Associations of Despair With Suicidality and Substance Misuse Among Young Adults
Associations of Despair With Suicidality and Substance Misuse Among Young Adults
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DOI：
10.1001/jamanetworkopen.2020.8627
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发表时间：
2020-06-23
影响因子：
13.8
通讯作者：
Shanahan, Lilly
中科院分区：
文献类型：
--
作者：
Copeland, William E.;Gaydosh, Lauren;Shanahan, Lilly
绝望死亡是一个术语，最近被用来描述美国成年人中自杀，药物过量（特别是阿片类药物）和酒精相关肝病导致的过早死亡率增加。尽管使用了绝望一词，但它在这些过早死亡原因中的作用尚未得到经验检验。目的探讨青年人的绝望情绪是否与自杀念头、自杀行为、酒精滥用和药物滥用有关。设计、设置和参与者大烟山研究是一项东南部、城乡混合人群队列研究，于1992年11月10日至2015年9月22日进行。共有1420名参与者最初的9，11和13岁，随访11次至30岁（11230人观察）。在1400名在世参与者中，共有1154名（82.4%）在30岁时接受了评估。统计分析时间为2019年5月7日至2020年4月10日。参与者进行了评估与结构化访谈的绝望指标（例如，绝望，无助，自我价值低，感觉不被爱）。绝望的评估项目从结构化的采访：儿童和青少年精神病评估和年轻的成年人精神病评估。主要结果和措施结构化访谈被用来评估自杀想法和行为，物质使用，精神疾病诊断和统计手册（第五版）酒精使用障碍和药物使用障碍（包括阿片类药物）在年轻的成年人（2424观察1266人之间的25和30岁）。结果本研究共纳入1420例受试者，其中男性790例。在青年期（25岁和30岁），任何绝望的3个月加权患病率为19.5%（2424次观察中的476次），7.6%的参与者（2424次观察中的201次）报告了2个或更多的绝望项目。在纵向滞后模型中，（范围，0-3）与更多的自杀想法和行为相关（比值比[OR]，1.5; 95% CI，1.1-2.0），非法药物使用（OR，1.7; 95%CI，1.2-2.5）和阿片类药物使用（OR，1.9; 95%CI，1.1-3.3），但不是酒精使用障碍（OR，0.8; 95%CI，0.6-1.2）。在考虑了社会人口学因素（如贫困和教育水平）、滞后结果状态和滞后抑郁状态后，这些相关性仍然存在。绝望和学习结果之间的联系在考虑长期绝望措施的模型中更强，可以追溯到童年。社会人口因素没有一致的节制模式。结论和相关性-这项研究的结果表明，绝望和几个，但不是全部，在农村阿巴拉契亚的“绝望的死亡”的前兆之间的纵向关联的实证基础。个体的绝望应该作为一个潜在的因素与发病率和损害在年轻adult.This队列研究使用的数据从大烟山研究，以检查是否绝望的年轻人与自杀的想法和行为，酒精滥用，药物滥用。
Importance Deaths of despair is a term that has recently been used to describe the increases in premature mortality from suicides, drug overdoses (particularly from opiates), and alcohol-related liver disease among US adults. Despite the use of the term despair, its role in these causes of premature death has not been empirically tested. Objective To test whether despair among young adults is associated with suicidal thoughts and behavior, alcohol misuse, and drug misuse. Design, Setting, and Participants The Great Smoky Mountains Study is a Southeastern, mixed urban-rural population-based cohort study conducted from November 10, 1992, to September 22, 2015. A total of 1420 participants originally 9, 11, and 13 years of age were followed up 11 times to 30 years of age (11 230 person-observations). A total of 1154 of 1400 living participants (82.4%) were assessed at 30 years of age. Statistical analysis was performed from May 7, 2019, to April 10, 2020. Exposures Participants were assessed with structured interviews for indicators of despair (eg, hopelessness, helplessness, low self-worth, and feeling unloved). Despair was assessed with items from structured interviews: the Child and Adolescent Psychiatric Assessment and the Young Adult Psychiatric Assessment. Main Outcomes and Measures Structured interviews were used to assess suicidal thoughts and behavior, substance use, and Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) alcohol use disorder and drug use disorder (including opioids) in young adulthood (2424 observations of 1266 individuals between 25 and 30 years of age). Results This study included 1420 individuals (790 male individuals). During young adulthood (25 and 30 years of age), the 3-month weighted prevalence of any despair was 19.5% (476 of 2424 observations) with 7.6% of participants (201 of 2424 observations) reporting 2 or more despair items. In longitudinal, lagged models, despair scores (range, 0-3) were associated with more suicidal thoughts and behaviors (odds ratio [OR], 1.5; 95% CI, 1.1-2.0), illicit drug use (OR, 1.7; 95% CI, 1.2-2.5), and opioid use (OR, 1.9; 95% CI, 1.1-3.3) but not alcohol use disorder (OR, 0.8; 95% CI, 0.6-1.2). These associations persisted after accounting for sociodemographic factors (eg, poverty and educational level), lagged outcome status, and lagged depression status. The associations between despair and study outcomes were stronger in models accounting for long-term measures of despair extending back to childhood. There was no consistent pattern of moderation by sociodemographic factors. Conclusions and Relevance This study's findings suggest an empirical basis for longitudinal associations between despair and several, but not all, precursors of "deaths of despair" in rural Appalachia. Individual despair should be studied as a potential factor associated with morbidity and impairment in young adulthood.This cohort study uses data from the Great Smoky Mountains Study to examine whether despair among young adults is associated with suicidal thoughts and behavior, alcohol misuse, and drug misuse.