Telethon Kids Institute, the University of Western Australia, PO Box 855, West Perth, Western Australia 6872, Australia; The School of Population Health, the University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia.
Telethon Kids Institute, the University of Western Australia, PO Box 855, West Perth, Western Australia 6872, Australia.
Child Abuse Negl. 2017 May;67:322-337. doi: 10.1016/j.chiabu.2017.03.012. Epub 2017 Mar 24.
Adolescents exposed to maltreatment have an elevated risk of deliberate self-harm (DSH). The aim of this study was to investigate longitudinally the effects of the number, timing, and type of maltreatment allegations on adolescent risk of having a DSH-related hospital admission, using linked data in Western Australia. A total of 351,372 children born between 1986 and 2000 were followed from birth up to the year 2010. Cox regression models were utilized, while controlling for a range of psychosocial covariates. Compared to children without allegations of maltreatment, children with unsubstantiated allegations only (aHR=1.04, 95%CI: 1.00-1.08, p<.01) and children with a substantiated allegation (aHR=1.10, 95%CI: 1.06-1.15, p<.001) all had significantly increased risk of DSH in adolescence. Among children with a substantiated allegation of maltreatment, the greater the number of allegations, the longer the exposure to maltreatment, and the more types of maltreatment experienced by a child, the higher the child's risk of DSH. However, this dose-response pattern was not found among children with unsubstantiated allegations only. This study calls for the early identification of children who are vulnerable to maltreatment, the better identification of the duration and severity of maltreatment experiences, and the provision of continued care and support, to reduce the child's DSH risk in adolescence.
遭受虐待的青少年有更高的故意自伤（DSH）风险。本研究旨在使用西澳大利亚州的关联数据，从纵向角度探讨虐待指控的数量、时间和类型对青少年发生与 DSH 相关的住院治疗的风险的影响。共对 1986 年至 2000 年间出生的 351372 名儿童进行了从出生到 2010 年的随访。利用 Cox 回归模型，同时控制了一系列社会心理协变量。与没有虐待指控的儿童相比，只有未证实的虐待指控的儿童（aHR=1.04，95%CI：1.00-1.08，p<.01）和有证实的虐待指控的儿童（aHR=1.10，95%CI：1.06-1.15，p<.001）在青春期发生 DSH 的风险均显著增加。在有证实的虐待指控的儿童中，指控数量越多、暴露于虐待的时间越长、经历的虐待类型越多，儿童发生 DSH 的风险越高。然而，在只有未证实的虐待指控的儿童中，并未发现这种剂量-反应模式。本研究呼吁早期识别易受虐待的儿童，更好地识别虐待经历的持续时间和严重程度，并提供持续的护理和支持，以降低儿童在青春期发生 DSH 的风险。
