Childhood adversity and mental health admission patterns prior to young person suicide (CHASE): a case-control 36 year linked hospital data study, Scotland UK 1981-2017.

IF 3.9 3区医学 Q1 PSYCHIATRY BJPsych Open Pub Date : 2024-06-03 DOI:10.1192/bjo.2024.69

Nadine Dougall, Jan Savinc, Margaret Maxwell, Thanos Karatzias, Rory C O'Connor, Brian Williams, Ann John, Helen Cheyne, Claire Fyvie, Jonathan I Bisson, Carina Hibberd, Susan Abbott-Smith, Liz Nolan, Jennifer Murray

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Abstract

Background: Childhood adversity is associated with increased later mental health problems and suicidal behaviour. Opportunities for earlier healthcare identification and intervention are needed.

Aim: To determine associations between hospital admissions for childhood adversity and mental health in children who later die by suicide.

Method: Population-based longitudinal case-control study. Scottish in-patient general and psychiatric records were summarised for individuals born 1981 or later who died by suicide between 1991 and 2017 (cases), and matched controls (1:10), for childhood adversity and mental health (broadly defined as psychiatric diagnoses and general hospital admissions for self-harm and substance use).

Results: Records were extracted for 2477 'cases' and 24 777 'controls'; 2106 cases (85%) and 13 589 controls (55%) had lifespan hospitalisations. Mean age at death was 23.7; 75.9% were male. Maltreatment or violence-related childhood adversity codes were recorded for 7.6% cases aged 10-17 (160/2106) versus 2.7% controls (371/13 589), odds ratio = 2.9 (95% CI, 2.4-3.6); mental health-related admissions were recorded for 21.7% cases (458/2106), versus 4.1% controls (560/13 589), odds ratio = 6.5 (95% CI, 5.7-7.4); 80% of mental health admissions were in general hospitals. Using conditional logistic models, we found a dose-response effect of mental health admissions <18y, with highest adjusted odds ratio (aOR) for three or more mental health admissions: aOR_male = 8.17 (95% CI, 5.02-13.29), aOR_female = 15.08 (95% CI, 8.07-28.17). We estimated that each type of childhood adversity multiplied odds of suicide by aOR_male = 1.90 (95% CI, 1.64-2.21), aOR_female = 2.65 (95% CI, 1.94-3.62), and each mental health admission by aOR_male = 2.06 (95% CI, 1.81-2.34), aOR_female = 1.78 (95% CI, 1.50-2.10).

Conclusions: Our lifespan study found that experiencing childhood adversity (primarily maltreatment or violence-related admissions) or mental health admissions increased odds of young person suicide, with highest odds for those experiencing both. Healthcare practitioners should identify and flag potential 'at-risk' adolescents to prevent future suicidal acts, especially those in general hospitals.

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1981-2017年英国苏格兰青少年自杀前的童年逆境和心理健康入院模式（CHASE）：一项为期36年的病例对照关联医院数据研究。

背景：儿童时期的逆境与日后心理健康问题和自杀行为的增加有关。目的：确定因童年逆境而入院的儿童与后来死于自杀的儿童的心理健康之间的关系：方法：基于人口的纵向病例对照研究。研究汇总了苏格兰普通住院病人和精神病患者的记录，其中包括 1981 年或以后出生、在 1991 年至 2017 年期间自杀身亡的人（病例），以及匹配对照组（1:10）的儿童逆境和心理健康情况（广义上指精神病诊断以及因自我伤害和药物使用而入住普通医院的情况）：提取了 2477 个 "病例 "和 24 777 个 "对照 "的记录；其中 2106 个病例（85%）和 13 589 个对照（55%）终生住院。死亡时的平均年龄为23.7岁；75.9%为男性。7.6%的 10-17 岁病例（160/2106）与 2.7%的对照组（371/13 589）有虐待或与暴力相关的童年逆境代码记录，几率比=2.9（95% CI，2.4-3.6）；21.7%的病例（458/2106）与 4.1%的对照组（560/13 589）有精神健康相关入院记录，几率比=6.5（95% CI，5.7-7.4）；80%的精神健康入院病例在综合医院。利用条件逻辑模型，我们发现入院精神疾病的剂量反应效应为男性=8.17（95% CI，5.02-13.29），女性=15.08（95% CI，8.07-28.17）。我们估计，每种类型的童年逆境都会使自杀几率成倍增加，aORmale = 1.90 (95% CI, 1.64-2.21), aORfemale = 2.65 (95% CI, 1.94-3.62), 每次精神健康入院aORmale = 2.06 (95% CI, 1.81-2.34), aORfemale = 1.78 (95% CI, 1.50-2.10)：我们的终身研究发现，童年时期的逆境（主要是虐待或与暴力相关的入院治疗）或精神疾病入院治疗会增加青少年自杀的几率，而同时经历这两种情况的青少年自杀几率最高。医疗保健从业人员应识别并标记潜在的 "高危 "青少年，以防止他们将来发生自杀行为，尤其是那些住进综合医院的青少年。

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来源期刊

BJPsych Open Medicine-Psychiatry and Mental Health

CiteScore

6.30

自引率

3.70%

发文量

610

审稿时长

16 weeks

期刊介绍： Announcing the launch of BJPsych Open, an exciting new open access online journal for the publication of all methodologically sound research in all fields of psychiatry and disciplines related to mental health. BJPsych Open will maintain the highest scientific, peer review, and ethical standards of the BJPsych, ensure rapid publication for authors whilst sharing research with no cost to the reader in the spirit of maximising dissemination and public engagement. Cascade submission from BJPsych to BJPsych Open is a new option for authors whose first priority is rapid online publication with the prestigious BJPsych brand. Authors will also retain copyright to their works under a creative commons license.