Mars Becky, Heron Jon, Crane Catherine, Hawton Keith, Lewis Glyn, Macleod John, Tilling Kate, Gunnell David
School of Social and Community Medicine, University of Bristol, Oakfield House, Bristol BS8 2BN, UK
School of Social and Community Medicine, University of Bristol, Oakfield House, Bristol BS8 2BN, UK.
BMJ. 2014 Oct 21;349:g5954. doi: 10.1136/bmj.g5954.
To investigate the mental health, substance use, educational, and occupational outcomes of adolescents who self harm in a general population sample, and to examine whether these outcomes differ according to self reported suicidal intent.
Population based birth cohort study.
Avon Longitudinal Study of Parents and Children (ALSPAC), a UK birth cohort of children born in 1991-92.
Data on lifetime history of self harm with and without suicidal intent were available for 4799 respondents who completed a detailed self harm questionnaire at age 16 years. Multiple imputation was used to account for missing data.
Mental health problems (depression and anxiety disorder), assessed using the clinical interview schedule-revised at age 18 years, self reported substance use (alcohol, cannabis, cigarette smoking, and illicit drugs) at age 18 years, educational attainment at age 16 and 19 years, occupational outcomes at age 19 years, and self harm at age 21 years.
Participants who self harmed with and without suicidal intent at age 16 years were at increased risk of developing mental health problems, future self harm, and problem substance misuse, with stronger associations for suicidal self harm than for non-suicidal self harm. For example, in models adjusted for confounders the odds ratio for depression at age 18 years was 2.21 (95% confidence interval 1.55 to 3.15) in participants who had self harmed without suicidal intent at age 16 years and 3.94 (2.67 to 5.83) in those who had self harmed with suicidal intent. Suicidal self harm, but not self harm without suicidal intent, was also associated with poorer educational and employment outcomes.
Adolescents who self harm seem to be vulnerable to a range of adverse outcomes in early adulthood. Risks were generally stronger in those who had self harmed with suicidal intent, but outcomes were also poor among those who had self harmed without suicidal intent. These findings emphasise the need for early identification and treatment of adolescents who self harm.
调查在普通人群样本中自我伤害的青少年的心理健康、物质使用、教育和职业结局，并检验这些结局是否因自我报告的自杀意图而有所不同。
基于人群的出生队列研究。
阿冯父母与儿童纵向研究（ALSPAC），英国一个针对1991 - 1992年出生儿童的出生队列。
4799名在16岁时完成详细自我伤害问卷的受访者提供了有或无自杀意图的终身自我伤害史数据。采用多重填补法处理缺失数据。
使用18岁时修订的临床访谈时间表评估心理健康问题（抑郁和焦虑症）、18岁时自我报告的物质使用情况（酒精、大麻、吸烟和非法药物）、16岁和19岁时的教育程度、19岁时的职业结局以及21岁时的自我伤害情况。
16岁时有或无自杀意图的自我伤害参与者出现心理健康问题、未来自我伤害和物质滥用问题的风险增加，自杀性自我伤害的关联比非自杀性自我伤害更强。例如，在针对混杂因素进行调整的模型中，16岁时无自杀意图的自我伤害参与者在18岁时患抑郁症的比值比为2.21（95%置信区间1.55至3.15），有自杀意图的自我伤害参与者为3.94（2.67至5.83）。自杀性自我伤害而非无自杀意图的自我伤害也与较差的教育和就业结局相关。
自我伤害的青少年在成年早期似乎易受一系列不良结局影响。有自杀意图的自我伤害者风险通常更强，但无自杀意图的自我伤害者结局也较差。这些发现强调了对自我伤害青少年进行早期识别和治疗的必要性。
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