London School of Hygiene and Tropical Medicine, London, United Kingdom; and
London School of Hygiene and Tropical Medicine, London, United Kingdom; and.
Pediatrics. 2014 May;133(5):e1331-44. doi: 10.1542/peds.2013-2166. Epub 2014 Apr 14.
Self-inflicted injuries are one of the major causes of disease burden and death globally. Understanding the extent to which this is associated with childhood sexual abuse (CSA) exposure can help inform prevention strategies. We aimed to quantify to what extent CSA was associated with incident suicide attempts in men and women.
We searched 20 health and social science databases from first record until February 2009 and updated the search in Medline from February 2009 to February 1, 2013. Longitudinal studies and cotwin analyses from twin studies in any population from any year were eligible for inclusion. Of 22 235 abstracts screened as part of a series of reviews, 9 studies met the inclusion criteria for this review. Characteristics, effect estimates, and quality data were extracted. Random-effects meta-analysis was used to generate pooled odds ratios (ORs).
Seven longitudinal and 2 twin studies with 8733 participants met the inclusion criteria. The overall pooled estimate for longitudinal studies was OR = 2.43 (95% confidence interval: 1.94-3.05), I(2) = 87.5%, P < .0001. The pooled OR from cotwin analysis was 2.65 (95% confidence interval: 0.82-4.49, I(2) = 0%, P = .867). Studies adjusted for a range of confounders, but baseline suicidal behavior was not well-controlled. Too few studies met the inclusion criteria to quantitatively examine sources of heterogeneity.
CSA exposure is associated with suicide attempts when a range of different confounders are controlled for, but the temporality of the association is not well established, and the association is highly heterogeneous.
自残是全球疾病负担和死亡的主要原因之一。了解这在多大程度上与儿童期性虐待（CSA）暴露有关，可以帮助制定预防策略。我们旨在确定 CSA 与男性和女性发生自杀企图的关联程度。
我们搜索了 20 个健康和社会科学数据库，检索时间从首次记录到 2009 年 2 月，并在 2009 年 2 月至 2013 年 2 月 1 日更新了 Medline 的检索。所有人群的纵向研究和来自双胞胎研究的同卵双胞胎分析都符合纳入标准。在一系列综述的一部分中，对 22235 篇摘要进行了筛选，其中 9 项研究符合本综述的纳入标准。提取了特征、效应估计值和质量数据。采用随机效应荟萃分析生成汇总优势比（OR）。
7 项纵向研究和 2 项双胞胎研究共纳入 8733 名参与者，符合纳入标准。纵向研究的总体汇总估计值为 OR = 2.43（95%置信区间：1.94-3.05），I²=87.5%，P<.0001。来自同卵双胞胎分析的汇总 OR 为 2.65（95%置信区间：0.82-4.49，I²=0%，P=0.867）。研究调整了一系列混杂因素，但基线自杀行为控制不佳。符合纳入标准的研究太少，无法定量检查异质性的来源。
当控制一系列不同的混杂因素时，CSA 暴露与自杀企图有关，但关联的时间顺序尚未明确，且关联具有高度异质性。
