger J;Bandara P;López-López JA;Senarathna L;Metcalfe C;Gunnell D;Knipe D
不良童年经历（ACE）已被认为是成年人自杀行为的一个重要风险因素，但缺乏来自中低收入国家的证据。本研究探讨了ACE与斯里兰卡非致命性自我中毒住院之间的关系。这是一项病例对照研究。在三级保健医院接受自我中毒医疗管理的成年人被纳入病例，年龄和性别匹配的对照组从门诊部门招募。ACE是用世界卫生组织的童年逆境量表来测量的。采用调整年龄、性别、种族和宗教的Logistic回归模型来量化ACE与自我中毒之间的关系。该研究包括235例病例和451例对照。病例报告ACE的可能性是对照组的2.5倍（95% CI 1.8, 3.6）， ACE评分也较高。儿童身体虐待(19.0或4.7,95% CI 1.2)和情感虐待或忽视(或3.7,95% CI 1.3, 10.1, 3.7, 95% CI 2.3, 6.0),增加了在成年后自我毒害的危险,也目睹家庭暴力(或2.2,95% CI 1.4, 3.4),生长在一个家庭与精神疾病或自杀的家庭成员(或2.1,95% CI 1.2, 3.4),和经历父母死亡/分离/离婚(或3.1,95% CI 2.0, 4.9)。在斯里兰卡，减少接触ace应成为预防自杀和自残的优先事项。应该探索创新的方法来增加对面临逆境的儿童的支持。
Adverse childhood experiences (ACE) have been recognized as an important risk factor for suicidal behaviour among adults, but evidence from low and middle-income countries is lacking. This study explored associations between ACE and hospital admission due to non-fatal self-poisoning in Sri Lanka. This was a case-control study. Adults admitted to a tertiary care hospital for medical management of self-poisoning were included as cases, and age and sex matched controls were recruited from the outpatient department. ACE were measured using the World Health Organization’s Childhood Adversity Scale. Logistic regression models adjusting for age, sex, ethnicity, and religion were used to quantify the association between ACE and self-poisoning. The study included 235 cases and 451 controls. Cases were 2.5 times (95% CI 1.8, 3.6) more likely to report an ACE than controls and had higher ACE scores. Childhood physical abuse (OR 4.7, 95% CI 1.2, 19.0) and emotional abuse or neglect (OR 3.7, 95% CI 1.3, 10.1, and 3.7, 95% CI 2.3, 6.0 respectively), increased the risk of self-poisoning in adulthood, as did witnessing household violence (OR 2.2, 95% CI 1.4, 3.4), growing up in a household with a mentally ill or suicidal household member (OR 2.1, 95% CI 1.2, 3.4), and experiencing parental death/separation/divorce (OR 3.1, 95% CI 2.0, 4.9) as a child. Reducing exposures to ACEs should be a priority for prevention of suicide and self-harm in Sri Lanka. Innovative methods to increase support for children facing adversity should be explored.
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