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Sun X, Zhu Z, Fan X, Mei S, Jiang L, Cong S, Xie H, Han J, Ni S, Liu Y, Zeng L, Gu T, Li D, Zhang A. Neuroticism trait and postnatal depression among Chinese women: the mediating role of childbirth experience and the moderating role of perceived social support. BMC Psychiatry 2024; 24:883. [PMID: 39633300 PMCID: PMC11616328 DOI: 10.1186/s12888-024-06337-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 11/25/2024] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND Despite the link between neuroticism trait and postnatal depression has been confirmed, little is known about the factors that influence this association. This study aimed to examine whether childbirth experience mediated the association between neuroticism trait and postnatal depression, and whether this indirect effect was moderated by perceived social support. METHODS A cross-sectional study was conducted with 1686 women within one year postpartum from 38 hospitals in China. Participants completed anonymous questionnaires measuring neuroticism trait, postnatal depression, childbirth experience, perceived social support, and demographic and obstetric variables. Data were analyzed using SPSS 26.0 and PROCESS 4.0. RESULTS The prevalence of postnatal depression among Chinese women was 24.1%, higher than the global pooled prevalence. The results showed a positive correlation between neuroticism trait and postnatal depression, which was partially mediated by childbirth experience. The negative correlation between neuroticism trait and childbirth experience was moderated by perceived social support. Specifically, the negative impact of neuroticism trait on childbirth experience was stronger among women with high perceived social support. CONCLUSIONS Our findings highlight the critical importance of interventions dedicated to improving the childbirth experience, which may help reduce postnatal depression. Moreover, neuroticism and perceived social support are highly correlated and must be considered simultaneously to inform individualized interventions for postnatal depression.
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Affiliation(s)
- Xiaoqing Sun
- Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, #123 Tianfei Alley, Qinhuai District, Nanjing, 210004, Jiangsu, China
- Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Zhu Zhu
- Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, #123 Tianfei Alley, Qinhuai District, Nanjing, 210004, Jiangsu, China
| | - Xuemei Fan
- Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, #123 Tianfei Alley, Qinhuai District, Nanjing, 210004, Jiangsu, China
| | - Shijuan Mei
- Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, #123 Tianfei Alley, Qinhuai District, Nanjing, 210004, Jiangsu, China
| | - Lijuan Jiang
- Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, #123 Tianfei Alley, Qinhuai District, Nanjing, 210004, Jiangsu, China
| | - Shengnan Cong
- Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, #123 Tianfei Alley, Qinhuai District, Nanjing, 210004, Jiangsu, China
| | - Hongyan Xie
- School of Nursing, Nanjing Medical University, Jiangsu, China
| | - Jingjing Han
- School of Nursing, Suzhou University, Jiangsu, China
| | - Shiqian Ni
- School of Nursing, Nanjing Medical University, Jiangsu, China
| | - Ying Liu
- Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, #123 Tianfei Alley, Qinhuai District, Nanjing, 210004, Jiangsu, China
| | - Lihua Zeng
- Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, #123 Tianfei Alley, Qinhuai District, Nanjing, 210004, Jiangsu, China
| | - Tingting Gu
- Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Dandan Li
- Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Aixia Zhang
- Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, #123 Tianfei Alley, Qinhuai District, Nanjing, 210004, Jiangsu, China.
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Ahun MN, Appiah R, Aurino E, Wolf S. Caregiver mental health and school-aged children's academic and socioemotional outcomes: Examining associations and mediators in Northern Ghana. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003724. [PMID: 39269978 PMCID: PMC11398656 DOI: 10.1371/journal.pgph.0003724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 08/26/2024] [Indexed: 09/15/2024]
Abstract
While there is a strong link between caregiver mental health, caregiver engagement, and child development, limited research has examined the underlying mechanisms of these associations in Africa. We examined the mediating role of dimensions of caregiver engagement in the association of caregiver psychological distress with children's academic and socioemotional outcomes in Ghana. Data came from 4,714 children (aged 5-17 years) and their caregivers in five regions of northern Ghana. Caregiver psychological distress and engagement (i.e., engagement in education, emotional supportiveness, and parenting self-efficacy) were self-reported by children's primary caregiver. Children's academic (literacy and numeracy) and socioemotional (prosocial skills and socioemotional difficulties) outcomes were directly assessed using validated measures. Structural equation modelling was used to estimate mediation models. We tested moderation by caregiver exposure to formal education, child's age, and child's sex. Fourteen percent of caregivers experienced elevated psychological distress. Higher levels of psychological distress were associated with children's poorer literacy and numeracy skills, and higher socioemotional difficulties, but not prosocial skills. The mediating role of caregiver engagement varied by caregiver exposure to formal education but not child's age or sex. Caregiver engagement in education explained the association between psychological distress and children's literacy skills (but not numeracy or socioemotional) in families where the caregiver had no formal education (indirect effect: β = 0.007 [95% CI: 0.000, 0.016]), explaining 23% of the association. No mediator explained the association of psychological distress with child outcomes among families where the caregiver had some formal education. The mechanisms through which caregiver psychological distress is associated with child outcomes in rural Ghana differ as a function of caregivers' exposure to formal education. These results highlight the importance of developing multi-component and culturally-sensitive programs to improve child outcomes. Further research in similar contexts is needed to advance scientific understanding on how to effectively promote child and family wellbeing.
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Affiliation(s)
- Marilyn N Ahun
- Department of Medicine, McGill University, Montréal, Canada
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Richard Appiah
- Department of Psychology, Northumbria University, Newcastle-upon-Tyne, United Kingdom
- College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - Sharon Wolf
- Graduate School of Education, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Zheng J, Han R, Gao L. Social Support, Parenting Self-Efficacy, and Postpartum Depression Among Chinese Parents: The Actor-Partner Interdependence Mediation Model. J Midwifery Womens Health 2024; 69:559-566. [PMID: 38148288 DOI: 10.1111/jmwh.13588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/14/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION Postpartum depression affects both mothers and fathers. This study aimed to examine the relationships between social support, parenting self-efficacy, and postpartum depression in Chinese mothers and fathers and assess the mediating effect of parenting self-efficacy using a dyadic perspective. METHODS A cross-sectional study was implemented from December 2020 to July 2021 in Guangzhou, China, with 309 pairs of parents. The Edinburgh Postnatal Depression Scale, Social Support Rating Scale, Parenting Sense of Competence Scale-Efficacy subscale, and sociodemographic data sheet were completed by both parents. Dyadic analysis was conducted using the actor-partner interdependence mediation model. An actor effect is the relationship between variables within an individual, whereas a partner effect is the relationship between variables in the individual and the dyadic partner. RESULTS In total, 20.7% of mothers and 11.7% of fathers had elevated postpartum depressive symptoms at 6 weeks postpartum. The model revealed 6 actor effects: social support was positively associated with parenting self-efficacy for mothers (β, 0.39; 95% CI, 0.28-0.49) and fathers (β, 0.39; 95% CI, 0.30-0.48) and negatively associated with postpartum depression for mothers (β, -0.22; 95% CI, -0.32 to -0.12) and fathers (β, -0.37; 95% CI, -0.48 to -0.26). Parenting self-efficacy was negatively associated with postpartum depression in mothers (β, -0.41; 95% CI, -0.53 to -0.29) and fathers (β, -0.24; 95% CI, -0.37 to -0.12). Maternal social support had a partner effect on paternal parenting self-efficacy (β, 0.14; 95% CI, 0.04-0.24). Parenting self-efficacy mediated between social support and postpartum depression for both parents (mothers: β, -0.16; 95% CI, -0.23 to -0.10; fathers: β, -0.10; 95% CI, -0.16 to -0.05). DISCUSSION Postpartum depression was a dyadic phenomenon. Increasing mother-centered social support has the potential to improve the parenting self-efficacy of both parents and reduce the likelihood of postpartum depression.
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Affiliation(s)
- Jie Zheng
- School of Nursing, Peking University, Beijing, China
| | - Rongrong Han
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Lingling Gao
- School of Nursing, Sun Yat-sen University, Guangzhou, China
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Hu L, Mei H, Cai X, Song L, Xu Q, Gao W, Zhang D, Zhou J, Sun C, Li Y, Xiang F, Wang Y, Zhou A, Xiao H. Prenatal exposure to poly- and perfluoroalkyl substances and postpartum depression in women with twin pregnancies. Int J Hyg Environ Health 2024; 256:114324. [PMID: 38271819 DOI: 10.1016/j.ijheh.2024.114324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/18/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Women with multiple pregnancies are vulnerable to experience postpartum depression (PPD). Emerging evidence indicates an association between poly- and perfluoroalkyl substances (PFAS) exposure and PPD in women delivering singletons. The health risks of PFAS may also be present in women delivering twins. OBJECTIVE To estimate the impacts of prenatal PFAS exposure on the risk of PPD in women with twin pregnancies. METHODS Our study included 150 mothers who gave birth to twins and were enrolled in the Wuhan Twin Birth Cohort. The concentrations of maternal plasma PFAS were measured in each trimester and averaged. Eight individual PFAS were included in analyses. We used Edinburgh Postnatal Depression Scale to evaluate maternal depression at early pregnancy and 1 and 6 months after childbirth. The outcome was dichotomized using a cutoff value of ≥10 for main analyses. Associations were examined using multiple informant models and modified Poisson regressions. PFAS mixture effects were estimated using quantile g-computation. RESULTS Using quantile g-computation models, a quartile increase in the PFAS mixture during the first, second, third, and average pregnancy was significantly associated with a relative risk (RR) of 1.73 (95% CI: 1.42, 2.12), 1.54 (95% CI: 1.27, 1.84), 1.75 (95% CI: 1.49, 2.08), and 1.63 (95% CI: 1.35, 1.97) for PPD at 6 months after childbirth, respectively. The results of the single-PFAS models also indicated significant positive associations between individual PFAS and PPD at both 1 and 6 months. CONCLUSIONS The first study of women with twin pregnancies suggests that prenatal exposure to PFAS increases PPD risk up to 6 months postpartum. Twin pregnant women should receive long-term follow-up after delivery and extensive social support.
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Affiliation(s)
- Liqin Hu
- Institute of Maternal and Child Health, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Hong Mei
- Institute of Maternal and Child Health, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Xiaonan Cai
- Institute of Maternal and Child Health, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Lulu Song
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, Hubei, 430030, PR China; Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Qiao Xu
- Department of Obstetrics, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Wenqi Gao
- Institute of Maternal and Child Health, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Dan Zhang
- Woman Healthcare Department for Community, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Jieqiong Zhou
- Department of Obstetrics, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Chen Sun
- Maternal Health Care Department, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yi Li
- Department of Obstetrics, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Feiyan Xiang
- Institute of Maternal and Child Health, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Youjie Wang
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, Hubei, 430030, PR China; Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Aifen Zhou
- Institute of Maternal and Child Health, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
| | - Han Xiao
- Institute of Maternal and Child Health, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
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Besharati S, Akinyemi R. Accelerating African neuroscience to provide an equitable framework using perspectives from West and Southern Africa. Nat Commun 2023; 14:8107. [PMID: 38062039 PMCID: PMC10703764 DOI: 10.1038/s41467-023-43943-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- Sahba Besharati
- Department of Psychology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa.
- CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, Canada.
| | - Rufus Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Partap U, Nyundo A, Manu A, Regan M, Ismail A, Chukwu A, Dessie Y, Njau T, Kaaya SF, Fawzi WW. Depressive symptoms among adolescents in six sub-Saharan African countries: A pooled analysis of associated factors. Prev Med Rep 2023; 36:102499. [PMID: 38116275 PMCID: PMC10728441 DOI: 10.1016/j.pmedr.2023.102499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/23/2023] [Accepted: 11/05/2023] [Indexed: 12/21/2023] Open
Abstract
There is a need to identify risk factors, including nutrition-related factors, for depressive disorders among sub-Saharan African (SSA) adolescents. We examined the association of multiple measures with depressive symptoms among adolescents living across six SSA countries. Building on previous analyses, we used data from a cross-sectional study conducted from 2015 to 2017 among adolescents aged 10-19 years in six SSA countries (N = 7512). Depressive symptoms were defined as highest tertile of the 6-item Kutcher Adolescent Depression Scale score. Using mixed-effects Poisson regression models, we pooled data across sites and examined the association of sociodemographic, nutrition, and other indices with depressive symptoms. We additionally assessed effect modification by sex, age, and school-going status. We observed higher risk of depressive symptoms among girls (adjusted risk ratio [RR]: 1.29, 95 % confidence interval [95 % CI]: 1.05-1.58, P = 0.016), older adolescents (RR for 18-19 years: 1.59, 95 % CI: 1.44-1.76, P < 0.001), and adolescents experiencing bullying (RR: 1.43, 95 % CI: 1.26-1.62, P < 0.001) or violence (RR: 1.34, 95 % CI: 1.24-1.45, P < 0.001). Adolescents experiencing food insecurity also had a higher risk of depressive symptoms (RR: 1.90, 95 % CI: 1.64-2.19, P < 0.001) along with those consuming ≥ 5 servings of fruit and vegetables per day (RR: 1.18, 95 % CI: 1.03-1.34, P = 0.015); conversely, those who consumed grains, roots and tubers in the past day were at decreased risk (RR: 0.73, 95 % CI: 0.69-0.77, P < 0.001). There was no strong evidence of effect modification of associations. This study reinforces the potential role of multiple sociodemographic and nutrition-related measures on risk of depressive symptoms in these populations.
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Affiliation(s)
- Uttara Partap
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Azan Nyundo
- Department of Psychiatry and Mental Health, School of Medicine, University of Dodoma, Dodoma, Tanzania
| | - Adom Manu
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Mathilda Regan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Abbas Ismail
- Department of Mathematics and Statistics, University of Dodoma, Dodoma, Tanzania
| | - Angela Chukwu
- Department of Statistics, University of Ibadan, Ibadan, Nigeria
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Tasiana Njau
- Department of Psychiatry and Mental Health, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sylvia F. Kaaya
- Department of Psychiatry and Mental Health, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Orri M, Macalli M, Galera C, Tzourio C. Association of parental death and illness with offspring suicidal ideation: cross-sectional study in a large cohort of university students. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2251-2260. [PMID: 35794467 DOI: 10.1007/s00127-022-02329-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of this study was to (1) investigate the association of parental death and illness with suicidal ideation using a large sample of university students and (2) test whether associations were moderated by perceived family support. METHODS We used data from N = 15,008 French university students enrolled in the i-Share cohort (mean age, 20.5 years; 77% women). Students self-reported information on parental death, including the cause, parental illness (cardiovascular, stroke, cancer, depression/anxiety, alcohol abuse), and perceived family support during childhood/adolescence. Twelve-month suicidal ideation was self-reported and categorized into no, occasional, and frequent ideation. RESULTS Occasional and frequent suicidal ideation were, respectively, reported by 2692 (17.5%) and 699 (4.6%) students. After adjustment for age, gender, and parental education, we found associations between parental death and risk of occasional and frequent suicidal ideation (respectively, RR = 1.98 [1.81-2.17] and RR = 2.73 [2.30-3.24]). Parental deaths from illness, accidents, and suicides had the strongest associations. We also found associations for parental depression/anxiety (occasional, RR = 1.98 [1.81-2.17]; frequent, RR = 2.73 [2.30-3.24]), alcohol use problems (occasional, RR = 1.71 [1.5-1.94]; frequent, RR = 2.33 [1.89-2.87]), and cardiovascular diseases (occasional, RR = 1.22 [1.06-1.40]; frequent, RR = 1.83 [1.47-2.27]). For participants who experienced parental death and stroke, associations with occasional and frequent suicidal ideation (respectively) increased as perceived family support increased (Psinteraction ≤ 0.005). CONCLUSIONS Students who experienced parental death and common parental illnesses were at risk of reporting suicidal ideation, especially if their family were perceived as an important source of support. As information on parental death or illness can be routinely collected during health visits, attention should be paid to students reporting such experiences.
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Affiliation(s)
- Massimiliano Orri
- Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, 6875 Boulevard LaSalle, Montréal, QC, H4H 1R3, Canada. .,Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, CHU Bordeaux, F-33000, U1219, Bordeaux, France.
| | - Melissa Macalli
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, CHU Bordeaux, F-33000, U1219, Bordeaux, France
| | - Cedric Galera
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, CHU Bordeaux, F-33000, U1219, Bordeaux, France.,Department of Child and Adolescent Psychiatry, Charles Perrens Hospital, Bordeaux, France.,Research Unit on Children's Psychosocial Maladjustment, Montreal, QC, Canada
| | - Christophe Tzourio
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, CHU Bordeaux, F-33000, U1219, Bordeaux, France
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Orri M, Ahun MN, Naicker S, Besharati S, Richter LM. Childhood factors associated with suicidal ideation among South African youth: A 28-year longitudinal study of the Birth to Twenty Plus cohort. PLoS Med 2022; 19:e1003946. [PMID: 35290371 PMCID: PMC8923476 DOI: 10.1371/journal.pmed.1003946] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/14/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although early life factors are associated with increased suicide risk in youth, there is a dearth of research on these associations for individuals growing up in disadvantaged socioeconomic contexts, particularly in low- and middle-income countries (LMICs). We documented the association between individual, familial, and environmental factors in childhood with suicidal ideation among South African youth. METHODS AND FINDINGS We used data from 2,020 participants in the Birth to Twenty Plus (Bt20+) study, a South African cohort following children born in Soweto, Johannesburg from birth (1990) to age 28 years (2018). Suicidal ideation was self-reported at ages 14, 17, 22, and 28 years, and the primary outcome of interest was suicidal ideation reported at any age. We assessed individual, familial, and socioeconomic characteristics at childbirth and during infancy, adverse childhood experiences (ACEs) between ages 5 and 13 years, and externalizing and internalizing problems between 5 and 10 years. We estimated odds ratios (ORs) of suicidal ideation for individuals exposed to selected childhood factors using logistic regression. Lifetime suicidal ideation was reported by 469 (23.2%) participants, with a 1.7:1 female/male ratio. Suicidal ideation rates peaked at age 17 and decreased thereafter. Socioeconomic adversity, low birth weight, higher birth order (i.e., increase in the order of birth in the family: first, second, third, fourth, or later born child), ACEs, and childhood externalizing problems were associated with suicidal ideation, differently patterned among males and females. Socioeconomic adversity (OR 1.13, CI 1.01 to 1.27, P = 0.031) was significantly associated with suicidal ideation among males only, while birth weight (OR 1.20, CI 1.02 to 1.41, P = 0.03), ACEs (OR 1.11, CI 1.01 to 1.21, P = 0.030), and higher birth order (OR 1.15, CI 1.07 to 1.243, P < 0.001) were significantly associated with suicidal ideation among females only. Externalizing problems in childhood were significantly associated with suicidal ideation among both males (OR 1.23, 1.08 to 1.40, P = 0.002) and females (OR 1.16, CI 1.03 to 1.30, P = 0.011). Main limitations of the study are the high attrition rate (62% of the original sample was included in this analysis) and the heterogeneity in the measurements of suicidal ideation. CONCLUSIONS In this study from South Africa, we observed that early life social and environmental adversities as well as childhood externalizing problems are associated with increased risk of suicidal ideation during adolescence and early adulthood.
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Affiliation(s)
- Massimiliano Orri
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Canada
- Bordeaux Population Health Research Centre, Inserm U1219, University of Bordeaux, Bordeaux, France
- * E-mail:
| | - Marilyn N. Ahun
- Department of Social and Preventive Medicine, Université de Montréal School of Public Health, Montréal, Canada
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sara Naicker
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Sahba Besharati
- Department of Psychology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
- CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, Canada
| | - Linda M. Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
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