Bruwer Belinda, Govender Ravi, Bishop Melanie, Williams David R, Stein Dan J, Seedat Soraya
Department of Psychiatry, Stellenbosch University, Tygerberg, Republic of South Africa.
Department of Society, Human Development and Health, Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA Department of African and African American Studies, Harvard University, Boston, Massachusetts, USA.
BMJ Open. 2014 Jun 11;4(6):e004644. doi: 10.1136/bmjopen-2013-004644.
Suicide and suicidal behaviours are significant public health problems and a leading cause of death worldwide and in South Africa. We examined the association between childhood adversities and suicidal behaviour over the life course.
A national probability sample of 4351 South African adult participants (aged 18 years and older) in the South African Stress and Health (SASH) study was interviewed as part of the World Mental Health Surveys initiative. Respondents provided sociodemographic and diagnostic information, as well as an account of suicide-related thoughts and behaviours. Suicidality or suicidal behaviour were defined as were defined as suicide attempts and suicidal ideation in the total sample, and suicide plans and attempts among ideators. Childhood adversities included physical abuse, sexual abuse, parental death, parental divorce, other parental loss, family violence, physical illness and financial adversity. The association between suicidality and childhood adversities was examined using discrete-time survival models.
More than a third of the respondents with suicidal behaviour experienced at least one childhood adversity, with physical abuse, parental death and parental divorce being the most prevalent adversities. Physical abuse, sexual abuse and parental divorce were identified as significant risk markers for lifetime suicide attempts, while physical abuse and parental divorce were significantly correlated with suicidal ideation. Two or more childhood adversities were associated with a twofold higher risk of lifetime suicide attempts. Sexual abuse (OR 9.3), parental divorce (OR 3.1) and childhood physical abuse (OR 2.2) had the strongest associations with lifetime suicide attempts. The effect of childhood adversities on suicidal tendencies varied over the life course. For example, sexual abuse was significantly associated with suicide attempts during childhood and teen years, but not during young and later adulthood.
Childhood adversities, especially sexual abuse, physical abuse and parental divorce, are important risk factors for the onset and persistence of suicidal behaviour, with this risk being greatest in childhood and adolescence.
自杀及自杀行为是重大的公共卫生问题，也是全球及南非主要的死亡原因。我们研究了童年逆境与一生之中自杀行为之间的关联。
作为世界心理健康调查倡议的一部分，对南非压力与健康（SASH）研究中4351名南非成年参与者（年龄在18岁及以上）的全国概率样本进行了访谈。受访者提供了社会人口统计学和诊断信息，以及与自杀相关的想法和行为的描述。自杀或自杀行为在总样本中定义为自杀未遂和自杀意念，在有自杀意念者中定义为自杀计划和自杀未遂。童年逆境包括身体虐待、性虐待、父母死亡、父母离异、其他父母离世、家庭暴力、身体疾病和经济困境。使用离散时间生存模型研究自杀行为与童年逆境之间的关联。
超过三分之一有自杀行为的受访者经历过至少一次童年逆境，其中身体虐待、父母死亡和父母离异是最常见的逆境。身体虐待、性虐待和父母离异被确定为终生自杀未遂的重要风险指标，而身体虐待和父母离异与自杀意念显著相关。两种或更多童年逆境与终生自杀未遂风险高出两倍有关。性虐待（比值比9.3）、父母离异（比值比3.1）和童年身体虐待（比值比2.2）与终生自杀未遂的关联最强。童年逆境对自杀倾向的影响在一生中有所不同。例如，性虐待与童年和青少年时期的自杀未遂显著相关，但在青年和成年后期则不然。
童年逆境，尤其是性虐待、身体虐待和父母离异，是自杀行为发生和持续的重要风险因素，这种风险在童年和青春期最大。
