Fuller-Thomson E, Baird S L, Dhrodia R, Brennenstuhl S
Department of Family and Community Medicine, Factor-Inwentash Faculty of Social Work, and Institute for Life Course & Aging, University of Toronto, Toronto, Canada.
Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.
Child Care Health Dev. 2016 Sep;42(5):725-34. doi: 10.1111/cch.12351. Epub 2016 Jun 9.
To further our understanding of the relationship between Adverse Childhood Experiences (ACEs) and suicidal behaviour, this study investigates the association between three types of ACEs and lifetime suicide attempts, while considering potential gender-specific and mediating effects.
Data were obtained from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH), a cross-sectional, population-based survey comprised of respondents aged 18 or older who provided self-reported data on past experiences of suicide attempts, as well as childhood sexual abuse (CSA), childhood physical abuse (CPA) and parental domestic violence (PDV) (n = 22 559). After testing for ACE by gender interactions, we estimated the odds of lifetime suicide attempts for each ACE and then investigated whether depression, anxiety, substance abuse and chronic pain acted as mediators of the relationship.
The odds of suicide attempts are significantly higher among those with a history of CPA (OR = 3.29; 99.9% CI 2.33-4.64), CSA (OR = 4.42; 99.9% CI 3.14-6.23) or PDV (OR = 2.52; 99.9% CI 1.69-3.76), when ACEs are mutually adjusted. There is little evidence that gender acts as a moderator; however, depression, anxiety, substance abuse and chronic pain appear to partially mediate the associations. Depression alone accounts for about a quarter of the associations with CSA and CPA.
Mental health factors and chronic pain appear only to partially mediate relationships between ACEs and lifetime suicide attempts. Future research should look at other pathways with the goal of developing multi-level interventions.
为了进一步了解童年不良经历（ACEs）与自杀行为之间的关系，本研究调查了三种类型的ACEs与终生自杀未遂之间的关联，同时考虑了潜在的性别特异性和中介效应。
数据来自2012年加拿大社区健康调查-心理健康（CCHS-MH），这是一项基于人群的横断面调查，由18岁及以上的受访者组成，他们提供了关于过去自杀未遂经历以及童年性虐待（CSA）、童年身体虐待（CPA）和父母家庭暴力（PDV）的自我报告数据（n = 22559）。在通过性别交互作用测试ACEs后，我们估计了每种ACEs终生自杀未遂的几率，然后调查抑郁、焦虑、药物滥用和慢性疼痛是否作为这种关系的中介因素。
在相互调整ACEs后，有CPA史（OR = 3.29；99.9%CI 2.33 - 4.64）、CSA史（OR = 4.42；99.9%CI 3.14 - 6.23）或PDV史（OR = 2.52；99.9%CI 1.69 - 3.76）的人群中，自杀未遂的几率显著更高。几乎没有证据表明性别起调节作用；然而，抑郁、焦虑、药物滥用和慢性疼痛似乎部分介导了这种关联。仅抑郁就约占与CSA和CPA关联的四分之一。
心理健康因素和慢性疼痛似乎仅部分介导了ACEs与终生自杀未遂之间的关系。未来的研究应该探索其他途径，以制定多层次的干预措施。
