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Farooq B, Russell AE, Howe LD, Herbert A, Smith ADAC, Fisher HL, Baldwin JR, Arseneault L, Danese A, Mars B. The relationship between type, timing and duration of exposure to adverse childhood experiences and adolescent self-harm and depression: findings from three UK prospective population-based cohorts. J Child Psychol Psychiatry 2024. [PMID: 38613494 DOI: 10.1111/jcpp.13986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are well-established risk factors for self-harm and depression. However, despite their high comorbidity, there has been little focus on the impact of developmental timing and the duration of exposure to ACEs on co-occurring self-harm and depression. METHODS Data were utilised from over 22,000 children and adolescents participating in three UK cohorts, followed up longitudinally for 14-18 years: the Avon Longitudinal Study of Parents and Children (ALSPAC), the Millennium Cohort Study (MCS) and the Environmental Risk (E-Risk) Longitudinal Twin Study. Multinomial logistic regression models estimated associations between each ACE type and a four-category outcome: no self-harm or depression, self-harm alone, depression alone and self-harm with co-occurring depression. A structured life course modelling approach was used to examine whether the accumulation (duration) of exposure to each ACE, or a critical period (timing of ACEs) had the strongest effects on self-harm and depression in adolescence. RESULTS The majority of ACEs were associated with co-occurring self-harm and depression, with consistent findings across cohorts. The importance of timing and duration of ACEs differed across ACEs and across cohorts. For parental mental health problems, longer duration of exposure was strongly associated with co-occurring self-harm and depression in both ALSPAC (adjusted OR: 1.18, 95% CI: 1.10-1.25) and MCS (1.18, 1.11-1.26) cohorts. For other ACEs in ALSPAC, exposure in middle childhood was most strongly associated with co-occurring self-harm and depression, and ACE occurrence in early childhood and adolescence was more important in the MCS. CONCLUSIONS Efforts to mitigate the impact of ACEs should start in early life with continued support throughout childhood, to prevent long-term exposure to ACEs contributing to risk of self-harm and depression in adolescence.
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Affiliation(s)
- Bushra Farooq
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Abigail E Russell
- Children and Young People's Mental Health Research Collaboration, University of Exeter Medical School, Exeter, UK
| | - Laura D Howe
- MRC Integrative Epidemiology Unit, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Annie Herbert
- MRC Integrative Epidemiology Unit, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Andrew D A C Smith
- Mathematics and Statistics Research Group, University of the West of England, Bristol, UK
| | - Helen L Fisher
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Jessie R Baldwin
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Division of Psychology and Language Sciences, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Louise Arseneault
- Mathematics and Statistics Research Group, University of the West of England, Bristol, UK
| | - Andrea Danese
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National and Specialist CAMHS Clinic for Trauma, Anxiety, and Depression, South London and Maudsley NHS Foundation Trust, London, UK
| | - Becky Mars
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
- National Institute for Health and Care Research, Biomedical Research Centre, Bristol, UK
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Stea TH, Bonsaksen T, Smith P, Kleppang AL, Steigen AM, Leonhardt M, Lien L, Vettore MV. Are social pressure, bullying and low social support associated with depressive symptoms, self-harm and self-directed violence among adolescents? A cross-sectional study using a structural equation modeling approach. BMC Psychiatry 2024; 24:239. [PMID: 38553669 PMCID: PMC10981317 DOI: 10.1186/s12888-024-05696-1] [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: 03/16/2023] [Accepted: 03/18/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND More in-depth evidence about the complex relationships between different risk factors and mental health among adolescents has been warranted. Thus, the aim of the study was to examine the direct and indirect effects of experiencing social pressure, bullying, and low social support on mental health problems in adolescence. METHODS A school-based cross-sectional study was conducted in 2022 among 15 823 Norwegian adolescents, aged 13-19 years. Structural Equation Modelling was used to assess the relationships between socioeconomic status, social pressure, bullying, social support, depressive symptoms, self-harm and suicide thoughts. RESULTS Poor family economy and low parental education were associated with high pressure, low parental support and depressive symptoms in males and females. Moreover, poor family economy was associated with bullying perpetration and bullying victimization among males and females, and cyberbullying victimization among females, but not males. Low parental education was associated with bullying victimization among males, but not females. Further, high social pressure was associated with depressive symptoms among males and females, whereas high social pressure was linked to self-harm and suicide thoughts among females, but not males. Bullying victimization and cyberbullying victimization were associated with depressive symptoms, self-harm, and suicide thoughts among males and females. Bullying victimization was associated with depressive symptoms among males, but not females, whereas bullying perpetration was linked to self-harm and suicide thoughts among females, but not males. Low parental support was associated with bullying perpetration, bullying victimization, depressive symptoms, self-harm and suicide thoughts among males and females, whereas low parental support was associated with high social pressure among females, but not males. Low teacher support was associated with high social pressure and depressive symptoms. Low support from friends was associated with bullying victimization, depressive symptoms and suicide thoughts among males and females, whereas low support from friends was linked to self-harm among males, but not females. Finally, results showed that depressive symptoms were associated with self-harm and suicide thoughts among males and females. CONCLUSION Low socioeconomic status, social pressure, bullying and low social support were directly and indirectly associated with depressive symptoms and self-directed violence among Norwegian adolescents.
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Affiliation(s)
- Tonje Holte Stea
- Department of Health and Nursing Science, University of Agder, Kristiansand, Norway.
| | - Tore Bonsaksen
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
- Department of Health, VID Specialized University, Stavanger, Norway
| | - Pierre Smith
- Health information service. Epidemiology and public health. Sciensano, Brussels, Belgium
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Annette Løvheim Kleppang
- Department of Health and Nursing Science, University of Agder, Kristiansand, Norway
- Department of Public Health and Sport Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Anne Mari Steigen
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Marja Leonhardt
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Lars Lien
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
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Wichstrøm T, Wichstrøm L. Childhood Predictors of Nonsuicidal Self-injury in Adolescence: A Birth Cohort Study. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00073-X. [PMID: 38423281 DOI: 10.1016/j.jaac.2023.12.013] [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: 05/05/2023] [Revised: 11/18/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Nonsuicidal self-injury (NSSI) is rare in childhood but becomes prevalent in adolescence, which suggests that early intervention might be indicated. As childhood predictors of NSSI in adolescence are largely unknown, identifying these predictors was the aim of this study. METHOD In a birth cohort sample (n = 759) of Norwegian children, NSSI at 12, 14, or 16 years of age was regressed on predictors of NSSI at age 6 (parental factors: depression, parenting stress, negativity/hostility, emotional availability to the child; child factors: temperamental negative affectivity, emotion regulation, symptoms of emotional and behavioral disorders; external events: victimization from bullying, serious negative life events). Semistructured clinical interviews with adolescents and their parents were used to assess DSM-5-defined NSSI and NSSI disorder. RESULTS NSSI during the preceding 12 months at 12, 14, or 16 years of age was reported by 81 adolescents (10.0%, 95% CI 8.2-11.9), and NSSI disorder was reported by 20 adolescents (2.7%, 95% CI 1.9-3.8). In multivariable logistic regression analysis, female gender (odds ratio 11.6, 95% CI 4.0-33.5), parenting stress (odds ratio 4.8, 95% CI 1.4-16.5), and parental negativity/hostility (odds ratio 1.8, 95% CI 1.2-2.7) predicted NSSI, whereas child factors and external events were not predictive. CONCLUSION Parental factors when the child is 6 years of age-parenting stress and negativity/hostility toward the child-predict NSSI in adolescence. Universal and indicated programs targeting these aspects of parenting during childhood might reduce NSSI in adolescence. DIVERSITY & INCLUSION STATEMENT We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
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Affiliation(s)
- Tove Wichstrøm
- Norwegian University of Science and Technology, Trondheim, Norway.
| | - Lars Wichstrøm
- Norwegian University of Science and Technology, Trondheim, Norway; St. Olavs Hospital, Trondheim, Norway
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Gómez-Peresmitré G, Platas-Acevedo RS, León-Hernández R, Guzmán-Saldaña R. Self-Injurious Behavior and Its Characteristics in a Sample of Mexican Adolescent Students. Healthcare (Basel) 2023; 11:1682. [PMID: 37372799 PMCID: PMC10298567 DOI: 10.3390/healthcare11121682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Adolescence is a difficult stage, a period of risk for developing disorders, including depression and self-injurious behavior. A non-random sample was drawn (n = 563) from first-year high school students (32.8%) 185 males and 378 females (67.14%) from public schools in Mexico. The age range was 15 and 19 years, with a mean age of 15.63 (SD = 0.78). According to the results, the sample was divided into n1 = 414 (73.3%) adolescents without self-injury (S.I.) and n2 = 149 (26.4%) S.I. adolescents. In addition, results were obtained on methods, motives, time, and frequency of S.I., and a model was generated in which depression and first sexual experience obtained the highest Odd Ratio and d values in their relationship with S.I. Finally, we contrasted the results with earlier reports and concluded that depression is an important variable in S.I. behavior. Early S.I. detection will prevent the aggravation of S.I. and suicide attempts.
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Affiliation(s)
- Gilda Gómez-Peresmitré
- Faculty of Psychology, The National Autonomous University of Mexico, Av. Universidad 3004 Col Copilco-Universidad, Alcaldía, Coyoacán, Mexico City C.P. 04510, Mexico
| | - Romana Silvia Platas-Acevedo
- Faculty of Psychology, The National Autonomous University of Mexico, Av. Universidad 3004 Col Copilco-Universidad, Alcaldía, Coyoacán, Mexico City C.P. 04510, Mexico
| | - Rodrigo León-Hernández
- National Council of Science and Technology, Avenida Insurgentes Sur 1582, Crédito Constructor, Ciudad de México C.P. 03940, Mexico
| | - Rebeca Guzmán-Saldaña
- Institute of Health Sciences, Autonomous University of the State of Hidalgo, Camino a Tilcuautla s/n Pueblo San Juan Tilcuautla, Hidalgo C.P. 42160, Mexico
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Llamocca EN, Steelesmith DL, Ruch DA, Bridge JA, Fontanella CA. Association Between Social Determinants of Health and Deliberate Self-Harm Among Youths With Psychiatric Diagnoses. Psychiatr Serv 2023; 74:574-580. [PMID: 36377368 PMCID: PMC10948010 DOI: 10.1176/appi.ps.20220180] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The authors sought to examine the association between adverse social determinants of health (SDoHs) and risk for self-harm among youths. METHODS The authors performed a retrospective longitudinal analysis of Ohio Medicaid claims data (April 1, 2016-December 31, 2018) of 244,958 youths (ages 10-17 years) with a primary psychiatric diagnosis. SDoHs were identified from ICD-10 codes and classified into 14 categories, encompassing abuse and neglect, child welfare placement, educational problems, financial problems, exposure to violence, housing instability, legal issues, disappearance or death of a family member, family disruption by separation or divorce, family alcohol or drug use, parent-child conflict, other family problems, social and environmental problems, and nonspecific psychosocial needs. Cox proportional hazards analysis was used to examine the association between SDoHs and self-harm (i.e., nonsuicidal self-injury or suicide attempt). Analyses controlled for demographic characteristics and comorbid psychiatric and general medical conditions. RESULTS During follow-up after an index claim event, 51,796 youths (21.1%) had at least one adverse SDoH indicator, and 3,262 (1.3%) had at least one self-harm event. Abuse and neglect (hazard ratio [HR]=1.90, 99% CI=1.70-2.12), child welfare placement (HR=1.32, 99% CI=1.04-1.67), parent-child conflict (HR=1.52, 99% CI=1.23-1.87), other family problems (HR=1.25, 99% CI=1.01-1.54), and nonspecific psychosocial needs (HR=1.41, 99% CI=1.06-1.89) were associated with significantly increased hazard of self-harm. CONCLUSIONS Adverse SDoHs were significantly associated with self-harm, even after controlling for demographic and clinical characteristics, underscoring the need for capturing SDoH information in medical records to identify youths at elevated suicide risk and to inform targeted interventions.
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Affiliation(s)
- Elyse N. Llamocca
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Danielle L. Steelesmith
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Donna A. Ruch
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Jeffrey A. Bridge
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH USA
| | - Cynthia A. Fontanella
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
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Pitkänen J, Remes H, Aaltonen M, Martikainen P. Moderating role of sociodemographic factors in parental psychiatric treatment before and after offspring severe self-harm. J Affect Disord 2023; 327:145-154. [PMID: 36758868 DOI: 10.1016/j.jad.2023.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Parental psychiatric disorders are known risk factors for adolescent self-harm. Although this association is likely to have a bidirectional element, evidence on changes in parental psychiatric treatment following offspring self-harm is scarce. METHODS Finnish children born in 1987-1996 with a hospital-treated episode of self-harm between the ages 13 and 19 years (N = 3636) were identified using administrative register data, and their biological mothers (N = 3432) and fathers (N = 3167) were followed two years before and after the episode. Data on purchases of psychotropic medication, specialized psychiatric treatment and psychiatric sickness allowances were used to examine psychiatric treatment among parents. Differences by parental education, employment and living arrangements were assessed, and offspring self-harm was compared with offspring accidental poisonings and traffic accidents. RESULTS Psychiatric treatment peaked among mothers during the three-month period after offspring self-harm, after which the treatment prevalence decreased but remained slightly elevated relative to the time preceding offspring self-harm. Higher levels of education and being employed increased the likelihood of treatment right after the episode. Among fathers, changes in treatment were negligible. Treatment trajectories around the comparison events of accidents were similar in shape but more muted than among the parents whose children had self-harmed. LIMITATIONS General practitioner visits or other data from primary health care were not available. CONCLUSION Mothers receive increased psychiatric treatment after stressful offspring events. Our results indicate that prevention of self-harm and accidents would be beneficial not only for those directly concerned but also for their family members.
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Affiliation(s)
- Joonas Pitkänen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland; International Max Planck Research School for Population, Health and Data Science, Rostock, Germany.
| | - Hanna Remes
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland
| | - Mikko Aaltonen
- Institute of Criminology and Legal Policy, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; Law School, University of Eastern Finland, Joensuu, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland; Max Planck Institute for Demographic Research, Rostock, Germany; Department of Public Health Sciences, Stockholm University, Sweden
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Paul E, Kwong A, Moran P, Pawlby S, Howard LM, Pearson RM. Maternal thoughts of self-harm and their association with future offspring mental health problems. J Affect Disord 2021; 293:422-428. [PMID: 34246951 PMCID: PMC8370273 DOI: 10.1016/j.jad.2021.06.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/21/2021] [Accepted: 06/27/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Depression and self-harm are leading causes of disability in young people, but prospective data on how maternal depression and self-harm thoughts contribute to these outcomes, and how they may interact is lacking. METHODS The study sample consisted of 8,425 mothers and offspring from the Avon Longitudinal Study of Parents and Children, an ongoing birth cohort study. Exposures were maternal self-harm ideation and depression measured using the Edinburgh Postnatal Depression Scale, collected at eleven time points over the period 18 weeks' gestation to 18 years post-partum. Outcomes were offspring past-year major depressive disorder and lifetime self-harm assessed at age 24. RESULTS Nearly one-fifth (16.7%) of mothers reported thoughts of self-harm on at least one of the eleven assessment points. The frequency of maternal self-harm ideation was related to both outcomes in a dose-response manner. Young adults whose mothers had self-harm ideation on 5-11 occasions were over three times more likely (Odds ratio (OR), 3.32; 95% CI, 1.63-6.76) to be depressed and over 1.5 times as likely (OR, 1.55; 95% CI, 0.73, 3.29) to have self-harmed than their peers whose mothers had never reported self-harm thoughts. Maternal self-harm thoughts remained associated with both offspring outcomes independent of maternal depression, and no evidence was found for an interaction between the two exposures. DISCUSSION Clinicians collecting data on maternal depression may consider paying attention to questions about self-harm ideation in assessments. Examining accumulated maternal self-harm ideation over time may provide insights into which children are most at risk for later self-harm and depression.
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Affiliation(s)
- Elise Paul
- Department of Behavioural Science and Health at University College, London, United Kingdom.
| | - Alex Kwong
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Bristol, United Kingdom
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Bristol, United Kingdom.
| | - Susan Pawlby
- Faculty of Life Sciences & Medicine, School of Life Course Sciences, King's College London, London, United Kingdom.
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Rebecca M Pearson
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Bozzini AB, Bauer A, Maruyama J, Simões R, Matijasevich A. Factors associated with risk behaviors in adolescence: a systematic review. ACTA ACUST UNITED AC 2021; 43:210-221. [PMID: 32756805 PMCID: PMC8023154 DOI: 10.1590/1516-4446-2019-0835] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 04/15/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Understanding the distal (≤ 6 years of age) and proximal (between 6 years of age and early adolescence) factors in adolescent risk behavior is important for preventing and reducing morbidity and mortality in this population. This study sought to investigate the factors associated with the following adolescent risk behaviors: i) aggressiveness and violence, ii) tobacco, alcohol, and illicit substance use, iii) depressive behavior and self-harm (including suicidal ideation and attempts), iv) sexual risk behavior, and v) multiple risk behavior. METHODS A systematic review was conducted to identify longitudinal studies that examined factors associated with adolescent risk behaviors. The PubMed, PsycINFO, and LILACS databases were searched. RESULTS Of the 249 included studies, 23% reported distal risk factors, while the remaining reported proximal risk factors. Risk factors were related to sociodemographic characteristics (neighborhood, school, and peers), family patterns, and the presence of other adolescent risk behaviors. CONCLUSION Distal and proximal factors in adolescent risk behavior that are not exclusively socioeconomic, familial, environmental, or social should be explored more thoroughly.
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Affiliation(s)
- Ana Beatriz Bozzini
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Andreas Bauer
- Department of Psychology, University of Bath, Bath, Somerset, UK
| | - Jessica Maruyama
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Ricardo Simões
- Departamento de Ginecologia, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Departamento de Epidemiologia, Universidade Federal de Pelotas (UFPel), Pelotas, RS, Brazil
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Pitkänen J, Bijlsma MJ, Remes H, Aaltonen M, Martikainen P. The effect of low childhood income on self-harm in young adulthood: Mediation by adolescent mental health, behavioural factors and school performance. SSM Popul Health 2021; 13:100756. [PMID: 33681447 PMCID: PMC7910518 DOI: 10.1016/j.ssmph.2021.100756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 11/26/2022] Open
Abstract
Low childhood income is an established risk factor of self-harm in adolescence and young adulthood, and childhood income is additionally associated with various correlates of self-harm. How these correlates, such as psychiatric disorders, substance abuse, violent behaviour and school problems, mediate the effect of childhood income on self-harm, is less understood. The purpose of the current paper is to examine this mediation. The study is based on administrative register data on all Finnish children born in 1990–1995. An analytical sample of 384,121 children is followed from age 8 to 22. We apply the parametric g-formula to study the effect of childhood income on the risk of self-harm in young adulthood. Adolescent psychiatric disorders, substance abuse, prior self-harm, violent criminality and victimization, out-of-home placements, not being in education, employment or training and school performance are considered as potential mediators. We control for confounding factors related to childhood family characteristics. As a hypothetical intervention, we moved those in the lowest childhood income quintile to the second-lowest quintile, which resulted in a 7% reduction in hospital-presenting self-harm in young adulthood among those targeted by the intervention (2% reduction in the total population). 67% of the effect was mediated through the chosen mediators. The results indicate that increases in childhood material resources could protect from self-harm in young adulthood. Moreover, the large proportion of mediation suggests that targeted interventions for high-risk adolescents may be beneficial. To our knowledge, this is the first paper to use the parametric g-formula to study youth self-harm. Future applications are encouraged as the method offers several further opportunities for analysing the complex life course pathways to self-harm. We study mediation in the association between low childhood income and self-harm. Effects of a hypothetical intervention are examined. Most of the effect of low childhood income on the risk of self-harm is indirect. Distinct pathways are identified. The parametric g-formula offers further avenues for self-harm research.
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Affiliation(s)
- Joonas Pitkänen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014, Helsinki, Finland.,International Max Planck Research School for Population, Health and Data Science, Max Planck Institute for Demographic Research, Rostock, Germany
| | | | - Hanna Remes
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014, Helsinki, Finland
| | - Mikko Aaltonen
- Institute of Criminology and Legal Policy, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.,Law School. University of Eastern Finland, Joensuu, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014, Helsinki, Finland.,Max Planck Institute for Demographic Research, Rostock, Germany.,Department of Public Health Sciences, Stockholm University, Sweden
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10
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Navarro MC, Ouellet-Morin I, Geoffroy MC, Boivin M, Tremblay RE, Côté SM, Orri M. Machine Learning Assessment of Early Life Factors Predicting Suicide Attempt in Adolescence or Young Adulthood. JAMA Netw Open 2021; 4:e211450. [PMID: 33710292 PMCID: PMC7955274 DOI: 10.1001/jamanetworkopen.2021.1450] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Although longitudinal studies have reported associations between early life factors (ie, in-utero/perinatal/infancy) and long-term suicidal behavior, they have concentrated on 1 or few selected factors, and established associations, but did not investigate if early-life factors predict suicidal behavior. OBJECTIVE To identify and evaluate the ability of early-life factors to predict suicide attempt in adolescents and young adults from the general population. DESIGN, SETTING, AND PARTICIPANTS This prognostic study used data from the Québec Longitudinal Study of Child Development, a population-based longitudinal study from Québec province, Canada. Participants were followed-up from birth to age 20 years. Random forest classification algorithms were developed to predict suicide attempt. To avoid overfitting, prediction performance indices were assessed across 50 randomly split subsamples, and then the mean was calculated. Data were analyzed from November 2019 to June 2020. EXPOSURES Factors considered in the analysis included 150 variables, spanning virtually all early life domains, including pregnancy and birth information; child, parents, and neighborhood characteristics; parenting and family functioning; parents' mental health; and child temperament, as assessed by mothers, fathers, and hospital birth records. MAIN OUTCOMES AND MEASURES The main outcome was self-reported suicide attempt by age 20 years. RESULTS Among 1623 included youths aged 20 years, 845 (52.1%) were female and 778 (47.9%) were male. Models show moderate prediction performance. The areas under the curve for the prediction of suicide attempt were 0.72 (95% CI, 0.71-0.73) for females and 0.62 (95% CI, 0.60-0.62) for males. The models showed low sensitivity (females, 0.50; males, 0.32), moderate positive predictive values (females, 0.60; males, 0.62), and good specificity (females, 0.76; males, 0.82) and negative predicted values (females, 0.75; males, 0.71). The most important factors contributing to the prediction included socioeconomic and demographic characteristics of the family (eg, mother and father education and age, socioeconomic status, neighborhood characteristics), parents' psychological state (specifically parents' antisocial behaviors) and parenting practices. Birth-related variables also contributed to the prediction of suicidal behavior (eg, prematurity). Sex differences were also identified, with family-related socioeconomic and demographic characteristics being the top factors for females and parents' antisocial behavior being the top factor for males. CONCLUSIONS AND RELEVANCE These findings suggest that early life factors contributed modestly to the prediction of suicidal behavior in adolescence and young adulthood. Although these factors may inform the understanding of the etiological processes of suicide, their utility in the long-term prediction of suicide attempt was limited.
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Affiliation(s)
- Marie C. Navarro
- Bordeaux Population Health Research Center, Institut national de la santé et de la recherche médicale U1219, University of Bordeaux, Bordeaux, France
| | - Isabelle Ouellet-Morin
- School of Criminology, Research Center of the Montreal Mental Health University Institute, University of Montreal, Montreal, Canada
| | - Marie-Claude Geoffroy
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Michel Boivin
- School of Psychology, University of Laval, Quebec City, Canada
| | - Richard E. Tremblay
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Department of Pediatrics and Psychology, University of Montreal, Montreal, Canada
| | - Sylvana M. Côté
- Bordeaux Population Health Research Center, Institut national de la santé et de la recherche médicale U1219, University of Bordeaux, Bordeaux, France
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada
| | - Massimiliano Orri
- Bordeaux Population Health Research Center, Institut national de la santé et de la recherche médicale U1219, University of Bordeaux, Bordeaux, France
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Canada
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Levesque AR, MacDonald S, Berg SA, Reka R. Assessing the Impact of Changes in Household Socioeconomic Status on the Health of Children and Adolescents: A Systematic Review. ADOLESCENT RESEARCH REVIEW 2021; 6:91-123. [PMID: 33553578 PMCID: PMC7853168 DOI: 10.1007/s40894-021-00151-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/15/2021] [Indexed: 06/12/2023]
Abstract
UNLABELLED Understanding how child and adolescent health is influenced by fluctuations in socioeconomic status has important public health and policy implications, as children are often subjected to both micro and macro-level socioeconomic events. This study provides the first systematic review to date on the relationship between changes in household or parental socioeconomic status and subsequent child and adolescent health outcomes. Eighty articles were identified for inclusion in this review, examining 85 different socioeconomic exposures in five categories: Income (n = 64), Employment (n = 14), Socioeconomic Mobility (n = 3), Education (n = 2), and Food Insecurity (n = 2). The health outcomes analyzed by these eighty articles were separated into eight discrete categories, with many articles examining outcomes in more than one category: Anthropometric Measurements (n = 21), Cognition and Development (n = 15), Dental Health (n = 3), Health Behaviours (n = 9), Mental Health (n = 12), Overall Parent/Guardian Assessed health (n = 6); Physical Health Outcomes (n = 11), and Socio-Emotional Behaviour (n = 30). Several consistent patterns emerged in the literature, such as a link between increased income and improved, or decreased income and deteriorating, cognition, dental health, and physical health. The results of this review suggest a need to replicate current studies in diverse geographies to expand generalizability and clarify regional patterns. There should also be an effort to go beyond income, and employment, to assess the relationship between less frequently studied socioeconomic exposures and child health outcomes. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40894-021-00151-8.
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Affiliation(s)
| | - Sarah MacDonald
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON Canada
| | - Selinda Adelle Berg
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON Canada
- Leddy Library, University of Windsor, Windsor, ON Canada
| | - Roger Reka
- Leddy Library, University of Windsor, Windsor, ON Canada
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12
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Lower estimated intelligence quotient is associated with suicide attempts in pediatric bipolar disorder. J Affect Disord 2020; 261:103-109. [PMID: 31610309 DOI: 10.1016/j.jad.2019.09.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 08/28/2019] [Accepted: 09/30/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Approximately 20% of individual with pediatric bipolar disorder (PBD) have a lifetime history of suicide attempt. Some cognitive measures were associated with a suicide attempt, but no study has assessed the association of this event with the estimated intelligence quotient (IQ) in PBI. In adult Bipolar Disorder no association between IQ and suicidality was found, with different correlations between cognitive measures. There are studies in general population showing a negative correlation and others did not find any association. In Schizophrenia, IQ had a positive correlation with suicide attempt. So, the correlation between IQ and suicidality still controversial. METHODS We recruited 63 children and adolescents younger than 18 years of age with PBD based on DSM-IV criteria from an outpatient clinic in Brazil. Manic and depressive symptoms were assessed with the YMRS and CDRS, respectively. Estimated IQ was assessed with the WISC-III. The presence or absense of suicidal attempt, clinical and demographic variables were assessed with the K-SADS-PL-W. RESULTS Patients who attempted suicide had lower estimated IQ compared to patients who did not attempt suicide (82.72 ± 18.70 vs. 101.0 ± 14.36; p = 0.009). This finding remained after correction for depressive symptoms and family income (OR = 0.94; 95% CI = 0.89 - 0.99; p = 0.029). LIMITATIONS Small sample, reverse causality could not be discarded, we only used two subscales of the WISC-III to estimate intelligence. CONCLUSION Estimated IQ and suicide attempts were negative correlated in PBD. Future longitudinal and larger studies may confirm our findings.
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Pitkänen J, Remes H, Aaltonen M, Martikainen P. Experience of maternal and paternal adversities in childhood as determinants of self-harm in adolescence and young adulthood. J Epidemiol Community Health 2019; 73:1040-1046. [PMID: 31431474 DOI: 10.1136/jech-2019-212689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/02/2019] [Accepted: 08/07/2019] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Previous studies suggest that childhood experience of parental adversities increases the risk of subsequent offspring self-harm, but studies on distinct paternal and maternal characteristics are few and it remains unclear how these interact with childhood social position. The study aims to assess whether paternal and maternal adversities have different associations with offspring self-harm in adolescence and young adulthood. Interaction by offspring gender and childhood income are investigated, as well as cumulative effects of multiple adversities. METHODS The study uses administrative register data on a 20% random sample of Finnish households with children aged 0-14 years in 2000. We follow children born in 1986-1998 (n=155 855) from their 13th birthday until 2011. Parental substance abuse, psychiatric disorders, criminality and hospitalisations due to interpersonal violence or self-harm are used to predict offspring self-harm with Cox proportional hazards models. RESULTS The results show a clear increase in the risk of self-harm among those exposed to maternal or paternal adversities with HRs between 1.5 and 5.4 among boys and 1.7 and 3.9 among girls. The excess risks hold for every measure of maternal and paternal adversities after adjusting for childhood income and parental education. Evidence was found suggesting that low income, accumulation of adversity and female gender may exacerbate the consequences of adversities. CONCLUSIONS Our findings suggest that both parents' adversities increase the risk of self-harm and that multiple experiences of parental adversities in childhood are especially harmful, regardless of parent gender. Higher levels of childhood income can protect from the negative consequences of adverse experiences.
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Affiliation(s)
- Joonas Pitkänen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Hanna Remes
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Mikko Aaltonen
- Institute of Criminology and Legal Policy, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.,Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Stockholm, Sweden.,Max Planck Institute for Demographic Research, Rostock, Germany
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Ibrahim N, Che Din N, Ahmad M, Amit N, Ghazali SE, Wahab S, Abdul Kadir NB, Halim FW, A Halim MRT. The role of social support and spiritual wellbeing in predicting suicidal ideation among marginalized adolescents in Malaysia. BMC Public Health 2019; 19:553. [PMID: 31196009 PMCID: PMC6565529 DOI: 10.1186/s12889-019-6861-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background The high number of adolescents and young adults harbouring suicidal ideation, as reported by the Ministry of Health Malaysia, is alarming. This cross-sectional study aims to examine the association between social support and spiritual wellbeing in predicting suicidal ideation among Malaysian adolescents. Methods A total of 176 adolescents in selected urban areas in the states of Wilayah Persekutuan and Selangor were selected. The Suicide Ideation Scale (SIS) was used to measure the level of severity or tendency of suicidal ideation. The Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure the perceived social support received by the respondent while the Spiritual Wellbeing Scale (SWBS) was used to measure the religious wellbeing (RWB), the existential wellbeing (EWB) and the overall score of spiritual wellbeing (SWB). Results The study found that both RWB and EWB showed significant negative correlation with suicidal ideation. Similarly, support from family and friends also showed a negative correlation with suicidal ideation. Further analysis using multiple regressions showed that RWB and SWB, and family support predict suicidal ideation in adolescents. Conclusion Spiritual wellbeing in combination with family support plays a major role in predicting suicidal ideation. Therefore, intervention for encompassing spirituality and family support may contribute to a more positive outcome in suicidal adolescents.
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Affiliation(s)
- Norhayati Ibrahim
- Health Psychology Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Normah Che Din
- Health Psychology Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mahadir Ahmad
- Health Psychology Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noh Amit
- Health Psychology Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
| | - Shazli Ezzat Ghazali
- Health Psychology Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Suzaily Wahab
- Psychiatry Department, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Bandar Tun Razak Cheras, Malaysia
| | - Nor Ba'yah Abdul Kadir
- Centre of Human and Societal Well-being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Fatimah Wati Halim
- Centre of Human and Societal Well-being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Mohd Radzi Tarmizi A Halim
- Centre of Human and Societal Well-being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
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Orri M, Gunnell D, Richard-Devantoy S, Bolanis D, Boruff J, Turecki G, Geoffroy MC. In-utero and perinatal influences on suicide risk: a systematic review and meta-analysis. Lancet Psychiatry 2019; 6:477-492. [PMID: 31029623 DOI: 10.1016/s2215-0366(19)30077-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/12/2019] [Accepted: 02/26/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Adverse in-utero and perinatal conditions might contribute to an increased suicide risk throughout the lifespan; however, existing evidence is sparse and contradictory. We aimed to investigate in-utero and perinatal exposures associated with suicide, suicide attempt, and suicidal ideation. METHODS We did a systematic review and meta-analysis and searched MEDLINE, Embase, and PsycINFO from inception to Jan 24, 2019, for population-based prospective studies that investigated the association between in-utero and perinatal factors and suicide, suicide attempt, and suicidal ideation. Only papers published in English in peer-reviewed journals were considered. Two researchers independently extracted formal information (eg, country, year, duration of follow-up) and number of cases and non-cases exposed and non-exposed to each risk factor. We calculated pooled odds ratios (ORs) with 95% CIs using random-effects models and used meta-regression to investigate heterogeneity. This study was registered with PROSPERO, number CRD42018091205. FINDINGS We identified 42 eligible studies; they had a low risk of bias (median quality score 9/9 [IQR 8-9]). Family or parental characteristics, such as high birth order (eg, for fourth-born or later-born vs first-born, pooled OR 1·51 [95% CIs 1·21-1·88]), teenage mothers (1·80 [1·52-2·14]), single mothers (1·57 [1·31-1·89]); indices of socioeconomic position, such as low maternal (1·36 [1·28-1·46]) and paternal (1·38 [1·27-1·51]) education; and fetal growth (eg, low birthweight 1·30 [1·09-1·55] and small for gestational age 1·18 [1·00-1·40]) were associated with higher suicide risk. Father's age, low gestational age, obstetric characteristics (eg, caesarean section), and condition or exposure during pregnancy (eg, maternal smoking or hypertensive disease) were not associated with higher suicide risk. Similar patterns of associations were observed for suicide attempt and suicidal ideation; however, these results were based on a lower number of studies. In meta-regression, differences in length of follow-up explained most between-study heterogeneity (inital I2 ranged from 0 to 79·5). INTERPRETATION These findings suggest that prenatal and perinatal characteristics are associated with increased suicide risk during the life course, supporting the developmental origin of health and diseases hypothesis for suicide. The low number of studies for some risk factors, especially for suicide attempt and ideation, leaves gaps in knowledge that need to be addressed. The mechanisms underlying the reported associations and their causal nature still remain unclear. FUNDING Horizon 2020 (EU).
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Affiliation(s)
- Massimiliano Orri
- McGill Group for Suicide Studies, Douglas Mental Health University Institute and Department of Psychiatry, McGill University, Montreal, QC, Canada; Bordeaux Population Health Research Centre, Inserm U1219, University of Bordeaux, Bordeaux, France
| | - David Gunnell
- Population Health Sciences, University of Bristol, Bristol, UK; National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Stephane Richard-Devantoy
- McGill Group for Suicide Studies, Douglas Mental Health University Institute and Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Despina Bolanis
- McGill Group for Suicide Studies, Douglas Mental Health University Institute and Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Jill Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, QC, Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute and Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Marie-Claude Geoffroy
- McGill Group for Suicide Studies, Douglas Mental Health University Institute and Department of Psychiatry, McGill University, Montreal, QC, Canada; Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada.
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Family income inequalities and trajectories through childhood and self-harm and violence in young adults: a population-based, nested case-control study. LANCET PUBLIC HEALTH 2019; 3:e498-e507. [PMID: 30314594 DOI: 10.1016/s2468-2667(18)30164-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/02/2018] [Accepted: 08/17/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Childhood poverty is associated with elevated later risks for self-directed and externalised violence, but how risks are modified by parental socioeconomic mobility remains unclear. We investigated parental income trajectories during childhood and subsequent risks of self-harm and violent criminality in young adulthood. METHODS Using Danish national registers, we delineated a nested case-control study of Danish citizens born from Jan 1, 1982, to Dec 31, 2000, with first hospital-treated self-harm episodes and first violent crime convictions at ages 15-33 years. Each case was matched on age and gender to 25 randomly selected controls. Parental income was assessed in birth-year and at ages 5 years, 10 years, and 15 years. We considered parental age, the child's number of siblings, parental mental health, and parental education to be covariates. We estimated incidence rate ratios (IRRs) by conditional logistic regression inherently adjusted for age, gender, and calendar year; we then made additional adjustments for the covariates considered. FINDINGS We identified 21 267 first episodes of hospital-treated self-harm, to which we matched 531 675 controls, and 23 724 first violent crime convictions, to which we matched 593 100 controls. We observed inverse relationships between parental income and risks for the two outcomes for each of the ages parental income was measured. The longer a child lived in poorer circumstances, the higher their subsequent risks for self-harm and violent criminality, and vice versa for time spent living in affluent conditions. Associations were stronger for violent criminality than for self-harm. Compared with individuals who were born and remained in the most affluent families, all other income trajectories were associated with elevated risks for both outcomes. Those who remained in the least affluent quintile showed the highest risks for self-harm (IRR 7·2, 95% CI 6·6-7·9; 1174 [6%] cases) and for violent criminality (IRR 13·0; 95% CI 11·9-14·1; 1640 [7%] cases). The risk patterns were attenuated, but essentially persisted, after covariate adjustment. For any parental income level at birth, being upwardly mobile was associated with lower risk compared with downward mobility. INTERPRETATION Parental income represents a multitude of unmeasured familial sociodemographic indices. Tackling the causes of inequality and associated psychosocial and sociocultural challenges to enable upwards socioeconomic mobility could potentially reduce risks for self-directed and externalised violence. FUNDING European Research Council.
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Rukundo GZ, Kemigisha E, Ocan M, Adriko W, Akena DH. A systematic review of the risk factors for suicidal ideation, suicidal attempt and completed suicide among children and adolescents in sub-Saharan Africa between 1986 and 2018: protocol for a systematic review of observational studies. Syst Rev 2018; 7:230. [PMID: 30541623 PMCID: PMC6292009 DOI: 10.1186/s13643-018-0901-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is one of the leading causes of death among children and adolescents. Most studies about the burden and risk factors for suicide have been conducted in high-income countries. However, there is a dearth in the literature about the burden and risk factors for suicide among children and adolescents in low- and middle-income countries including within Sub-Saharan Africa (SSA). There is need to summarise the available literature about the burden and risk factors for suicide among children and adolescents in SSA. In this review, we will (a) determine the overall prevalence of suicidal ideation, suicidal attempt and completed suicide among children and adolescents in SSA; (b) describe the methods (such as hanging, firearms, overdose, poisoning, drowning and burning) used for suicidal attempt, and completed suicide among children and adolescents in SSA; and (c) document the risk factors for suicidal ideation, suicidal attempt and completed suicide among children and adolescents in SSA. METHODS The review will be conducted and reported in accordance to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. We will include journal articles that have documented the prevalence and risk factors for suicidal ideation, suicidal attempt and completed suicide among children and adolescents aged 5-19 years in SSA. We will also include accessible grey literature about the topic. Qualitative studies will be excluded from the study since they are limited in estimating prevalence. We will search different search engines including PUBMED, EMBASE, Psych-INFO, Cochrane Library, Africa wide-information and global health using suicide, adolescents and children, SSA as the keywords. We will use a meta-analysis, should we find that there is no heterogeneity between included studies. DISCUSSION This protocol describes a systematic review of observational studies reporting completed suicide, suicidal ideation and suicidal attempt among children and adolescents in sub-Saharan Africa. We anticipate that once this review is complete and published, our findings will be of interest to adolescents with suicidal behaviour, their families and caregivers, clinicians and other healthcare professionals, scientists and policy makers. SYSTEMATIC REVIEW REGISTRATION PROSPERO International prospective register of systematic reviews: CRD42016048610 .
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Affiliation(s)
- Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology and African Centre for Suicide Research, Mbarara, Uganda.
| | - Elizabeth Kemigisha
- Faculty of Interdiscilinary Studies, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Moses Ocan
- Department of Pharmacology & Therapeutics, Makerere College of Health Sciences, Kampala, Uganda
| | - Wilson Adriko
- Library, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Dickens Howard Akena
- Department of Psychiatry, Makerere College of Health Sciences and African Centre for Systematic, Kampala, Uganda
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Nilsson SF, Nordentoft M. How family income is associated with suicidal and violent behaviour in young adults. LANCET PUBLIC HEALTH 2018; 3:e463-e464. [DOI: 10.1016/s2468-2667(18)30181-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 11/30/2022]
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Horváth LO, Balint M, Ferenczi-Dallos G, Farkas L, Gadoros J, Gyori D, Kereszteny A, Meszaros G, Szentivanyi D, Velo S, Sarchiapone M, Carli V, Wasserman C, Hoven CW, Wasserman D, Balazs J. Direct Self-Injurious Behavior (D-SIB) and Life Events among Vocational School and High School Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1068. [PMID: 29795028 PMCID: PMC6025121 DOI: 10.3390/ijerph15061068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/28/2018] [Accepted: 05/19/2018] [Indexed: 01/21/2023]
Abstract
Although several studies have recently assessed direct self-injurious behavior (D-SIB) among adolescents, it is still understudied in adolescents attending vocational schools: an educational setting generally associated with lower socioeconomic status. After extending the "Saving and Empowering Young Lives in Europe" (SEYLE) project to a vocational school population, we examined their D-SIB and life event characteristics compared to the high school population. SEYLE's Hungarian randomly selected high school sample (N = 995) was completed with a randomly selected vocational school sample (N = 140) in Budapest, Hungary. Participants aged 14⁻17 years completed the SEYLE project's self-administered questionnaires. D-SIB lifetime prevalence was significantly higher (29.4%) in the vocational school group compared to the high school group (17.2%) (Χ²(1) = 12.231, p< 0.001). D-SIB was associated with suicidal ideation in the vocational school group. Different life events were more frequent in the high school than in the vocational school group, and associations between D-SIB and life events differed in the vocational school group compared to the high school group. In conclusion, vocational school students are a vulnerable population with a higher prevalence of D-SIB compared to high school students. Life events and their association with D-SIB also differ in vocational school students compared to high school students. Taking all these into account might contribute to prevention/intervention designed for this population.
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Affiliation(s)
- Lili O Horváth
- Doctoral School of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
| | - Maria Balint
- Pedagogical Services, Budapest District 12, 1126 Budapest, Hungary.
| | | | - Luca Farkas
- West Hertfordshire Specialist CAMHS St Albans Clinic, AL3 5TL St Albans, UK.
| | - Julia Gadoros
- Vadaskert Child and Adolescent Psychiatry Hospital and Outpatient Clinic, 1021 Budapest, Hungary.
| | - Dora Gyori
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
| | - Agnes Kereszteny
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
- Semmelweis University, Mental Health Sciences Doctoral School, 1083 Budapest, Hungary.
| | - Gergely Meszaros
- Vadaskert Child and Adolescent Psychiatry Hospital and Outpatient Clinic, 1021 Budapest, Hungary.
- Semmelweis University, Mental Health Sciences Doctoral School, 1083 Budapest, Hungary.
| | - Dora Szentivanyi
- Doctoral School of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
| | - Szabina Velo
- Doctoral School of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
| | - Marco Sarchiapone
- Department of Health Sciences, University of Molise, 86100 Molise, Italy.
| | - Vladimir Carli
- Department of Health Sciences, University of Molise, 86100 Molise, Italy.
- Karolinska Institutet, SE-171 77 Stockholm, Sweden.
| | - Camilla Wasserman
- Global Psychiatric Epidemiology, Columbia University-New York State Psychiatric Institute, New York, NY 10032, USA.
| | - Christina W Hoven
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
| | | | - Judit Balazs
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
- Vadaskert Child and Adolescent Psychiatry Hospital and Outpatient Clinic, 1021 Budapest, Hungary.
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Valencia-Agudo F, Burcher GC, Ezpeleta L, Kramer T. Nonsuicidal self-injury in community adolescents: A systematic review of prospective predictors, mediators and moderators. J Adolesc 2018. [PMID: 29522914 DOI: 10.1016/j.adolescence.2018.02.012] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nonsuicidal self-injury (NSSI) usually starts during adolescence and is associated with an array of psychological and psychiatric symptoms and future suicide attempts. The aim of this study is to determine prospective predictors, mediators and moderators of NSSI in adolescent community samples in order to target prevention and treatment strategies. Two team members searched online databases independently. Thirty-nine studies were included in the review. Several variables were seen to prospectively predict NSSI: female gender, family-related variables, peer victimisation, depression, previous NSSI and self-concept. Few studies analysed mediators and moderators. Low self-concept was highlighted as a relevant moderator in the relationship between intra/interpersonal variables and NSSI. Implications of these findings are discussed. The considerable heterogeneity between studies posed a limitation to determine robust predictors of NSSI. Further prospective studies using standardised measures of predictors and outcomes are needed to ascertain the most at risk individuals and develop prevention strategies.
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Affiliation(s)
- Fatima Valencia-Agudo
- Clinical and Health Psychology Department, Autonomous University of Barcelona, Facultat de Psicologia UAB, Departament de Psicologia Clínica i de la Salut, Edifici B1, Campus de la Universitat Autònoma de Barcelona, Carrer de Ca n'Altayó, s/n, 08193, Bellaterra, Barcelona, Spain; Centre for Psychiatry, Imperial College London, 7th Floor Commonwealth Building, Du Cane Road, London, W12 0NN, UK.
| | - Georgina Corbet Burcher
- Centre for Psychiatry, Imperial College London, 7th Floor Commonwealth Building, Du Cane Road, London, W12 0NN, UK
| | - Lourdes Ezpeleta
- Clinical and Health Psychology Department, Autonomous University of Barcelona, Facultat de Psicologia UAB, Departament de Psicologia Clínica i de la Salut, Edifici B1, Campus de la Universitat Autònoma de Barcelona, Carrer de Ca n'Altayó, s/n, 08193, Bellaterra, Barcelona, Spain
| | - Tami Kramer
- Centre for Psychiatry, Imperial College London, 7th Floor Commonwealth Building, Du Cane Road, London, W12 0NN, UK
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Lodebo BT, Möller J, Larsson JO, Engström K. Socioeconomic position and self-harm among adolescents: a population-based cohort study in Stockholm, Sweden. Child Adolesc Psychiatry Ment Health 2017; 11:46. [PMID: 28878818 PMCID: PMC5585967 DOI: 10.1186/s13034-017-0184-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/23/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Understanding the association between parental socioeconomic position and self-harm in adolescence is crucial due to its substantial magnitude and associated inequality. Most previous studies have been either of cross-sectional nature or based solely on self-reports or hospital treated self-harm. The aim of this study is to determine the association between parental socioeconomic position and self-harm among adolescents with a specific focus on gender and severity of self-harm. METHODS A total of 165,932 adolescents born 1988-1994 who lived in Stockholm at the age of 13 were followed in registers until they turned 18. Self-harm was defined as first time self-harm and severity of self-harm was defined as hospitalized or not. Socioeconomic position was defined by parental education and household income. Cox proportional hazards regression were used to estimate hazard ratios (HR) with 95% confidence intervals (CI). RESULTS Analyses showed an association between parental socioeconomic position and self-harm. Among adolescents with parents with primary and secondary education compared to tertiary parental education the HR were 1.10 (95% CI 0.97-1.24) and 1.16 (95% CI 1.08-1.25) respectively. Compared to the highest income category, adolescents from the lower income categories were 1.08 (95% CI 0.97-1.22) to 1.19 (95% CI 1.07-1.33) times more likely to self-harm. In gender-stratified analyses, an association was found only among girls. Further, restriction to severe cases eliminated the association. CONCLUSIONS This study suggested that low parental socioeconomic position is associated with self-harm in adolescence, predominantly among girls. The desertion of an association among severe cases may be explained by differences in suicidal intent and underlying psychiatric diagnosis. Efforts to prevent self-harm should consider children with low parental socioeconomic position as a potential target group.
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Affiliation(s)
- Bereket T. Lodebo
- 0000 0004 1937 0626grid.4714.6Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18a, 17177 Stockholm, Sweden
| | - Jette Möller
- 0000 0004 1937 0626grid.4714.6Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18a, 17177 Stockholm, Sweden
| | - Jan-Olov Larsson
- 0000 0004 1937 0626grid.4714.6Department of Women’s and Children’s Health, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Karin Engström
- 0000 0004 1937 0626grid.4714.6Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18a, 17177 Stockholm, Sweden
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Parents of youth who self-injure: a review of the literature and implications for mental health professionals. Child Adolesc Psychiatry Ment Health 2015; 9:35. [PMID: 26421058 PMCID: PMC4586015 DOI: 10.1186/s13034-015-0066-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/25/2015] [Indexed: 11/18/2022] Open
Abstract
Non-suicidal self-injury (NSSI) is a common mental health concern among youth, and parents can be valuable supports for these youth. However, youth NSSI can have a significant impact on parents' wellbeing, which may in turn alter parents' ability to support the youth. To date, no single article has consolidated the research on parents of youth who self-injure. This review synthesizes the literature on parent factors implicated in youth NSSI risk, the role of parents in help-seeking and intervention for youth NSSI, and the impact of youth NSSI on parent wellbeing and parenting. Clinical implications for supporting parents as they support the youth are also discussed, and recommendations for future research are outlined.
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Mars B, Heron J, Crane C, Hawton K, Kidger J, Lewis G, Macleod J, Tilling K, Gunnell D. Differences in risk factors for self-harm with and without suicidal intent: findings from the ALSPAC cohort. J Affect Disord 2014; 168:407-14. [PMID: 25108277 PMCID: PMC4160300 DOI: 10.1016/j.jad.2014.07.009] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/04/2014] [Accepted: 07/07/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a lack of consensus about whether self-harm with suicidal intent differs in aetiology and prognosis from non-suicidal self-harm, and whether they should be considered as different diagnostic categories. METHOD Participants were 4799 members of the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK population-based birth cohort who completed a postal questionnaire on self-harm with and without suicidal intent at age 16 years. Multinomial logistic regression analyses were used to examine differences in the risk factor profiles of individuals who self-harmed with and without suicidal intent. RESULTS Many risk factors were common to both behaviours, but associations were generally stronger in relation to suicidal self-harm. This was particularly true for mental health problems; compared to those with non-suicidal self-harm, those who had harmed with suicidal intent had an increased risk of depression (OR 3.50[95% CI 1.64, 7.43]) and anxiety disorder (OR 3.50[95% CI 1.72, 7.13]). Higher IQ and maternal education were risk factors for non-suicidal self-harm but not suicidal self-harm. Risk factors that appeared specific to suicidal self-harm included lower IQ and socioeconomic position, physical cruelty to children in the household and parental self-harm. LIMITATIONS i) There was some loss to follow-up, ii) difficulty in measuring suicidal intent, iii) we cannot rule out the possibility of reverse causation for some exposure variables, iv) we were unable to identify the subgroup that had only ever harmed with suicidal intent. CONCLUSION Self-harm with and without suicidal intent are overlapping behaviours but with some distinct characteristics, indicating the importance of fully exploring vulnerability factors, motivations, and intentions in adolescents who self harm.
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Affiliation(s)
- Becky Mars
- School of Social and Community Medicine, University of Bristol, United Kingdom.
| | - Jon Heron
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Catherine Crane
- Department of Psychiatry, University of Oxford, United Kingdom
| | - Keith Hawton
- Department of Psychiatry, University of Oxford, United Kingdom
| | - Judi Kidger
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Glyn Lewis
- Mental Health Sciences Unit, University College London, United Kingdom
| | - John Macleod
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, United Kingdom
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Parental suicide attempt and offspring self-harm and suicidal thoughts: Results from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. J Am Acad Child Adolesc Psychiatry 2014; 53:509-17.e2. [PMID: 24745951 DOI: 10.1016/j.jaac.2013.12.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 12/18/2013] [Accepted: 01/02/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Parental suicidal behavior is associated with offspring's risk of suicidal behavior. However, much of the available evidence is from population registers or clinical samples. We investigated the associations of self-reported parental suicide attempt (SA) with offspring self-harm and suicidal thoughts in the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective birth cohort. METHOD Parental SA was self-reported on 10 occasions from pregnancy until their child was 11 years of age. Offspring self-reported lifetime self-harm, with and without suicidal intent, suicidal thoughts, and suicide plans, at age 16 to 17 years. Multivariable regression models quantified the association between parental SA and offspring outcomes controlling for confounders. RESULTS Data were available for 4,396 mother-child and 2,541 father-child pairs. Adjusting for confounders including parental depression, maternal SA was associated with a 3-fold increased risk of self-harm with suicidal intent in their children (adjusted odds ratio [aOR] = 2.94, 95% confidence interval [CI] = 1.43-6.07) but not with self-harm without suicidal intent (aOR = 0.83, 95% CI = 0.35-1.99). Children whose mother attempted suicide were more likely to report suicidal thoughts and plans (aOR = 5.04, 95% CI = 2.24-11.36; aOR = 2.17, 95% CI = 1.07-4.38, respectively). Findings in relation to paternal SA were somewhat weaker and not significant. CONCLUSIONS Maternal SA increased their offspring's risk of self-harm with suicidal intent and of suicidal thoughts, but was unrelated to self-harm without intent; findings for paternal suicide attempt were weaker and not significant. Maternal SA, which may not come to the attention of health care professionals, represents a major risk for psychiatric morbidity in their offspring.
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School effects on risk of non-fatal suicidal behaviour: a national multilevel cohort study. Soc Psychiatry Psychiatr Epidemiol 2014; 49:609-18. [PMID: 24158314 DOI: 10.1007/s00127-013-0782-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 10/14/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Research has demonstrated school effects on health, over and above the effects of students' individual characteristics. This approach has however been uncommon in mental health research. The aim of the study was to assess whether there are any school-contextual effects related to socioeconomic characteristics and academic performance, on the risk of hospitalization from non-fatal suicidal behaviour (NFSB). METHODS A Swedish national cohort of 447,929 subjects was followed prospectively in the National Patient Discharge Register from the completion of compulsory school in 1989-93 (≈16 years) until 2001. Multilevel logistic regression was used to assess the association between school-level characteristics and NFSB. RESULTS A small but significant share of variation in NFSB was accounted for by the school context (variance partition coefficient <1%, median odds ratio = 1.26). The risk of NFSB was positively associated with the school's proportion of students from low socioeconomic status (SES), single parent household, and the school's average academic performance. School effects varied, in part, by school location. CONCLUSION NFSB seems to be explained mainly by individual-level characteristics. Nevertheless, a concentration of children from disadvantaged backgrounds in schools appears to negatively affect mental health, regardless of whether or not they are exposed to such problems themselves. Thus, school SES should be considered when planning prevention of mental health problems in children and adolescents.
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