Enns Murray W, Cox Brian J, Afifi Tracie O, De Graaf Ron, Ten Have Margreet, Sareen Jitender
Department of Psychiatry and Community Health Sciences, University of Manitoba, Canada.
Psychol Med. 2006 Dec;36(12):1769-78. doi: 10.1017/S0033291706008646. Epub 2006 Sep 26.
Developmental adversities may be risk factors for adult suicidal behavior, but this relationship has rarely been studied prospectively. The present study examined the association between childhood adversities and new onset suicidal ideation and attempts in an adult population-based sample.
The study used a large community mental health survey (the Netherlands Mental Health Survey and Incidence Study; n=7076, age range 18-64 years). Logistic regression analyses were used to evaluate the relationship between childhood adversities and new onset of suicidal ideation and attempts over 3 years of longitudinal follow-up.
During the study period 85 new cases of suicidal ideation and 39 new onset suicide attempts were observed. The incidence rate for new suicide ideation was 0.67% per year and the incidence rate for new suicide attempts was 0.28% per year. Childhood neglect, psychological abuse and physical abuse were strongly associated with new onset suicidal ideation and suicide attempts. Odds ratios (ORs) ranged from 2.80 to 4.66 for new onset suicidal ideation and from 3.60 to 5.43 for new onset suicide attempts. The total number of adversities reported had a strong graded relationship to new onset suicidal ideation and attempts. These associations remained significant after controlling for the effects of mental disorders.
Childhood abuse and multiple adversities are strongly associated with future suicidal behavior and the mental disorders assessed in the present study do not fully account for this effect. A comprehensive understanding of suicidal behavior must take childhood adversities into account.
发育逆境可能是成人自杀行为的危险因素，但这种关系很少得到前瞻性研究。本研究在一个基于成人人群的样本中，考察了童年逆境与新发自杀意念及自杀未遂之间的关联。
本研究采用了一项大型社区心理健康调查（荷兰心理健康调查与发病率研究；n = 7076，年龄范围18 - 64岁）。采用逻辑回归分析来评估在3年的纵向随访中，童年逆境与新发自杀意念及自杀未遂之间的关系。
在研究期间，观察到85例新发自杀意念和39例新发自杀未遂。新发自杀意念的发病率为每年0.67%，新发自杀未遂的发病率为每年0.28%。童年期忽视、心理虐待和身体虐待与新发自杀意念及自杀未遂密切相关。新发自杀意念的优势比（OR）范围为2.80至4.66，新发自杀未遂的优势比范围为3.60至5.43。报告的逆境总数与新发自杀意念及自杀未遂之间存在强烈的分级关系。在控制精神障碍的影响后，这些关联仍然显著。
童年期虐待和多重逆境与未来的自杀行为密切相关，本研究中评估的精神障碍并不能完全解释这种影响。对自杀行为的全面理解必须考虑童年逆境因素。
