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Zheng X, Chen Y, Zhu J. Sleep problems mediate the influence of childhood emotional maltreatment on adolescent non-suicidal self-injury: The moderating effect of rumination. CHILD ABUSE & NEGLECT 2023; 140:106161. [PMID: 37002976 DOI: 10.1016/j.chiabu.2023.106161] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/01/2023] [Accepted: 03/24/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a highly serious public health problem among adolescents in China, and childhood emotional maltreatment has been found to be a risk factor for NSSI. OBJECTIVE Little is known about the longitudinal association between childhood emotional maltreatment and NSSI as well as its underlying mediating and moderating mechanisms. Thus, we hypothesized whether sleep problems mediated the association between childhood emotional maltreatment and NSSI, and whether this indirect effect was moderated by rumination. PARTICIPANTS AND SETTING A total of 1987 Chinese adolescents (56.1 % males; ages 10 to 14, M = 12.32, SD = 0.53) completed self-report questionnaires regarding childhood emotional maltreatment, sleep problems, rumination non-suicidal self-injury (NSSI) in three waves. METHODS Structural equation model was used to test a moderated mediation model, with gender, age and socioeconomic status and baseline measures as covariates. RESULTS Childhood emotional maltreatment was significantly associated with NSSI, and this association was mediated by sleep problems. Moderated mediation analyses revealed that rumination intensified the relation between childhood emotional maltreatment and sleep problems as well as the relation between sleep problems and NSSI. CONCLUSIONS Findings of this study demonstrate a relationship among childhood emotional maltreatment, sleep problems, rumination and NSSI. Interventions that target sleep problems and rumination may be beneficial for reducing NSSI for at-risk adolescents.
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Affiliation(s)
- Xiaoyu Zheng
- Center for Early Environment and Brain Development, School of Education, Guangzhou University, Guangzhou, China; Jing Hengyi School of Education, Hangzhou Normal University, Hangzhou, China
| | - Yuanyuan Chen
- School of Education, Guangzhou University, Guangzhou, Guangdong, China.
| | - Jianjun Zhu
- Center for Early Environment and Brain Development, School of Education, Guangzhou University, Guangzhou, China.
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Pham TTL, O’Brien KS, Berecki-Gisolf J, Liu S, Gibson K, Clapperton A. Intentional self-harm in culturally and linguistically diverse communities: A study of hospital admissions in Victoria, Australia. Aust N Z J Psychiatry 2023; 57:69-81. [PMID: 34881672 PMCID: PMC9791328 DOI: 10.1177/00048674211063421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To examine the rates and profiles of intentional self-harm hospital admissions among people from culturally and linguistically diverse and non-culturally and linguistically diverse backgrounds. METHODS A retrospective analysis of 29,213 hospital admissions for self-harm among people aged 15 years or older in Victoria, Australia, was conducted using data from the Victorian Admitted Episodes Dataset between 2014/2015 and 2018/2019. The Victorian Admitted Episodes Dataset records all hospital admissions in public and private hospitals in Victoria (population 6.5 million). Population-based incidence of self-harm, logistic regression and percentages (95% confidence intervals) were calculated to compare between culturally and linguistically diverse groups by birthplaces and the non-culturally and linguistically diverse groups of self-harm admissions. RESULTS When grouped together culturally and linguistically diverse individuals had lower rates of (hospital-treated) self-harm compared with the non-culturally and linguistically diverse individuals. However, some culturally and linguistically diverse groups such as those originating from Sudan and Iran had higher rates than non-culturally and linguistically diverse groups. Among self-harm hospitalised patients, those in the culturally and linguistically diverse group (vs non-culturally and linguistically diverse group) were more likely to be older, Metropolitan Victorian residents, from the lowest socioeconomic status, and being ever or currently married. Self-harm admissions by persons born in Southern and Eastern Europe were the oldest of all groups; in all other groups number of admissions tended to decrease as age increased whereas in this group the number of admissions increased as age increased. CONCLUSION There was considerable heterogeneity in rates of hospital-treated self-harm in culturally and linguistically diverse communities, with some countries of origin (e.g. Sudan, Iran) having significantly higher rates. Some of this variation may be due to factors relating to the mode of entry into Australia (refugee vs planned migration), and future research needs to examine this possibility and others, to better plan for support needs in the culturally and linguistically diverse communities most affected by self-harm. Combining all culturally and linguistically diverse people into one group may obscure important differences in self-harm. Different self-harm prevention strategies are likely to be needed for different culturally and linguistically diverse populations.
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Affiliation(s)
- Thi Thu Le Pham
- Monash University Accident Research Centre, Monash University, Clayton, VIC, Australia,Thi Thu Le Pham, Monash University Accident Research Centre, Monash University, Clayton, VIC 3800, Australia. ;
| | - Kerry S O’Brien
- School of Social Sciences, Monash University, Melbourne, VIC, Australia
| | | | - Sara Liu
- Monash University Accident Research Centre, Monash University, Clayton, VIC, Australia
| | - Katharine Gibson
- Prevention and Population Health Branch, Public Health Division, The Victorian Department of Health, Melbourne, VIC, Australia
| | - Angela Clapperton
- Centre for Mental Health, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
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Widnall E, Epstein S, Polling C, Velupillai S, Jewell A, Dutta R, Simonoff E, Stewart R, Gilbert R, Ford T, Hotopf M, Hayes RD, Downs J. Autism spectrum disorders as a risk factor for adolescent self-harm: a retrospective cohort study of 113,286 young people in the UK. BMC Med 2022; 20:137. [PMID: 35484575 PMCID: PMC9052640 DOI: 10.1186/s12916-022-02329-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/09/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Individuals with autism spectrum disorder (ASD) are at particularly high risk of suicide and suicide attempts. Presentation to a hospital with self-harm is one of the strongest risk factors for later suicide. We describe the use of a novel data linkage between routinely collected education data and child and adolescent mental health data to examine whether adolescents with ASD are at higher risk than the general population of presenting to emergency care with self-harm. METHODS A retrospective cohort study was conducted on the population aged 11-17 resident in four South London boroughs between January 2009 and March 2013, attending state secondary schools, identified in the National Pupil Database (NPD). Exposure data on ASD status were derived from the NPD. We used Cox regression to model time to first self-harm presentation to the Emergency Department (ED). RESULTS One thousand twenty adolescents presented to the ED with self-harm, and 763 matched to the NPD. The sample for analysis included 113,286 adolescents (2.2% with ASD). For boys only, there was an increased risk of self-harm associated with ASD (adjusted hazard ratio 2·79, 95% CI 1·40-5·57, P<0·01). Several other factors including school absence, exclusion from school and having been in foster care were also associated with a higher risk of self-harm. CONCLUSIONS This study provides evidence that ASD in boys, and other educational, social and clinical factors, are risk factors for emergency presentation with self-harm in adolescents. These findings are an important step in developing early recognition and prevention programmes.
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Affiliation(s)
- Emily Widnall
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Sophie Epstein
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - Catherine Polling
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sumithra Velupillai
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Amelia Jewell
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Rina Dutta
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Emily Simonoff
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ruth Gilbert
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Tamsin Ford
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Richard D Hayes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Johnny Downs
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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4
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Granlund A, Soares FC, Hjern A, Dahllöf G, Julihn A. Acculturation and 4-year caries increment among children of foreign-born mothers in Sweden: a register-based cohort study. BMC Oral Health 2022; 22:111. [PMID: 35392882 PMCID: PMC8991709 DOI: 10.1186/s12903-022-02130-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background To study the association of maternal age upon arrival and length of residence in Sweden with the 4-year caries increment in their children between ages 3 and 7 years in relation to the human development index (HDI) of the maternal country of origin. Method This registry-based cohort study included all children born in 2000–2003 who resided in Stockholm County, Sweden, at age 3 years and who were followed up at age 7 (n = 63,931). Negative binomial regressions were used to analyze different models adjusted for sociodemographic factors. Results Children of foreign-born mothers, regardless of the HDI of the maternal country of origin, had a higher risk of caries increment between ages 3 and 7 years than children of Swedish-born mothers. Furthermore, children of mothers who had arrived from a low or medium HDI country had a lower caries increment if their mothers arrived before age 7 compared with after age 7. Nearly half (44%) of the children whose mothers arrived in Sweden at age ≥ 20 years from a low HDI country had a caries increment compared to 22% of the children whose mothers had arrived in Sweden before 7 years of age. Furthermore, children whose mothers were born in a low HDI country and had resided in Sweden ≤ 19 years had approximately 1.5 times higher risk of caries increment compared to children of mothers who had resided in Sweden for more than 20 years. Conclusions Caries increment in the children of foreign-born mothers was associated with the age of their mother when she arrived in Sweden and was lower when the mother had arrived before age 7 years. This indicates an intergenerational effect that carries over to the children and is greater the longer the mother has participated in Swedish dental healthcare.
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Affiliation(s)
- Anna Granlund
- Public Dental Service, Folktandvården Stockholms Län AB, Stockholm, Sweden.,Center for Pediatric Oral Health Research, Stockholm, Sweden
| | - Fernanda Cunha Soares
- Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Hjern
- Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Health Equity Studies (CHESS), Stockholm University, Stockholm, Sweden
| | - Göran Dahllöf
- Center for Pediatric Oral Health Research, Stockholm, Sweden.,Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.,Center for Oral Health Services and Research, Mid-Norway, Trondheim, Norway
| | - Annika Julihn
- Center for Pediatric Oral Health Research, Stockholm, Sweden. .,Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden. .,Department of Pediatric Dentistry, Eastmaninstitutet, Folktandvården Stockholms Län AB, Stockholm, Sweden.
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5
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Pawer S, Rajabali F, Zheng A, Smith J, Purssell R, Pike I. Analyses of Child and Youth Self-Poisoning Hospitalizations by Substance and Socioeconomic Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137003. [PMID: 34208955 PMCID: PMC8297021 DOI: 10.3390/ijerph18137003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/27/2022]
Abstract
Child and youth self-poisoning is a growing public health issue in many regions of the world, including British Columbia (BC), Canada, where 15–19-year-olds have the highest rates of self-poisoning hospitalizations compared with those of all other ages. The purpose of this study was to identify what substances children and youth commonly used to poison themselves in BC and how socioeconomic status may impact self-poisoning risk. Self-poisoning hospitalization rates among 10–14 and 15–19-year-olds from 1 April 2012 to 31 March 2020 were calculated by substance using ICD-10-CA codes X60-X69 and T36-T65, as well as by socioeconomic status using the Institut National de Santé Publique du Québec’s Deprivation Index. Nonopioid analgesics, antipyretics, and antirheumatics were the most common substances involved, with rates of 27.6 and 74.3 per 100,000 population among 10–14 and 15–19-year-olds, respectively, followed by antiepileptic, sedative–hypnotic, antiparkinsonism, and psychotropic drugs, with rates of 20.2 and 68.1 per 100,000 population among 10–14 and 15–19-year-olds, respectively. In terms of socioeconomic status, rates were highest among 10–19-year-olds living in neighbourhoods with the fewest social connections (243.7 per 100,000 population). These findings can inform poisoning prevention strategies and relevant policies, thereby reducing the number of self-poisoning events among children and youth.
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Affiliation(s)
- Samantha Pawer
- BC Injury Research and Prevention Unit, BC Children’s Hospital, Vancouver, BC V6H 3V4, Canada; (S.P.); (A.Z.); (J.S.); (I.P.)
| | - Fahra Rajabali
- BC Injury Research and Prevention Unit, BC Children’s Hospital, Vancouver, BC V6H 3V4, Canada; (S.P.); (A.Z.); (J.S.); (I.P.)
- Correspondence: ; Tel.: +1-604-875-3572
| | - Alex Zheng
- BC Injury Research and Prevention Unit, BC Children’s Hospital, Vancouver, BC V6H 3V4, Canada; (S.P.); (A.Z.); (J.S.); (I.P.)
| | - Jennifer Smith
- BC Injury Research and Prevention Unit, BC Children’s Hospital, Vancouver, BC V6H 3V4, Canada; (S.P.); (A.Z.); (J.S.); (I.P.)
| | - Roy Purssell
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
- British Columbia Drug and Poison Information Centre, BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC V5Z 4R4, Canada
| | - Ian Pike
- BC Injury Research and Prevention Unit, BC Children’s Hospital, Vancouver, BC V6H 3V4, Canada; (S.P.); (A.Z.); (J.S.); (I.P.)
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada
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Anxiety symptoms mediates the influence of cybervictimization on adolescent non-suicidal self-injury: The moderating effect of self-control. J Affect Disord 2021; 285:144-151. [PMID: 33647582 DOI: 10.1016/j.jad.2021.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/28/2020] [Accepted: 01/02/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) has received increased attention as a major public health problem among adolescents. However, there is a lack of evidence testing the longitudinal association between cybervictimization and NSSI as well as its underlying mediating and moderating mechanisms. The current study investigated the potential mediator (i.e., anxiety symptoms) and moderator (i.e., self-control) of the relation between cybervictimization and NSSI over a 12-month period. METHODS Three waves of data (called T1, T2 and T3) were collected 6 months apart, between November 2018 and 2019. 1987 Chinese adolescents completed self-report measures in their classrooms. SEM was used to test a moderated mediation model, with gender, age and childhood trauma and baseline measures as covariates. RESULTS The results found a longitudinal association between cybervictimization and NSSI as well as the mediating role of anxiety symptoms in explaining this association. Moderated mediation analyses revealed that greater cybervictimization contributed to anxiety symptoms, which in turn predicted increased levels of NSSI only among adolescents with lower self-control. LIMITATIONS Measures of study variables were self-reported, and generalizability may be limited by a sample of adolescents from school in China. CONCLUSIONS The present study demonstrated that the indirect effect of anxiety symptoms in the association between cybervictimization and NSSI was conditioned by self-control. These results have implications for preventative interventions aimed toward reducing NSSI for at-risk adolescents.
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7
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Baralla F, Ventura M, Negay N, Di Napoli A, Petrelli A, Mirisola C, Sarchiapone M. Clinical Correlates of Deliberate Self-Harm Among Migrant Trauma-Affected Subgroups. Front Psychiatry 2021; 12:529361. [PMID: 34630170 PMCID: PMC8492940 DOI: 10.3389/fpsyt.2021.529361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Studies have shown that exposure to potentially traumatic events (PTEs) during the migration process has serious consequences on mental health. Migrants with a history of PTEs are more likely to inflict deliberate self-harm (DSH), a spectrum of behavior that includes non-suicidal self-injury (NSSI). With reference to a nonclinical sample of trauma-exposed migrants, this study aims to explore the prevalence of DSH and to assess the association with sociodemographic characteristics and clinical conditions, with particular attention to post-traumatic stress disorder (PTSD) symptoms, resilience capabilities, and feelings of hopelessness. Methods: A sample of migrants underwent a baseline evaluation at an outpatient department of the National Institute for Health, Migration and Poverty (INMP). Migrants with a history of torture, rape, or other severe forms of psychological, physical, or sexual violence were invited to undergo screening at the Institute's Mental Health Unit. Trauma-exposed migrants completed a series of self-report questionnaires that assessed the presence of PTSD, depression, anxiety, suicidal ideation, resilience, and feelings of hopelessness, in addition to DSH. Univariate and multivariate log-binomial regression models were used to test the association of age and clinical characteristic of migrants with DSH. Prevalence ratio (PR) with 95% confidence intervals (95% CI) and p-values were estimated. Results: A total of 169 migrants (76.9% males), aged between 18 and 68 years, M = 28.93; SD = 8.77), were selected. Of the sample, 26.6% were frequently engaging in some form of DSH, and 30.2% were diagnosed with at least one trauma-related disorder. DSH behaviors were most common in single and unemployed migrants as well as in subjects with post-traumatic stress symptoms, feelings of anxiety, hopelessness, low capability of resilience, and suicidal ideation. Taking into account age and hopelessness, we found that PTSD and low resilience capabilities were associated with a higher risk of DSH [PR adj: 2.21; 95% CI: (1.30-3.75) and PR adj: 2.32; 95% CI: (1.16-4.62), respectively]. Conclusion: Given the association between trauma exposure and DSH among migrants, exploring the presence of DSH behavior within the immigrant community is crucial for the implementation of measures to develop intervention in a clinical setting.
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Affiliation(s)
- Francesca Baralla
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Martina Ventura
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Nikolay Negay
- Department of Psychiatry and Narcology of Asfendiyarov, Kazakh National Medical University, Almaty, Kazakhstan
| | - Anteo Di Napoli
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty, Rome, Italy
| | | | - Marco Sarchiapone
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.,National Institute for Health, Migration and Poverty, Rome, Italy
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Hjern A, Palacios J, Vinnerljung B, Manhica H, Lindblad F. Increased risk of suicidal behaviour in non-European international adoptees decreases with age - A Swedish national cohort study. EClinicalMedicine 2020; 29-30:100643. [PMID: 33305197 PMCID: PMC7710634 DOI: 10.1016/j.eclinm.2020.100643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Non-European international adoptees in Sweden were shown to have a three-to fourfold higher risk of suicidal behaviour in youth during 1986-1995 compared with the general population. The aim of this study was to investigate whether this high risk persists beyond youth and in later cohorts. METHODS A register study of Swedish national cohorts born 1972-86 including 20 625 non-European international adoptees, and comparison populations of 10 915 non-European immigrants and 1 435 167 Swedish born was performed. The study population was followed from age 18 between 1991 and 2016, with suicide and hospital admissions due to suicide attempt as outcomes. Poisson regression models of person time in the study, adjusted for gender and household income at age 17, were fitted to calculate relative risks (RR). FINDINGS Adjusted RR for suicide in non-European international adoptees was high at age 18-22, 2·74 (95% C.I. 1·95-3·86), but decreased gradually to age 33-43 when the risk was similar to Swedish-born. Adjusted RR for suicide attempts in international adoptees was 2·33 (2·15-2·52) at age 18-22, decreased slightly with older age, but remained higher than Swedish born in all age-classes. Risks for both outcomes were greatest, around three times higher compared with the Swedish-born in the oldest birth cohorts of non-European international adoptees, born 1972-76. Risks for both suicidal outcomes increased with higher age at adoption. INTERPRETATION The risk of suicidal behaviour in non-European international adoptees in Sweden decreases with age and is lower in later birth cohorts and in infant adoptions.
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Affiliation(s)
- Anders Hjern
- Centre for Health Equity Studies (CHESS), Karolinska Institutet/Stockholm University, and Clinical Epidemiology/Department of Medicine, Karolinska Institutet, S 171 77 Stockholm, Sweden
- Corresponding author.
| | - Jesús Palacios
- Department of Developmental Psychology, University of Seville, Seville, Spain
| | - Bo Vinnerljung
- Department of Social Work, Stockholm University, S 106 91 Stockholm, Sweden
| | - Helio Manhica
- Department of Public Health, Karolinska Institutet, S 171 77 Stockholm, Sweden
| | - Frank Lindblad
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
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Non-suicidal self-injury in adolescence: Longitudinal evidence of recursive associations with adolescent depression and parental rejection. J Adolesc 2020; 84:36-44. [DOI: 10.1016/j.adolescence.2020.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 01/19/2023]
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10
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Gargiulo A, Tessitore F, Le Grottaglie F, Margherita G. Self-harming behaviours of asylum seekers and refugees in Europe: A systematic review. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2020; 56:189-198. [PMID: 32557612 DOI: 10.1002/ijop.12697] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 05/21/2020] [Indexed: 11/06/2022]
Abstract
The increasing number of asylum seekers and refugees in Europe calls for even more professionals to take care of refugees' mental health. Although different studies claim that migration could be a potential risk factor for self-harming behaviours, an in-depth exploration of the presence and characteristics of self-harm in the context of asylum is needed. In accordance with PRISMA guidelines, a systematic review was conducted across the databases Scopus, PubMed, Web of Knowledge and PsycArticles, regarding the main features of self-harming behaviour among refugees in Europe. Twelve articles and 3 main trajectories were identified: (1) A context at-risk: self-harm and detention centres; (2) A target at-risk: self-harm and unaccompanied minors; (3) A comparison between the mental health of asylum seekers and natives. Research on this topic in Europe is still underdeveloped and disorganised. Studies have mainly carried out wider quantitative investigations on mental health, usually overlapping self-harm with suicide. Detention centres emerged as the most widely investigated context and the one with the highest risk for self-harming behaviours. Instead, unaccompanied minors emerged as a particularly vulnerable category. Research in this field should be improved, combining quantitative and qualitative methods for a deeper understanding of the meanings of self-harm across cultures.
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Affiliation(s)
- Anna Gargiulo
- Department of Humanities, University of Naples Federico II, Naples, Italy
| | | | | | - Giorgia Margherita
- Department of Humanities, University of Naples Federico II, Naples, Italy
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11
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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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The use of psychiatric services by young adults who came to Sweden as teenage refugees: a national cohort study. Epidemiol Psychiatr Sci 2017; 26:526-534. [PMID: 27353562 PMCID: PMC6999002 DOI: 10.1017/s2045796016000445] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS To investigate the patterns of use of different forms of psychiatric care in refugees who settled in Sweden as teenagers. METHOD Cox proportional hazards models were used to estimate the use of different forms of psychiatric care from 2009 to 2012 in a population of 35 457 refugees, aged from 20 to 36, who had settled in Sweden as teenagers between 1989 and 2004. These findings were compared with 1.26 million peers from the same birth cohorts in the general Swedish population. RESULTS Unaccompanied and accompanied refugees were more likely to experience compulsory admission to a psychiatric hospital compared with the native Swedish population, with hazard ratios (HRs) of 2.76 (1.86-4.10) and 1.89 (1.53-2.34), respectively, as well as psychiatric inpatient care, with HRs of 1.62 (1.34-1.94) and 1.37 (1.25-1.50). Outpatient care visits by the young refugees were similar to the native Swedish population. The longer the refugees had residency in Sweden, the more they used outpatient psychiatric care. Refugees born in the Horn of Africa and Iran were most likely to undergo compulsory admission, with HRs of 3.98 (2.12-7.46) and 3.07 (1.52-6.19), respectively. They were also the groups who were most likely to receive inpatient care, with HRs of 1.55 (1.17-2.06) and 1.84 (1.37-2.47), respectively. Our results also indicated that the use of psychiatric care services increased with the level of education in the refugee population, while the opposite was true for the native Swedish population. In fact, the risks of compulsory admissions were particularly higher among refugees who had received a secondary education, compared with native Swedish residents, with HRs of 4.72 (3.06-7.29) for unaccompanied refugees and 2.04 (1.51-2.73) for accompanied refugees. CONCLUSIONS Young refugees received more psychiatric inpatient care than the native Swedish population, with the highest rates seen in refugees who were not accompanied by their parents. The discrepancy between the use of inpatient and outpatient care by young refugees suggests that there are barriers to outpatient care, but we did note that living in Sweden longer increased the use of outpatient services. Further research is needed to clarify the role that education levels among Sweden's refugee populations have on their mental health and health-seeking behaviour.
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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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Carlsson C. Triads in Equine-Assisted Social Work Enhance Therapeutic Relationships with Self-Harming Adolescents. CLINICAL SOCIAL WORK JOURNAL 2016; 45:320-331. [PMID: 29187767 PMCID: PMC5684297 DOI: 10.1007/s10615-016-0613-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Despite an increasing number of studies, there is still a lack of knowledge about the unique features that underlie the process in equine assisted social work (EASW). This study aimed to reveal, through qualitative methods, the dyads within the triad that become stronger during the process of EASW, as well as the effect of the participation of the horse on the relationship between the counselor and client. Data were collected through in-depth interviews with nine female self-harming clients aged 15-21 years and eight staff members. The interviews, together with video-recorded human-horse interactions with three staff members and four clients were analyzed, resulting in additional issues answered by these three staff members and four clients in a second interview. Critical dialogues between patterns and fragmentations in the narratives and video-recordings, as well as a dialogue with the participants while they were viewing videos of their own EASW sessions, led to the conclusion that adding a horse qualitatively changes therapeutic relationships in EASW. The different triads consist of different liaisons between actors in the triad, giving rise to unique combinations. The quality of the relationships depends on both the staff and the clients' attachment orientations. Further research is needed to investigate how the degree of emotional connection to the horse affects the impact that horses have on triads in EASW.
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Klemera E, Brooks FM, Chester KL, Magnusson J, Spencer N. Self-harm in adolescence: protective health assets in the family, school and community. Int J Public Health 2016; 62:631-638. [PMID: 27658811 PMCID: PMC5487889 DOI: 10.1007/s00038-016-0900-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/10/2016] [Accepted: 09/13/2016] [Indexed: 11/26/2022] Open
Abstract
Objectives The aim of this paper was to examine if the multiple environments of the adolescent including family, peers, school and neighbourhood might function as protective health assets against self-harming behaviour during adolescence. Methods The present study utilised data collected from 1608 respondents aged 15 years as part of the England WHO Health Behaviour in School-aged Children (HBSC) Study. Multilevel modelling was undertaken using the package MLwiN (version 2.33) to investigate the potential domains and dimensions of family life, school culture and environment, and neighbourhood factors that may operate as protective health assets. Results The results indicated that while peer support did not appear to operate as a protective health asset in the context of self-harm, key dimensions of adolescent/parent interaction and adolescent experience of the school culture and their neighbourhood were associated with reduced likelihood of self-harming behaviours during adolescence. Conclusions The Findings highlight the significance of belonging and connectedness as important constituent elements of protective health assets for young people. Interventions that address the multiple environments of the young person, may offer an effective means to reduce the levels of self-harm.
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Affiliation(s)
- Ellen Klemera
- The Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AL Hertfordshire UK
| | - Fiona M. Brooks
- The Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AL Hertfordshire UK
- Faculty of Health, University of Technology Sydney, PO Box 123 Broadway, Sydney NSW 2007, Australia
| | - Kayleigh L. Chester
- The Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AL Hertfordshire UK
| | - Josefine Magnusson
- The Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AL Hertfordshire UK
| | - Neil Spencer
- Statistical Services and Consultancy Unit, Hertfordshire Business School, University of Hertfordshire, de Havilland Campus, Hatfield, AL10 9EU Hertfordshire UK
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Chandler A, King C, Burton C, Platt S. General Practitioners' Accounts of Patients Who Have Self-Harmed: A Qualitative, Observational Study. CRISIS 2015; 37:42-50. [PMID: 26572907 PMCID: PMC4904492 DOI: 10.1027/0227-5910/a000325] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract.Background: The relationship between self-harm and suicide is
contested. Self-harm is simultaneously understood to be largely nonsuicidal but
to increase risk of future suicide. Little is known about how self-harm is
conceptualized by general practitioners (GPs) and particularly how they assess
the suicide risk of patients who have self-harmed. Aims: The
study aimed to explore how GPs respond to patients who had self-harmed. In this
paper we analyze GPs’ accounts of the relationship between self-harm, suicide,
and suicide risk assessment. Method: Thirty semi-structured
interviews were held with GPs working in different areas of Scotland. Verbatim
transcripts were analyzed thematically. Results: GPs provided
diverse accounts of the relationship between self-harm and suicide. Some
maintained that self-harm and suicide were distinct and that risk assessment was
a matter of asking the right questions. Others suggested a complex
inter-relationship between self-harm and suicide; for these GPs, assessment was
seen as more subjective. In part, these differences appeared to reflect the
socioeconomic contexts in which the GPs worked. Conclusion:
There are different conceptualizations of the relationship between self-harm,
suicide, and the assessment of suicide risk among GPs. These need to be taken
into account when planning training and service development.
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Affiliation(s)
- Amy Chandler
- 1 Centre for Research on Families and Relationships, University of Edinburgh, Edinburgh, UK
| | - Caroline King
- 2 Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | | | - Stephen Platt
- 4 Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Plener PL, Munz LM, Allroggen M, Kapusta ND, Fegert JM, Groschwitz RC. Immigration as risk factor for non-suicidal self-injury and suicide attempts in adolescents in Germany. Child Adolesc Psychiatry Ment Health 2015; 9:34. [PMID: 26417389 PMCID: PMC4584432 DOI: 10.1186/s13034-015-0065-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/24/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Whereas non-suicidal self-injury (NSSI) and suicide attempts (SA) are rather common among adolescents, the description of risk factors has often failed to take migration into perspective. Our study aimed to describe immigration status in adolescents with regards to their lifetime history of NSSI and SA. METHODS We carried out a population based study in a school community of ninth-graders (N = 452, mean age 14.85, SD 0.58) in southern Germany. Data were collected via adolescent self report on sociodemographic variables and on NSSI and SA using the Self Harm Behavior Questionnaire. RESULTS Adolescents born outside Germany showed an elevated rate of a lifetime history of NSSI and SA. When compared to German adolescents without a (family) history of migration (NSSI 19.16%, SA 3.24%), adolescents who were born in another country had an elevated risk for NSSI (42.86%, OR 3.36) and SA (17.86%, OR 6.78), which was higher than the risk of adolescents who had at least one parent who had emigrated from another country (NSSI 30.08%, OR 2.46 and SA 8.94%, OR 4.45). CONCLUSION Our findings should inform intervention services and prevention programs for NSSI and suicidality in youth. Adopting such programs to include culturally sensible modules could improve the outcome in ethnically diverse adolescents.
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Affiliation(s)
- Paul L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhoevelstr. 5, 89075 Ulm, Germany
| | - Lara M Munz
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhoevelstr. 5, 89075 Ulm, Germany
| | - Marc Allroggen
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhoevelstr. 5, 89075 Ulm, Germany
| | - Nestor D Kapusta
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhoevelstr. 5, 89075 Ulm, Germany
| | - Rebecca C Groschwitz
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhoevelstr. 5, 89075 Ulm, Germany
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Webb RT, Antonsen S, Mok PLH, Agerbo E, Pedersen CB. National Cohort Study of Suicidality and Violent Criminality among Danish Immigrants. PLoS One 2015; 10:e0131915. [PMID: 26121654 PMCID: PMC4488292 DOI: 10.1371/journal.pone.0131915] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/08/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Immigrant populations in western societies have grown in their size and diversity yet evidence is incomplete for their risks of suicidality and criminal violence. We examined these correlated harmful behaviours in a national cohort. AIMS (i) Compare absolute risk between first and second generation immigrants, foreign-born adoptees and native Danes by plotting cumulative incidence curves to onset of early middle age; (ii) estimate sex-specific relative risks for these immigrant type subgroups vs. native Danes; (iii) examine effect modification by higher vs. lower socio-economic status. METHODS In a cohort of over two million persons, attempted suicides and violent crimes were investigated using data from multiple interlinked registers. We plotted sex-specific cumulative incidence curves and estimated incidence rate ratios. RESULTS In the whole study cohort, 1414 people died by suicide, 46,943 attempted suicide, and 51,344 were convicted of committing a violent crime. Among all immigrant subgroups combined, compared with native Danes, relative risk of attempted suicide was greater in female immigrants (incidence rate ratio, 1.59; 95% confidence interval: CI 1.54-1.64) than in male immigrants (1.26; CI 1.20-1.32), and vice versa for relative risk of violent offending in male immigrants (2.36; CI 2.31-2.42) than in female immigrants (1.74; CI 1.62-1.87). Risk for both adverse outcomes was significantly elevated in virtually every gender-specific immigrant type subgroup examined. Violent crime risk was markedly raised in first generation immigrant males and in the Danish born male children of two immigrant parents. However, male immigrants of lower social status had lower risk of attempted suicide than their native Danish peers. CONCLUSION Young immigrants of both first and second generation status face serious challenges and vulnerabilities that western societies need to urgently address. Relative risk patterns for these adverse outcomes vary greatly between the genders and also by socioeconomic status. This high degree of heterogeneity points to the existence of modifiable factors that are amenable to positive change and a potential for effective intervention.
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Affiliation(s)
- Roger T. Webb
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, United Kingdom
- * E-mail:
| | - Sussie Antonsen
- NCRR—National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- CIRRAU—Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Pearl L. H. Mok
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, United Kingdom
| | - Esben Agerbo
- NCRR—National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- CIRRAU—Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Carsten B. Pedersen
- NCRR—National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- CIRRAU—Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
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Manhica H, Toivanen S, Hjern A, Rostila M. Mortality in adult offspring of immigrants: a Swedish national cohort study. PLoS One 2015; 10:e0116999. [PMID: 25706297 PMCID: PMC4338186 DOI: 10.1371/journal.pone.0116999] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 12/18/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Higher risks of psychiatric disorders and lower-than-average subjective health in adulthood have been demonstrated in offspring of immigrants in Sweden compared with offspring of native Swedes, and linked to relative socioeconomic disadvantage. The present study investigated mortality rates in relation to this inequity from a gender perspective. METHODS We used data from national registers covering the entire Swedish population aged 18-65 years. Offspring of foreign-born parents who were either Swedish born or had received residency in Sweden before school age (<7 years) were defined as "offspring of immigrants." We used Cox regression models to examine the association between parental country of birth and mortality between 1990 and 2008, with adjustment for education, income, age and family type. RESULTS Male offspring of immigrants from the Middle East (HR:2.00, CI:1.66-2.26), other non-European countries (HR:1.80, CI:1.36-2.36) and Finland (HR:1.56, CI:1.48-1.65) showed an age-adjusted excess mortality risk from all causes of death when compared to offspring with Swedish-born parents. Income, but not education, greatly attenuated these increased mortality risks. No excess mortality rates were found among female offspring of immigrants, with the exception of external cause of death among offspring of Finnish immigrants. CONCLUSION The study demonstrates high mortality rates in male offspring of immigrants from Finland and non-European countries that are associated with economic, but not educational, disadvantage. No increased mortality rates were found among female offspring of immigrants. Future studies are needed to explain this gender differential and why income, but not education, predicts mortality in male offspring of immigrants.
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Affiliation(s)
- Hélio Manhica
- Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Susanna Toivanen
- Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Anders Hjern
- Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Rostila
- Department of Sociology and Centre for Health Equity Studies, Stockholm University, Stockholm, Sweden
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Ivert AK, Torstensson Levander M, Merlo J. Adolescents' utilisation of psychiatric care, neighbourhoods and neighbourhood socioeconomic deprivation: a multilevel analysis. PLoS One 2013; 8:e81127. [PMID: 24260548 PMCID: PMC3829940 DOI: 10.1371/journal.pone.0081127] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 10/09/2013] [Indexed: 11/28/2022] Open
Abstract
Mental health problems among adolescents have become a major public health issue, and it is therefore important to increase knowledge on the contextual determinants of adolescent mental health. One such determinant is the socioeconomic structure of the neighbourhood. The present study has two central objectives, (i) to examine if neighbourhood socioeconomic deprivation is associated to individual variations in utilisation of psychiatric care in a Swedish context, and (ii) to investigate if neighbourhood boundaries are a valid construct for identifying contexts that influence individual variations in psychiatric care utilization. Data were obtained from the Longitudinal Multilevel Analysis in Scania (LOMAS) database. The study population consists of all boys and girls aged 13–18 years (N=18,417), who were living in the city of Malmö, Sweden, in 2005. Multilevel logistic regression analysis was applied to estimate the probability of psychiatric care utilisation. The results from the study indicate that the neighbourhood of residence had little influence on psychiatric care utilisation. Although we initially found a variation between neighbourhoods, this general contextual effect was very small (i.e. 1.6 %). The initial conclusive association between the neighbourhood level of disadvantage and psychiatric care utilisation (specific contextual effect) disappeared following adjustment for individual and family level variables. Our results suggest the neighbourhoods in Malmö (at least measured in terms of SAMS-areas), do not provide accurate information for discriminating adolescents utilisation of psychiatric care. The SAMS-areas appears to be an inappropriate construct of the social environment that influences adolescent utilisation of psychiatric care. Therefore, public health interventions should be directed to the whole city rather than to specific neighbourhoods. However, since geographical, social or cultural contexts may be important for our understanding of adolescent mental health further research is needed to identify such contexts.
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Affiliation(s)
- Anna-Karin Ivert
- Faculty of Health and Society, Malmö University, Malmö, Sweden
- * E-mail:
| | | | - Juan Merlo
- Unit of Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
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Chesin MS, Moster AN, Jeglic EL. Non-Suicidal Self-Injury Among Ethnically and Racially Diverse Emerging Adults: Do Factors Unique to the Minority Experience Matter? CURRENT PSYCHOLOGY 2013. [DOI: 10.1007/s12144-013-9185-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kumar S, Dixit V, Chaudhury S, Kenswar DK. Racial differences in suicidal ideation among school going adolescents. Ind Psychiatry J 2013; 22:118-24. [PMID: 25013312 PMCID: PMC4085803 DOI: 10.4103/0972-6748.132924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Young adults are at increased risk for suicidal behavior and there is growing concern about racial differences in suicidal ideation, especially in the younger population. AIM The aim of this study is to assess suicidal ideation in school going tribal and nontribal adolescents and to study its relationships with psychological well-being, depression, and anxiety. MATERIALS AND METHODS A total of 259 students of Classes X, XI, and XII of three Schools of Ranchi, who fulfilled inclusion and exclusion criteria, were screened for suicidal ideation by Suicidal Ideation Questionnaire (SIQ) and psychological well-being by General Health Questionnaire-12 (GHQ-12). The level of anxiety and depression was assessed by Hospital Anxiety Depression Scale (HADS). RESULTS Overall 33.2% of the adolescents had suicidal ideation out of which 34.2% were tribal-students and 32.8% nontribal-students with no significant intergroup difference. Psychological discomfort (GHQ-12 Score ≥3) was noticed in 59.1% of adolescents, but no racial difference was found. However, the mean HADS depression score was significantly higher in tribal adolescents, more so in tribal boys than nontribal adolescents or boys, respectively. There was a significant positive correlation of SIQ total score in all the adolescents with GHQ-12 total score, HADS total score, HADS anxiety score, and HADS depression score. CONCLUSION There were no racial differences in suicidal ideation and psychological discomfort among tribal and nontribal adolescents. Tribal adolescents, and more specifically tribal boys, had more depression than their nontribal counterparts. Suicidal ideation was positively correlated with psychological discomfort, anxiety, and depression.
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Affiliation(s)
- Santosh Kumar
- Department of Psychiatry, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India
| | - Vidhata Dixit
- Department of Psychiatry, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Pravara Institute of Medical Sciences (Deemed University), Rural Medical College, Pravaras Rural Hospital, Loni, Maharashtra, India
| | - D. K. Kenswar
- Department of Clinical Psychology, Ranchi Institute of Neuro-Psychiatry and Allied Sciences, Kanke, Ranchi, Jharkhand, India
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How are immigrant background and gender associated with the utilisation of psychiatric care among adolescents? Soc Psychiatry Psychiatr Epidemiol 2013; 48:693-9. [PMID: 23001409 DOI: 10.1007/s00127-012-0589-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 09/08/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To investigate how parental country of birth and individual gender affect utilisation of psychiatric care in adolescents. METHODS On the basis of data from the Longitudinal Multilevel Analysis in Scania database, the article employs logistic regression to analyse the utilisation of psychiatric care among adolescents aged 13-18 (n = 92203) who were living in the southern Swedish county of Scania in 2005. RESULTS Adolescents whose parents were born in middle- or low-income countries presented lower levels of psychiatric outpatient care utilisation than those with native parents. Initially, no associations were found between the utilisation of psychiatric inpatient care and parental country of birth. Following adjustment for socio-demographic variables, it was found that adolescents with parents born in low-income countries were less likely to utilise psychiatric inpatient care. Girls presented higher levels of psychiatric care utilisation, but controls for possible interactions revealed that this was true primarily for girls with parents born in Sweden or other high-income countries. CONCLUSIONS The different utilisation patterns found among adolescents with different backgrounds should be taken into consideration when planning and designing psychiatric care for adolescents, and when allocating resources. Our results may indicate lower levels of mental health problems among adolescents with parents born in middle- or low-income countries implying that protective factors compensate other stressors implicated in mental health problems. On the other hand, our findings may indicate an unmet health-care need as a result of problems accessing care.
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Nyberg C, Schyllander J, Stark Ekman D, Janson S. Socio-economic risk factors for injuries in Swedish children and adolescents: a national study over 15 years. Glob Public Health 2012; 7:1170-84. [PMID: 23152975 DOI: 10.1080/17441692.2012.736172] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Few studies have assessed if Sweden's injury prevention work has been equally effective for children of different socio-economic backgrounds. The goal of this paper is to review the country's injury rates for children over time, stratified by socio-economic status (SES), to see if the effects are similar across SES levels. This study employs a retrospective case-control study design, using data from the hospitalisation records of 51,225 children, which were linked to family socio-economic data. Children and adolescents in families receiving social welfare benefits, and those living with single parents and mothers with less education had higher risks of injuries leading to hospitalisation. The population-based safety work over the past decades seems to have had only minor effects on reducing the impact of socio-economic based difference in injury risks to younger Swedes.
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Affiliation(s)
- Cecilia Nyberg
- Department of Public Health, Karlstad University, Karlstad, Sweden
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Kosidou K, Hellner-Gumpert C, Fredlund P, Dalman C, Hallqvist J, Isacsson G, Magnusson C. Immigration, transition into adult life and social adversity in relation to psychological distress and suicide attempts among young adults. PLoS One 2012; 7:e46284. [PMID: 23056275 PMCID: PMC3463579 DOI: 10.1371/journal.pone.0046284] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 08/29/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The increasing incidence of mental health problems among young people is a major concern in many Western countries. The causal mechanisms underlying these trends are not well established, but factors influenced by current societal changes ought to be implicated. Such factors include immigration and social adversity as well as the timing of taking on adult social roles (e.g. gainful employment, parenthood and own housing tenure). We therefore examined relationships between these factors and the risks of psychological distress as well as suicide attempts in young adults, with a focus on gender differences. METHODS We conducted a population-based study including 10,081 individuals aged 18-29, recruited in 2002 and 2006 in Stockholm, Sweden. Data were collected by record linkage and questionnaires. RESULTS Non-European immigrants had an increased risk of distress, and female non-European immigrants had a markedly higher risk of suicide attempts. Both early parenthood (≤ 24 years) and not being a parent, being a student and the lack of own housing tenure were associated with distress, but only in women. In both sexes, financial strain was associated with the increased risk of distress and suicide attempts, while unemployment was only associated with distress. CONCLUSIONS Immigration from outside Europe and social adversity are associated with mental health problems in young adults, especially females. Postponed transition into adulthood is associated with poor mental health in young women. These factors are influenced by current societal changes, and may have contributed to the increasing incidence of mental health problems among young people in Western countries.
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Affiliation(s)
- Kyriaki Kosidou
- Division of Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
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Dekeyser L, Svedin CG, Agnafors S, Sydsjö G. Self-reported mental health in 12-year-old second-generation immigrant children in Sweden. Nord J Psychiatry 2011; 65:389-95. [PMID: 21417579 DOI: 10.3109/08039488.2011.566936] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Today 29.3% of all newborns in Sweden are second-generation immigrants. Studies on mental health among these children are few, inconclusive and vary widely with regard to the informant used and the age of the immigrant. The majority of previous studies focus on study groups that cover a wide age span but since mental health varies considerably during the preadolescent and adolescent years, more age-specific studies are needed. Additional focus on the health and well-being of these children is necessary if a well-functioning society is to develop. AIM To investigate whether and how second-generation immigrant children in Sweden differ from non-immigrant children in their presentation of self-reported mental health at the age of 12. METHODS Second-generation immigrant children (n = 142) from a birth cohort in southern Sweden, subjects of the SESBiC-study (the South East Sweden Birth Cohort-study) were compared with non-immigrant children (n = 1036) from the same cohort in their presentation of self-reported mental health at the age of 12 using the Strengths and Difficulties Questionnaire. Gender, family structure and parents' educational level were controlled for. RESULTS Second-generation immigrant children did not differ from the non-immigrant children in their own presentation of mental health at the age of 12 in any of the categories of immigrant groups. CONCLUSION It is a promising sign for future integration that second-generation immigrant children's self-reported mental health at the age of 12 was quite similar to that of non-immigrant children.
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Affiliation(s)
- Linda Dekeyser
- Division of Child and Adolescent Psychiatry and Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Linköping University, Sweden
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Calling S, Li X, Sundquist J, Sundquist K. Socioeconomic inequalities and infant mortality of 46,470 preterm infants born in Sweden between 1992 and 2006. Paediatr Perinat Epidemiol 2011; 25:357-65. [PMID: 21649678 DOI: 10.1111/j.1365-3016.2011.01200.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Studies on possible sociodemographic inequities in the survival of preterm infants are scarce. Individual and neighbourhood sociodemographic factors are related to preterm birth and to infant mortality in full-term infants. The aim here was to examine whether infant mortality in Swedish preterm infants is related to individual and neighbourhood sociodemographic factors, and to study whether the hypothesised association between neighbourhood deprivation and infant mortality persists after accounting for individual sociodemographic factors. The study included 46,470 infants with a gestational length of <37 weeks, born in Sweden between 1992 and 2006. Neighbourhood deprivation was assessed by an index (education, income, unemployment, welfare assistance) in small geographical units, and categorised into low, moderate and high deprivation. Adjusted odds ratios for infant mortality were examined in relation to individual and neighbourhood sociodemographic factors. After adjusting for maternal age, infant mortality was associated with the following sociodemographic variables: maternal non-married/non-cohabiting status, low family income, low maternal education and rural status. After full adjustment, the odds ratio [95% confidence interval] was 2.98 [2.42, 3.67] for low family income compared with high family income. An increase in infant mortality was also associated with high neighbourhood deprivation; however, this increased risk no longer remained statistically significant after adjusting for individual sociodemographic factors. In conclusion, this study showed an increased infant mortality in preterm infants born to women with a less favourable sociodemographic profile.
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Affiliation(s)
- Susanna Calling
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.
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Carlerby H, Viitasara E, Knutsson A, Gillander Gådin K. Subjective health complaints among boys and girls in the Swedish HBSC study: focussing on parental foreign background. Int J Public Health 2011; 56:457-64. [PMID: 21404065 DOI: 10.1007/s00038-011-0246-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 10/21/2010] [Accepted: 02/28/2011] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE The general aim of this study was to explore the associations between foreign extraction and subjective health complaints (SHC) among school-aged children in Sweden. METHODS Data were obtained from the global cross-sectional survey Health Behaviour in School-aged Children (HBSC), 1997/1998, 2001/2002, and 2005/2006. A total of 11,972 pupils in grades 5, 7 and 9 participated in the survey. Logistic regression analyses were used to estimate remaining risk of SHC among the subgroups of pupils. The analyses were adjusted for socio-demographic indicators, grade and measurement year. RESULTS Parental background: Swedish n = 9,585, mixed n = 1,263, and foreign n = 1,124. The results showed an increased risk of SHC among girls with a foreign background OR 1.27 (95% CI 1.04-1.55) compared with girls with a Swedish background and among girls in single-adult households OR 1.42 (95% CI 1.20-1.67) compared with girls in two-adult households. No such differences were shown among boys. CONCLUSIONS A significantly increased risk of ill health remained in girls of foreign background after adjustment for socio-demographic indicators, grade and measurement year.
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Affiliation(s)
- Heidi Carlerby
- Department of Health Sciences, Mid Sweden University, 851 70 Sundsvall, Sweden.
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Landstedt E, Gillander Gådin K. Deliberate self-harm and associated factors in 17-year-old Swedish students. Scand J Public Health 2010; 39:17-25. [PMID: 20846995 DOI: 10.1177/1403494810382941] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Deliberate self-harm (DSH) in young people is an important public health issue. To prevent DSH, more knowledge is needed about its prevalence and associated contextual factors in community samples of adolescents. AIMS To determine the prevalence of deliberate self-harm in 17-year-old Swedish students and to explore the association of demographic variables, psychological distress, experiences of violence, and school-related factors with DSH. METHODS Data were derived from a cross-sectional study in which 17-year-old students completed questionnaires during school hours (n = 1,663; 78.3%). The variables used in this analysis are as follows: deliberate self-harm, demographic variables, psychological distress, experiences of violence, and school-related factors. Data were analysed using chi-squared statistics and logistic regression. RESULTS The lifetime prevalence of DSH was 17%, and it was more common among girls (23.3%) than boys (10.5%). There were considerable socioeconomic differences in reports of DSH. Psychological distress was strongly associated with DSH in both boys and girls, as were experiences of bullying, sexual harassment, physical violence and sexual assault. Social support, safety and academic factors in school were related to reports of DSH in both girls and boys. There were some gender differences with respect to which factors were associated with DSH. CONCLUSIONS Deliberate self-harm is common and more frequently reported by girls than boys. Psychological distress, experiences of different types of violence, and school-related factors (academic, social and safety-related), should be considered risk factors for DSH in young people. Findings can be applied to health-promotion policy and interventions in various contexts, for example schools.
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Affiliation(s)
- Evelina Landstedt
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
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Immigration and suicidality in the young. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:274-81. [PMID: 20482953 DOI: 10.1177/070674371005500502] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Little research has focused on the relation of immigration and suicidal behaviour in youth. Nevertheless, the impact of migration on the mental health of youth is an issue of increasing societal importance. This review aimed to present studies on the prevalence of suicidal behaviour in immigrant youth in various countries and to provide possible explanations for suicidal behaviour in immigrant youth, especially regarding acculturation. METHODS The review included a literature search to locate articles on the subject of suicidal behaviour in immigrant youth in the context of acculturation. RESULTS Studies on suicidal behaviour in culturally diverse youth are few and most of the existing research does not differentiate ethnic minorities from immigrants. Studies on epidemiology and on specific risk factors were found regarding various immigrant youth including Hispanics in the United States, Asians in North America and Europe, as well as comparative studies between different immigrant groups in specific countries. CONCLUSIONS The relation between immigration status and suicidal behaviours in youth appears to vary by ethnicity and country of settlement. Time spent in the new country as well as intergenerational communication and conflicts with parents have, in many of the studies, been related to suicidality in immigrant youth. Summing up, there is a clear and urgent need to further pursue the work in this field, to develop targeted public health interventions as well as psychosocial treatment for preventing suicide in these youth.
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Stanford S, Jones MP. How Much Detail Needs to be Elucidated in Self-Harm Research? J Youth Adolesc 2009; 39:504-13. [DOI: 10.1007/s10964-009-9492-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 12/04/2009] [Indexed: 11/29/2022]
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Jablonska B, Lindberg L, Lindblad F, Rasmussen F, Ostberg V, Hjern A. School performance and hospital admissions due to self-inflicted injury: a Swedish national cohort study. Int J Epidemiol 2009; 38:1334-41. [PMID: 19556329 DOI: 10.1093/ije/dyp236] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Self-inflicted injury in youth has increased in many Western countries during recent decades. Education is the most influential societal determinant of living conditions in young people after early childhood. This study tested the hypothesis that school performance predicts self-inflicted injury. METHODS A national cohort of 447 929 children born during 1973-77 was followed prospectively in the National Patient Discharge Register from the end of their ninth and last year of compulsory school until 2001. Multivariate Cox analyses of proportional hazards were used to test hypotheses regarding grades in ninth grade as predictors of hospital admission due to self-inflicted injury. RESULTS The risk of hospital admission because of self-inflicted injury increased steeply in a step-wise manner with decreasing grade point average. Hazard ratios were 6.2 (95% confidence interval 5.5-7.0) in those with the lowest level of grade point average compared with the highest. The risks were similar for women and men. Adjustment for potential socio-economic confounders in a multivariate proportional hazards regression analysis attenuated this strong gradient only marginally. CONCLUSION School performance is a strong factor for predicting future mental ill-health as expressed by self-inflicted injury.
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Affiliation(s)
- Beata Jablonska
- Division of Applied Public Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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