1
|
Wang W, Liu Y, Yang Y, Jiang W, Ni Y, Han X, Lu C, Guo L. Adverse childhood and adulthood experiences and risk of new-onset cardiovascular disease with consideration of social support: a prospective cohort study. BMC Med 2023; 21:297. [PMID: 37553602 PMCID: PMC10408183 DOI: 10.1186/s12916-023-03015-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/28/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The relationship between adverse childhood experiences (ACEs) and adverse adulthood experiences (AAEs) and their association with incident cardiovascular disease (CVD) have not been extensively studied. Considering social support, we evaluated the complex relations of ACEs and AAEs with incident CVD. METHODS This prospective cohort study used data from the 2014 life course survey and the 2015 and 2018 surveys of the China Health and Retirement Longitudinal Study, a national survey of Chinese adults aged ≥ 45 years from 28 provinces across China. The study population included 5836 individuals (mean [SD] age, 59.59 [8.22] years, 49.7% were males). Information on ACEs, AAEs, young adulthood social support, health behavior factors, health status factors, and demographics was measured. Cox regression models, the difference method to estimate the mediation proportion, and the additive and multiplicative interactions were performed. Subgroup and sensitivity analyses were also conducted. RESULTS During follow-up, 789 incident cases of CVD occurred. The fully adjusted model, including demographics, health behaviors, health status factors (e.g., depressive symptoms), and social support as control variables, demonstrated that the overall number of ACEs (Hazard ratio [HR]: 1.11, 95% CI: 1.08 to 1.14) and AAEs (HR: 1.19, 95% CI: 1.16 to 1.22) were associated with an increased risk of incident CVD. A dose-response relationship existed between the number of ACEs or AAEs and incident CVD risk. The overall AAEs were found to mediate 17.7% (95% CI: 8.2 to 34.2%) of the association between ACEs and incident CVD. Moreover, a significant additive interaction between ACEs and AAEs was detected (RERI [95% CI]: 0.32 [0.09 to 0.56]). Compared with adults without exposure to both ACE and AAE, those with exposure to both at least one ACE and one AAE indicator had the highest risk of incident CVD (HR: 1.96, 95% CI: 1.72 to 2.23). CONCLUSIONS Exposure to ACEs or AAEs was independently associated with an increased risk of incident CVD among Chinese middle-aged and older adults in a dose-response manner, and the overall AAEs partially mediated the association between ACEs and incident CVD. Preventive measures aimed at addressing either ACEs or AAEs alone may not significantly reduce the risk of CVD later in life. The necessity of a comprehensive life-course health strategy targeting the prevention of adversity merits increased attention.
Collapse
Affiliation(s)
- Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Yifeng Liu
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, People's Republic of China
| | - Yuwei Yang
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, People's Republic of China
| | - Weiqing Jiang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Yanyan Ni
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Xue Han
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, People's Republic of China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Kappes JR, Huber DA, Kirchebner J, Sonnweber M, Günther MP, Lau S. Self-Harm Among Forensic Psychiatric Inpatients With Schizophrenia Spectrum Disorders: An Explorative Analysis. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023; 67:352-372. [PMID: 34861802 DOI: 10.1177/0306624x211062139] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The burden of self-injury among offenders undergoing inpatient treatment in forensic psychiatry is substantial. This exploratory study aims to add to the previously sparse literature on the correlates of self-injury in inpatient forensic patients with schizophrenia spectrum disorders (SSD). Employing a sample of 356 inpatients with SSD treated in a Swiss forensic psychiatry hospital, patient data on 512 potential predictor variables were retrospectively collected via file analysis. The dataset was examined using supervised machine learning to distinguish between patients who had engaged in self-injurious behavior during forensic hospitalization and those who had not. Based on a combination of ten variables, including psychiatric history, criminal history, psychopathology, and pharmacotherapy, the final machine learning model was able to discriminate between self-injury and no self-injury with a balanced accuracy of 68% and a predictive power of AUC = 71%. Results suggest that forensic psychiatric patients with SSD who self-injured were younger both at the time of onset and at the time of first entry into the federal criminal record. They exhibited more severe psychopathological symptoms at the time of admission, including higher levels of depression and anxiety and greater difficulty with abstract reasoning. Of all the predictors identified, symptoms of depression and anxiety may be the most promising treatment targets for the prevention of self-injury in inpatient forensic patients with SSD due to their modifiability and should be further substantiated in future studies.
Collapse
Affiliation(s)
| | | | | | | | | | - Steffen Lau
- Psychiatric University Hospital Zurich, Switzerland
| |
Collapse
|
4
|
Rajhvajn Bulat L, Sušac N, Ajduković M. Predicting prolonged non-suicidal self-injury behaviour and suicidal ideations in adolescence - the role of personal and environmental factors. CURRENT PSYCHOLOGY 2023; 43:1-12. [PMID: 36855643 PMCID: PMC9951151 DOI: 10.1007/s12144-023-04404-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/02/2023]
Abstract
Suicide is one of the leading causes of death among adolescents and repetitional suicidal ideations (SI) and non-suicidal self-injury (NSSI) often precede it. In order to improve recognition of youth who are at high risk of suicide, current study aims to identify which individual variables (personality, self-concept and adverse childhood experiences - ACE) predict prolonged NSSI and SI from middle to late adolescence. A 3-year longitudinal study was conducted with 1101 Croatian adolescents (aged 15-17). 181 students (72.4% females) reported either NSSI or SI or both in T1 and were included in all waves of the study. Analyses are focused on differentiation between adolescents who continue with NSSI/SI and those who stop with it in a 3-year period. Results showed that adolescents with prolonged NSSI/SI had more ACE, especially domestic violence, worse family financial status, higher neuroticism and lower results on self-concept variables. The prediction model of classification of those who have prolonged NSSI or SI was better for SI than NSSI, with predictors explaining 31% of variation in SI. Adolescents who experienced more ACE and report more neuroticism have a higher chance of prolonged SI, while youth who perceive better family financial status and have better relationships with parents have a greater chance to stop with it. For NSSI only neuroticism was a significant predictor. Considering significant variables which could predict prolonged NSSI and/or SI, data presented in this paper have both scientific and practical contribution in understanding, treating and preventing adolescents' mental health problems.
Collapse
Affiliation(s)
- Linda Rajhvajn Bulat
- Department of Social Work, Faculty of Law, University of Zagreb, Zagreb, Croatia
| | - Nika Sušac
- Department of Social Work, Faculty of Law, University of Zagreb, Zagreb, Croatia
| | - Marina Ajduković
- Department of Social Work, Faculty of Law, University of Zagreb, Zagreb, Croatia
| |
Collapse
|
5
|
Ejlskov L, Antonsen S, Wulff JN, Agerbo E, Plana-Ripoll O, Sabel CE, Fan CC, Thompson WK, Mok PLH, Pedersen CB, Webb RT. Multilevel interactions between family and neighbourhood socioeconomic indices in childhood and later risks of self-harm and violent criminality in Denmark: a national cohort study. Lancet Public Health 2023; 8:e99-e108. [PMID: 36709062 PMCID: PMC9896147 DOI: 10.1016/s2468-2667(22)00292-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND A socioeconomically disadvantaged childhood has been associated with elevated self-harm and violent criminality risks during adolescence and young adulthood. However, whether these risks are modified by a neighbourhood's socioeconomic profile is unclear. The aim of our study was to compare risks among disadvantaged young people residing in deprived areas versus risks among similarly disadvantaged individuals residing in affluent areas. METHODS We did a national cohort study, using Danish interlinked national registers, from which we delineated a longitudinal cohort of people born in Denmark between Jan 1, 1981, and Dec 31, 2001, with two Danish-born parents, who were alive and residing in the country when they were aged 15 years, who were followed up for a hospital-treated self-harm episode or violent crime conviction. A neighbourhood affluence indicator was derived based on nationwide income quartiles, with parental income and educational attainment indicating the socioeconomic position of each cohort member's family. Bayesian multilevel survival analyses were done to examine the moderating influences of neighbourhood affluence on associations between family socioeconomic position and sex-specific risks for the two adverse outcomes. FINDINGS 1 084 047 cohort members were followed up for 12·8 million person-years in aggregate. Individuals of a low socioeconomic position residing in deprived neighbourhoods had a higher incidence of both self-harm and violent criminality compared with equivalently disadvantaged peers residing in affluent areas. Women from a low-income background residing in affluent areas had, on average, 95 (highest density interval 76-118) fewer self-harm episodes and 25 (15-41) fewer violent crime convictions per 10 000 person-years compared with women of an equally low income residing in deprived areas, whereas men of a low income residing in affluent areas had 61 (39-81) fewer self-harm episodes and 88 (56-191) fewer violent crime convictions per 10 000 person-years than men of a low income residing in deprived areas. INTERPRETATION Even in a high-income European country with comprehensive social welfare and low levels of poverty and inequality, individuals residing in affluent neighbourhoods have lower risks of self-harm and violent criminality compared with individuals residing in deprived neighbourhoods. More research is needed to explore the potential of neighbourhood policies and interventions to reduce the harmful effects of growing up in socioeconomically deprived circumstances on later risk of self-harm and violent crime convictions. FUNDING European Research Council, Lundbeck Foundation Initiative for Integrative Psychiatric Research, and BERTHA, the Danish Big Data Centre for Environment and Health funded by the Novo Nordisk Foundation Challenge Programme.
Collapse
Affiliation(s)
- Linda Ejlskov
- National Centre for Register-Based Research, Aarhus Business and Social Sciences, Aarhus University, Aarhus, Denmark; Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
| | - Sussie Antonsen
- National Centre for Register-Based Research, Aarhus Business and Social Sciences, Aarhus University, Aarhus, Denmark; Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
| | - Jesper N Wulff
- Department of Econometrics and Business Analytics, Aarhus University, Aarhus, Denmark
| | - Esben Agerbo
- National Centre for Register-Based Research, Aarhus Business and Social Sciences, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Oleguer Plana-Ripoll
- National Centre for Register-Based Research, Aarhus Business and Social Sciences, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Clive E Sabel
- Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Chun Chieh Fan
- Department of Radiology, Population Neuroscience and Genetics Lab, University of California San Diego, La Jolla, CA, USA
| | - Wesley K Thompson
- Division of Biostatistics and Department of Radiology, Population Neuroscience and Genetics Lab, University of California San Diego, La Jolla, CA, USA
| | - Pearl L H Mok
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Carsten Bøcker Pedersen
- National Centre for Register-Based Research, Aarhus Business and Social Sciences, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark; Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Roger T Webb
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK; National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| |
Collapse
|
6
|
Junna L, Moustgaard H, Martikainen P. Current Unemployment, Unemployment History, and Mental Health: A Fixed-Effects Model Approach. Am J Epidemiol 2022; 191:1459-1469. [PMID: 35441659 PMCID: PMC9347014 DOI: 10.1093/aje/kwac077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/16/2022] [Accepted: 04/14/2022] [Indexed: 01/28/2023] Open
Abstract
Poor mental health among the unemployed-the long-term unemployed in particular-is established, but these associations may be driven by confounding from unobserved, time-invariant characteristics such as past experiences and personality. Using longitudinal register data on 2,720,431 residents aged 30-60 years, we assessed how current unemployment and unemployment history predict visits to specialized care due to psychiatric conditions and self-harm in Finland in 2008-2018. We used linear ordinary-least-squares and fixed-effects models. Prior to adjusting for time-invariant characteristics, current unemployment was associated with poor mental health, and the risk increased with longer unemployment histories. Accounting for all time-invariant characteristics with the fixed-effects models, these associations attenuated by approximately 70%, yet current unemployment was still associated with a 0.51 (95% confidence interval: 0.48, 0.53) percentage-point increase in the probability of poor mental health among men and women. Longer unemployment histories increased the probability among men in their 30s but not among older men or among women. The results indicate that selection by stable characteristics may explain a major part of the worse mental health among the unemployed and especially the long-term unemployed. However, even when controlling for this selection, current unemployment remains associated with mental health.
Collapse
Affiliation(s)
- Liina Junna
- Correspondence to Liina Junna, Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014 University of Helsinki, Helsinki, Finland (e-mail: )
| | | | | |
Collapse
|
7
|
Hansen CD, Kirkeby MJ, Kjelmann KG, Andersen JH, Møberg RJ. The importance of adverse childhood experiences for labour market trajectories over the life course: a longitudinal study. BMC Public Health 2021; 21:2044. [PMID: 34749681 PMCID: PMC8577013 DOI: 10.1186/s12889-021-12060-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transitioning from school to work is important in influencing people's trajectories throughout their life course. This study investigated the extent to which adverse childhood experiences (ACEs) were associated with differences in labour market trajectories for young adults in the context of a Nordic child care regime with low levels of child poverty. METHODS Information on labour market participation, educational events, and public transfer records was recoded into seven state spaces for each month between ages 16 and 32 for a cohort of Danish adolescents born in a rural county in 1983 (N = 3373). Cluster analysis of the sequences using the optimal matching algorithm was used to identify groups with similar trajectories. Multinomial regression was used to assess the association between self-reported ACEs and cluster membership, taking gender and family of origin into account. RESULTS 'In employment' was the state space in which the young adults spent the most time over their early life courses (mean: 85 out of 204 months; 42%). Cluster analysis identified three clusters. Cluster 3 was most distinct, where the mean time 'outside the labour market' was 149 months (73%), and only 17 months (8%) were spent 'in employment'. Cumulative ACEs increased the probability of being included in Cluster 3 (OR: 1.51). Experiencing parental divorce (OR: 3.05), witnessing a violent event (OR: 3.70), and being abused (OR: 5.64) were most strongly associated with Cluster 3 membership. CONCLUSIONS Labour market trajectories among adolescents with a higher number of ACEs consisted of more time outside the labour market, compared to adolescents who had experienced fewer adversities. The lasting consequences of childhood adversity should be taken more into account in welfare policies, even in countries such as Denmark, with high social security levels and high-quality universal childcare.
Collapse
Affiliation(s)
- Claus D Hansen
- Department of Sociology and Social Work, Aalborg University, Fibigerstræde 13, 63, DK-9220, Aalborg, Denmark.
| | - Mette J Kirkeby
- Department of Clinical Medicine, Danish Center for Clinical Health Service Research (DACS), Aalborg University, Aalborg, Denmark
| | - Kristian G Kjelmann
- Department of Sociology and Social Work, Aalborg University, Fibigerstræde 13, 63, DK-9220, Aalborg, Denmark
| | - Johan H Andersen
- Department of Occupational Medicine, Danish Ramazzini Centre, University Clinic, Herning, Denmark
| | - Rasmus J Møberg
- Department of Sociology and Social Work, Aalborg University, Fibigerstræde 13, 63, DK-9220, Aalborg, Denmark
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Russell AE, Joinson C, Roberts E, Heron J, Ford T, Gunnell D, Moran P, Relton C, Suderman M, Mars B. Childhood adversity, pubertal timing and self-harm: a longitudinal cohort study. Psychol Med 2021; 52:1-9. [PMID: 33682658 PMCID: PMC9811347 DOI: 10.1017/s0033291721000611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND The occurrence of early childhood adversity is strongly linked to later self-harm, but there is poor understanding of how this distal risk factor might influence later behaviours. One possible mechanism is through an earlier onset of puberty in children exposed to adversity, since early puberty is associated with an increased risk of adolescent self-harm. We investigated whether early pubertal timing mediates the association between childhood adversity and later self-harm. METHODS Participants were 6698 young people from a UK population-based birth cohort (ALSPAC). We measured exposure to nine types of adversity from 0 to 9 years old, and self-harm when participants were aged 16 and 21 years. Pubertal timing measures were age at peak height velocity (aPHV - males and females) and age at menarche (AAM). We used generalised structural equation modelling for analyses. RESULTS For every additional type of adversity; participants had an average 12-14% increased risk of self-harm by 16. Relative risk (RR) estimates were stronger for direct effects when outcomes were self-harm with suicidal intent. There was no evidence that earlier pubertal timing mediated the association between adversity and self-harm [indirect effect RR 1.00, 95% confidence interval (CI) 1.00-1.00 for aPHV and RR 1.00, 95% CI 1.00-1.01 for AAM]. CONCLUSIONS A cumulative measure of exposure to multiple types of adversity does not confer an increased risk of self-harm via early pubertal timing, however both childhood adversity and early puberty are risk factors for later self-harm. Research identifying mechanisms underlying the link between childhood adversity and later self-harm is needed to inform interventions.
Collapse
Affiliation(s)
- Abigail Emma Russell
- Children and Young People's Mental Health Research Collaboration, University of Exeter College of Medicine and Health, Exeter, UK
| | - Carol Joinson
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Elystan Roberts
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - David Gunnell
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Caroline Relton
- MRC Integrative Epidemiology Unit, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Matthew Suderman
- MRC Integrative Epidemiology Unit, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Becky Mars
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| |
Collapse
|
10
|
Rajapakse T, Russell AE, Kidger J, Bandara P, López-López JA, Senarathna L, Metcalfe C, Gunnell D, Knipe D. Childhood adversity and self-poisoning: A hospital case control study in Sri Lanka. PLoS One 2020; 15:e0242437. [PMID: 33211766 PMCID: PMC7676676 DOI: 10.1371/journal.pone.0242437] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/03/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Adverse childhood experiences (ACE) have been recognized as an important risk factor for suicidal behaviour among adults, but evidence from low and middle-income countries is lacking. This study explored associations between ACE and hospital admission due to non-fatal self-poisoning in Sri Lanka. METHODS This was a case-control study. Adults admitted to a tertiary care hospital for medical management of self-poisoning were included as cases, and age and sex matched controls were recruited from the outpatient department. ACE were measured using the World Health Organization's Childhood Adversity Scale. Logistic regression models adjusting for age, sex, ethnicity, and religion were used to quantify the association between ACE and self-poisoning. RESULTS The study included 235 cases and 451 controls. Cases were 2.5 times (95% CI 1.8, 3.6) more likely to report an ACE than controls and had higher ACE scores. Childhood physical abuse (OR 4.7, 95% CI 1.2, 19.0) and emotional abuse or neglect (OR 3.7, 95% CI 1.3, 10.1, and 3.7, 95% CI 2.3, 6.0 respectively), increased the risk of self-poisoning in adulthood, as did witnessing household violence (OR 2.2, 95% CI 1.4, 3.4), growing up in a household with a mentally ill or suicidal household member (OR 2.1, 95% CI 1.2, 3.4), and experiencing parental death/separation/divorce (OR 3.1, 95% CI 2.0, 4.9) as a child. CONCLUSIONS Reducing exposures to ACEs should be a priority for prevention of suicide and self-harm in Sri Lanka. Innovative methods to increase support for children facing adversity should be explored.
Collapse
Affiliation(s)
- Thilini Rajapakse
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Abigail Emma Russell
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Piumee Bandara
- Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - José A. López-López
- Department of Basic Psychology & Methodology, Faculty of Psychology, University of Murcia, Murcia, Spain
| | - Lalith Senarathna
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihinthale, Sri Lanka
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom
| | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- The South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| |
Collapse
|
11
|
Jackisch J, Brännström L, Almquist YB. Troubled childhoods cast long shadows: Childhood adversity and premature all-cause mortality in a Swedish cohort. SSM Popul Health 2019; 9:100506. [PMID: 31720363 PMCID: PMC6838963 DOI: 10.1016/j.ssmph.2019.100506] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/16/2019] [Accepted: 10/23/2019] [Indexed: 01/22/2023] Open
Abstract
Experiences of childhood adversity are common and have profound health impacts over the life course. Yet, studying health outcomes associated with childhood adversity is challenging due to a lack of conceptual clarity of childhood adversity, scarce prospective data, and selection bias. Using a 65-year follow-up of a Swedish cohort born in 1953 (n = 14,004), this study examined the relationship between childhood adversity (ages 0-18) and premature all-cause mortality (ages 19-65). Childhood adversity was operationalized as involvement with child welfare services, household dysfunction, and disadvantageous family socioeconomic conditions. Survival models were used to estimate how much of the association between child welfare service involvement and mortality could be explained by household dysfunction and socioeconomic conditions. Results show that individuals who were involved with child welfare services had higher hazards of dying prematurely than their majority population peers. These risks followed a gradient, ranging from a hazard ratio of 3.08 (95% CI: 2.68-3.53) among those placed in out-of-home care, followed by individuals subjected to in-home services who demonstrated a hazard ratio of 2.53 (95% CI: 1.93-3.32), to a hazard ratio of 1.81 among those investigated and not substantiated (95% CI: 1.55-2.12). Associations between involvement with child welfare services and premature all-cause mortality were robust to adjustment for household dysfunction and disadvantageous family socioeconomic conditions. Neither household dysfunction nor socioeconomic conditions were related with mortality independent of child welfare services involvement. This study suggests that involvement with child welfare services is a viable proxy for exposure to childhood adversity and avoids pitfalls of self-reported or retrospective measures.
Collapse
Affiliation(s)
- Josephine Jackisch
- Centre for Health Equity Studies (CHESS), Department of Public Health Sciences, Stockholm University, SE-106 91, Stockholm, Sweden
| | - Lars Brännström
- Department of Social Work, Stockholm University, SE-106 91, Stockholm, Sweden
| | - Ylva B Almquist
- Centre for Health Equity Studies (CHESS), Department of Public Health Sciences, Stockholm University, SE-106 91, Stockholm, Sweden
| |
Collapse
|
12
|
Russell AE, Heron J, Gunnell D, Ford T, Hemani G, Joinson C, Moran P, Relton C, Suderman M, Mars B. Pathways between early-life adversity and adolescent self-harm: the mediating role of inflammation in the Avon Longitudinal Study of Parents and Children. J Child Psychol Psychiatry 2019; 60:1094-1103. [PMID: 31486089 PMCID: PMC6771906 DOI: 10.1111/jcpp.13100] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) such as physical and emotional abuse are strongly associated with self-harm, but mechanisms underlying this relationship are unclear. Inflammation has been linked to both the experience of ACEs and self-harm or suicide in prior research. This is the first study to examine whether inflammatory markers mediate the association between exposure to ACEs and self-harm. METHODS Participants were 4,308 young people from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based birth cohort in the United Kingdom. A structural equation modelling approach was used to fit a mediation model with the number of ACEs experienced between ages 0 and 9 years old (yo), levels of the inflammatory markers interleukin-6 and C-reactive protein measured at 9.5 yo, and self-harm reported at 16 yo. RESULTS The mean number of ACEs young people experienced was 1.41 (SE 0.03). Higher ACE scores were associated with an increased risk of self-harm at 16 yo (direct effect relative risk (RR) per additional ACE 1.11, 95% CI 1.05, 1.18, p < 0.001). We did not find evidence of an indirect effect of ACEs on self-harm via inflammation (RR 1.00, 95% CI 1.00, 1.01, p = 0.38). CONCLUSIONS Young people who have been exposed to ACEs are a group at high risk of self-harm. The association between ACEs and self-harm does not appear to be mediated by an inflammatory process in childhood, as indexed by peripheral levels of circulating inflammatory markers measured in childhood. Further research is needed to identify alternative psychological and biological mechanisms underlying this relationship.
Collapse
Affiliation(s)
- Abigail Emma Russell
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - David Gunnell
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK.,NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Tamsin Ford
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Gibran Hemani
- MRC Integrative Epidemiology Unit, University of Bristol Medical School, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Carol Joinson
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK.,NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Caroline Relton
- MRC Integrative Epidemiology Unit, University of Bristol Medical School, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Matthew Suderman
- MRC Integrative Epidemiology Unit, University of Bristol Medical School, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Becky Mars
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK.,NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| |
Collapse
|
13
|
Hua P, Bugeja L, Maple M. A systematic review on the relationship between childhood exposure to external cause parental death, including suicide, on subsequent suicidal behaviour. J Affect Disord 2019; 257:723-734. [PMID: 31382125 DOI: 10.1016/j.jad.2019.07.082] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/19/2019] [Accepted: 07/29/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Exposure to parental death in childhood has been associated with offspring suicide risk, although the strength of this association is unclear. The primary aim of this systematic review was to synthesise primary studies on the relationship between childhood exposure to external cause parental death, including suicide, and subsequent suicidal behaviour in adulthood. The secondary objective was to compare suicide-related outcomes of exposure to parental suicide with the outcomes of exposure to other external cause parental deaths. METHODS A systematic review was conducted using guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Ovid MEDLINE, Cochrane Library, Ovid PsycINFO, Web of Science, CINAHL and EMBASE were searched from January 2008 until November 2018. Two researchers independently screened the articles, performed data extraction and assessed quality of evidence using the Newcastle-Ottawa Scale. RESULTS Of the 618 studies identified, 26 were included for review. Only one study found no significant association between childhood exposure to suicide and increased suicide risk in adulthood. Four studies suggested the risk of suicidality in adulthood was greater for those exposed to parental suicide compared to other external cause deaths. LIMITATIONS The use of national registers in many studies did not allow for all variables of interest to be examined. Selective samples also limited the generalizability of findings. CONCLUSIONS A strong association between parental suicide and suicidal behaviour in adult offspring exists. Interventions for bereaved youth should consider the long-term effects of parental suicide and target individual and environmental-level risk factors for subsequent suicidality.
Collapse
Affiliation(s)
- Phuong Hua
- Department of Forensic Medicine, Monash University, VIC 3800, Australia.
| | - Lyndal Bugeja
- Department of Forensic Medicine, Monash University, VIC 3800, Australia; School of Nursing and Midwifery, Monash University, VIC 3800, Australia
| | - Myfanwy Maple
- School of Health, University of New England, NSW 2351, Australia
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Eskin M, AlBuhairan F, Rezaeian M, Abdel-Khalek AM, Harlak H, El-Nayal M, Asad N, Khan A, Mechri A, Noor IM, Hamdan M, Isayeva U, Khader Y, Al Sayyari A, Khader A, Behzadi B, Öztürk CŞ, Hendarmin LA, Khan MM, Khatib S. Suicidal Thoughts, Attempts and Motives Among University Students in 12 Muslim-Majority Countries. Psychiatr Q 2019; 90:229-248. [PMID: 30498939 DOI: 10.1007/s11126-018-9613-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
There is a scarcity of research on suicidal phenomena in the Muslim world. Therefore, this study aimed at investigating the self-reported prevalence of suicidal thoughts, attempts and motives in 12 Muslim countries. A total of 8417 (54.4% women) university students were surveyed by means of a self-report questionnaire. Overall, 22% of the participants reported suicidal ideation and 8.6% reported attempting suicide. The odds of suicidal thoughts were elevated in Azerbaijan, Indonesia and Saudi Arabia, while reduced ORs were recorded in Egypt, Jordan, Lebanon and Malaysia. While odds of suicide attempts were high in Azerbaijan, Palestine and Saudi Arabia reduced odds ratios (OR) were detected in Indonesia, Iran, Jordan, Lebanon, Malaysia and Tunisia. Taking drugs and using a sharp instrument were the two most frequently used methods to attempt suicide. Only 32.7% of attempts required medical attention. Escape motives were endorsed more than social motives by participants who attempted suicide. Suicidal behaviors were more frequent in women than in men. Compered to men, fewer attempts by women required medical attention. Moreover, our results show that making suicide illegal does not reduce the frequency of suicidal behavior. Results from this comparative study show that suicidal thoughts and attempts are frequent events in young adults in countries where religious scripture explicitly prohibit suicide and the frequencies of nonfatal suicidal behavior show large variation in nations adhering to the same religion.
Collapse
Affiliation(s)
- Mehmet Eskin
- Department of Psychology, College of Social Sciences and Humanities, Koc University, Rumelifeneriyolu 34450 Sariyer, Istanbul, Turkey.
| | - Fadia AlBuhairan
- Al Dara Hospital and Medical Center, Riyadh, Saudi Arabia
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mohsen Rezaeian
- Epidemiology and Biostatistics, Rafsanjan Medical School, Rafsanjan, Iran
| | - Ahmed M Abdel-Khalek
- Department of Psychology, Faculty of Arts, Alexandria University, Alexandria, Egypt
| | - Hacer Harlak
- Department of Psychology, Faculty of Arts and Sciences, Adnan Menderes University, Aydin, Turkey
| | - Mayssah El-Nayal
- Department of Psychology, Faculty of Human Sciences, Beirut Arab University, Beirut, Lebanon
| | - Nargis Asad
- Department of Psychiatry, Medical College, Aga Khan University, Karachi, Pakistan
| | - Aqeel Khan
- Faculty of Education, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Anwar Mechri
- Department of Psychiatry, University hospital of Monastir, Monastir, Tunisia
| | | | - Motasem Hamdan
- School of Public Health, Al-Quds University, Jerusalem, Palestine
| | - Ulker Isayeva
- Department of Psychology, Khazar University, Baku, Azerbaijan
| | - Yousef Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Alaa Al Sayyari
- Population Health Research Section-Hospital-MNGHA, King Abdullah International Medical Research Center / King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Albaraa Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Bahareh Behzadi
- Epidemiology and Biostatistics, Rafsanjan Medical School, Rafsanjan, Iran
| | - Cennet Şafak Öztürk
- Department of Psychology, Faculty of Arts and Sciences, Adnan Menderes University, Aydin, Turkey
| | | | - Murad Moosa Khan
- Department of Psychiatry, Medical College, Aga Khan University, Karachi, Pakistan
| | - Salam Khatib
- Faculty of Health Professions, Department of Nursing, Al-Quds University, Jerusalem, Palestine
| |
Collapse
|
16
|
Liu C, Vinnerljung B, Östberg V, Gauffin K, Juarez S, Cnattingius S, Hjern A. Out-of-Home Care and Subsequent Preterm Delivery: An Intergenerational Cohort Study. Pediatrics 2018; 142:peds.2017-2729. [PMID: 30021856 DOI: 10.1542/peds.2017-2729] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Adverse early-life experience may affect preterm delivery later in life through priming of stress response. We aim to investigate the links between out-of-home care (OHC) experience in childhood, as a proxy of severe adversities, on subsequent risk of preterm delivery. METHODS A register-based national cohort of all women born in Sweden between 1973 and 1977 (N = 175 821) was crosslinked with information on these women's subsequent deliveries as recorded in the Swedish medical birth register. During 1986-2012, 343 828 livebirths of these women were identified. The associations between women's OHC experience and her risk of preterm delivery were analyzed through logistic regression models, adjusting for women's own preterm birth, intrauterine growth, and childhood socioeconomic situation. RESULTS Compared with women that never entered OHC, women with OHC experience up to and after age 10 were both associated with increased risks of preterm delivery (adjusted odds ratio [aOR] = 1.23 [95% confidence interval 1.08-1.40] and aOR = 1.29 [1.13-1.48], respectively). Women who experienced OHC before or at 10 years of age had increased risk of both spontaneous and medically indicated preterm delivery (aOR = 1.19 [1.03-1.38] and aOR = 1.27 [1.02-1.59], respectively). Women who experienced OHC after age 10 had a more pronounced risk of medically indicated preterm delivery (aOR = 1.76 [1.44-2.16]) than for spontaneous preterm delivery (aOR = 1.08 [0.92-1.27]). CONCLUSIONS Women who were placed in OHC in childhood had increased risk of preterm delivery independent from their own perinatal history. Stress response, as 1 consequence of early life adversities, may take its toll on women's reproductive health and their offspring, calling for integrative efforts in preventing early life adversity.
Collapse
Affiliation(s)
- Can Liu
- Centre for Health Equity Studies, and .,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Bo Vinnerljung
- Department of Social Work, Stockholm University, Stockholm, Sweden; and
| | | | | | | | - Sven Cnattingius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anders Hjern
- Centre for Health Equity Studies, and.,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
17
|
Björkenstam E, Hjern A, Vinnerljung B. Adverse childhood experiences and disability pension in early midlife: results from a Swedish National Cohort Study. Eur J Public Health 2018; 27:472-477. [PMID: 28040736 DOI: 10.1093/eurpub/ckw233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Few studies have examined the association between adverse childhood experiences (ACEs) and disability pension (DP). The current study aimed to investigate the relationship between different ACEs, cumulative ACEs, and DP, and the mediating role of school performance. We used a Swedish cohort of 522 880 individuals born between 1973 and 1978. ACEs included parental death, parental substance abuse and psychiatric disorder, substantial parental criminality, household public assistance, parental DP and child welfare intervention. Estimates of risk of DP in 2008 were calculated as odds ratios (OR) with 95% confidence intervals (CIs). A total of 2.3% (3.0% females, 1.7% males) received DP in 2008. All studied ACEs increased the odds for DP, particularly child welfare intervention and household public assistance. Cumulative ACEs increased the odds of DP in a graded manner. Females exposed to 4+ ACEs had a 4-fold odds (OR: 4.0, 95% CI 3.5-4.5) and males a 7-fold odds (OR: 7.1, 95% CI: 6.2-8.1). School performance mediated the ACEs-DP association. This study provides evidence that ACEs is associated with increased odds of DP, particularly when accumulated. The effects of ACEs should be taken into account when considering the determinants of DP, and when identifying high-risk populations.
Collapse
Affiliation(s)
- Emma Björkenstam
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Community Health Sciences, Fielding School of Public Health and California Center for Population Research, University of California Los Angeles, Los Angeles, CA, USA
| | - Anders Hjern
- Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden.,Clinical Epidemiology/Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bo Vinnerljung
- Department of Social Work, Stockholm University, Stockholm, Sweden
| |
Collapse
|
18
|
Webb RT, Antonsen S, Carr MJ, Appleby L, Pedersen CB, Mok PLH. Self-harm and violent criminality among young people who experienced trauma-related hospital admission during childhood: a Danish national cohort study. LANCET PUBLIC HEALTH 2017; 2:e314-e322. [PMID: 28736760 PMCID: PMC5500314 DOI: 10.1016/s2468-2667(17)30094-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Development of a better understanding of subsequent pathways for individuals who experienced trauma during childhood might usefully inform clinicians and public health professionals regarding the causes of self-harm and interpersonal violence. We aimed to examine these risks during late adolescence and early adulthood among people admitted to hospital following injuries or poisonings during their childhood. Methods This national cohort study included Danish people born between Jan 1, 1977, and Dec 31, 1997, and was linked to the National Patient Register and Psychiatric Central Research Register to identify all people exposed to hospital admissions for injuries or poisonings due to self-harm, interpersonal violence, or accidents before their 15th birthday. Linkage to these two registers and to the National Crime Register enabled ascertainment of self-harm and violent offending, respectively, as adverse outcomes at ages 15–35 years. Sex-specific incidence rate ratios (IRRs; relative risks) and cumulative incidence percentage values (absolute risks) were estimated. The confounding influence of parental socioeconomic status was also explored. Findings 1 087 672 Danish people were included in this study. The prevalence of any trauma-related hospital admission was 10% (105 753 per 1 087 672; males: 64 454 [11%]; females: 44 299 [8%]) and for both sexes, accident was by far the most prevalent of the categories assessed (males: 59 011 [11%]; females: 40 756 [8%]). Similar patterns of increased risk for self-harm and violent criminality were observed in both sexes, although the IRRs were consistently and significantly larger in women (self-harm: IRR 1·94 [95% CI 1·85–2·02]; violent criminality: 2·16 [1·97–2·36]) than in men (self-harm: 1·61 [1·53–1·69]; violent criminality: 1·58 [1·53–1·63]). Confounding by parental socioeconomic status explained little of the increased risks observed. For young adult men, the highest absolute risk observed was for violent offending among individuals admitted to hospital for interpersonal violence injury during childhood (cumulative incidence 25·0% [95% CI 21·2–28·9]). For young adult women, absolute risk was highest for repeat self-harm among those admitted to hospital following self-harm during childhood (cumulative incidence 21·4% [95% CI 19·8–23·1]). More frequent trauma-related hospital admissions in childhood, and being admitted multiple times for more than one reason, conferred substantial risk increases among young people, with especially steep gradients of this nature observed among women. Interpretation Trauma-related hospital admission early in life could be a useful marker for childhood distress that subsequently predicts internalised and externalised destructive behaviours among youths and young adults and might provide a timely opportunity for initiating family-oriented interventions. Funding European Research Council.
Collapse
Affiliation(s)
- Roger T Webb
- Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Sussie Antonsen
- National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Matthew J Carr
- Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Louis Appleby
- Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Carsten B Pedersen
- National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Pearl L H Mok
- Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| |
Collapse
|