Cluver Lucie, Orkin Mark, Boyes Mark E, Sherr Lorraine
Department of Social Policy and Intervention, Center for Evidence-Based Intervention, University of Oxford, Oxford, United Kingdom; Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
DST-NRF Centre of Excellence in Human Development, University of Witwatersrand, Braamfontein, Johannesburg, South Africa.
J Adolesc Health. 2015 Jul;57(1):52-9. doi: 10.1016/j.jadohealth.2015.03.001. Epub 2015 Apr 30.
This is the first known prospective study of child suicidal behavior in sub-Saharan Africa. Aims were to determine whether (1) cumulative exposure to adverse childhood experiences (ACEs) predicts later suicidality and (2) heightened risks are mediated by mental health disorder and drug/alcohol misuse.
Longitudinal repeated interviews were conducted 1 year apart (97% retention) with 3,515 adolescents aged 10-18 years in South Africa (56% female; <2.5% refusal). Random selection of census enumeration areas from urban/rural sites within two provinces and door-to-door sampling included all homes with a resident adolescent. Measures included past-month suicide attempts, planning, and ideation, mental health disorders, drug/alcohol use, and ACE, for example, parental death by AIDS or homicide, abuse, and exposure to community violence. Analyses included multivariate logistic regression and multiple mediation tests.
Past-month suicidality rates were 3.2% of adolescents attempting, 5.8% planning, and 7.2% reporting ideation. After controlling for baseline suicidality and sociodemographics, a strong, graded relationship was shown between cumulative ACE and all suicide behaviors 1 year later. Baseline mental health, but not drug/alcohol misuse, mediated relationships between ACE and subsequent suicidality. Suicide attempts rose from 1.9% among adolescents with no ACE to 6.3% among adolescents with >5 ACEs (cumulative odds ratio [OR], 2.46; confidence interval [CI], 1.00-6.05); for suicide planning, from 2.4% to 12.5% (cumulative OR, 4.40; CI, 2.08-9.29); and for suicide ideation, from 4.2% to 15.6% (cumulative OR, 2.99; CI, 1.68-5.53).
Preventing and mitigating childhood adversities have the potential to reduce suicidality. Among adolescents already exposed to adversities, effective mental health services may buffer against future suicidality.
这是撒哈拉以南非洲地区首次针对儿童自杀行为的前瞻性研究。研究目的是确定：（1）童年不良经历（ACEs）的累积暴露是否能预测日后的自杀倾向；（2）心理健康障碍和药物/酒精滥用是否会介导自杀风险的增加。
对南非3515名10 - 18岁青少年进行为期一年的纵向重复访谈（保留率97%）（56%为女性；拒绝率<2.5%）。从两个省份的城市/农村地区随机选择人口普查枚举区，并进行逐户抽样，纳入所有有青少年居住的家庭。测量指标包括过去一个月的自杀未遂、自杀计划和自杀意念、心理健康障碍、药物/酒精使用情况以及ACEs，例如父母因艾滋病或凶杀死亡、虐待以及遭受社区暴力。分析方法包括多变量逻辑回归和多重中介检验。
过去一个月的自杀率为：自杀未遂青少年占3.2%，有自杀计划的青少年占5.8%，有自杀意念的青少年占7.2%。在控制了基线自杀倾向和社会人口统计学因素后，累积ACEs与一年后的所有自杀行为之间呈现出强烈的分级关系。基线心理健康状况，而非药物/酒精滥用，介导了ACEs与后续自杀倾向之间的关系。自杀未遂率从无ACEs的青少年中的1.9%上升至有超过5种ACEs的青少年中的6.3%（累积比值比[OR]，2.46；置信区间[CI]，1.00 - 6.05）；自杀计划率从2.4%上升至12.5%（累积OR，4.40；CI，2.08 - 9.29）；自杀意念率从4.2%上升至15.6%（累积OR，2.99；CI，1.68 - 5.53）。
预防和减轻童年逆境有可能降低自杀倾向。对于已经遭受逆境的青少年，有效的心理健康服务可能会缓冲未来的自杀倾向。
