Webb Roger T, Antonsen Sussie, Carr Matthew J, Appleby Louis, Pedersen Carsten B, Mok Pearl L H
Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
Manchester Academic Health Science Centre (MAHSC), Manchester, UK.
Lancet Public Health. 2017 Jun 1;2(7):e314-e322. doi: 10.1016/S2468-2667(17)30094-4. eCollection 2017 Jul.
Development of a better understanding of subsequent pathways for individuals who experienced trauma during childhood might usefully inform clinicians and public health professionals regarding the causes of self-harm and interpersonal violence. We aimed to examine these risks during late adolescence and early adulthood among people admitted to hospital following injuries or poisonings during their childhood.
This national cohort study included Danish people born between Jan 1, 1977, and Dec 31, 1997, and was linked to the National Patient Register and Psychiatric Central Research Register to identify all people exposed to hospital admissions for injuries or poisonings due to self-harm, interpersonal violence, or accidents before their 15th birthday. Linkage to these two registers and to the National Crime Register enabled ascertainment of self-harm and violent offending, respectively, as adverse outcomes at ages 15-35 years. Sex-specific incidence rate ratios (IRRs; relative risks) and cumulative incidence percentage values (absolute risks) were estimated. The confounding influence of parental socioeconomic status was also explored.
1 087 672 Danish people were included in this study. The prevalence of any trauma-related hospital admission was 10% (105 753 per 1 087 672; males: 64 454 [11%]; females: 44 299 [8%]) and for both sexes, accident was by far the most prevalent of the categories assessed (males: 59 011 [11%]; females: 40 756 [8%]). Similar patterns of increased risk for self-harm and violent criminality were observed in both sexes, although the IRRs were consistently and significantly larger in women (self-harm: IRR 1·94 [95% CI 1·85-2·02]; violent criminality: 2·16 [1·97-2·36]) than in men (self-harm: 1·61 [1·53-1·69]; violent criminality: 1·58 [1·53-1·63]). Confounding by parental socioeconomic status explained little of the increased risks observed. For young adult men, the highest absolute risk observed was for violent offending among individuals admitted to hospital for interpersonal violence injury during childhood (cumulative incidence 25·0% [95% CI 21·2-28·9]). For young adult women, absolute risk was highest for repeat self-harm among those admitted to hospital following self-harm during childhood (cumulative incidence 21·4% [95% CI 19·8-23·1]). More frequent trauma-related hospital admissions in childhood, and being admitted multiple times for more than one reason, conferred substantial risk increases among young people, with especially steep gradients of this nature observed among women.
Trauma-related hospital admission early in life could be a useful marker for childhood distress that subsequently predicts internalised and externalised destructive behaviours among youths and young adults and might provide a timely opportunity for initiating family-oriented interventions.
European Research Council.
更好地了解童年时期经历过创伤的个体后续的发展路径，可能有助于临床医生和公共卫生专业人员了解自残和人际暴力的成因。我们旨在研究童年时期因受伤或中毒而住院的人群在青春期后期和成年早期的这些风险。
这项全国队列研究纳入了1977年1月1日至1997年12月31日出生的丹麦人，并与国家患者登记册和精神病学中央研究登记册相链接，以确定所有在15岁之前因自残、人际暴力或事故而住院的人。与这两个登记册以及国家犯罪登记册相链接，分别确定了15至35岁时自残和暴力犯罪这两个不良结局。估计了按性别划分的发病率比值（IRR；相对风险）和累积发病率百分比值（绝对风险）。还探讨了父母社会经济地位的混杂影响。
本研究纳入了1087672名丹麦人。任何与创伤相关的住院患病率为10%（每1087672人中105753人；男性：64454人[11%]；女性：44299人[8%]），对于男女两性来说，事故是所评估类别中最常见的（男性：59011人[11%]；女性：40756人[8%]）。在男女两性中均观察到自残和暴力犯罪风险增加的类似模式，尽管女性的发病率比值始终且显著高于男性（自残：IRR 1.94[95%CI 1.85 - 2.02]；暴力犯罪：2.16[1.97 - 2.36]），男性为（自残：1.61[1.53 - 1.69]；暴力犯罪：1.58[1.53 - 1.63]）。父母社会经济地位的混杂对观察到的风险增加解释甚少。对于年轻成年男性，观察到的最高绝对风险是童年时期因人际暴力受伤而住院的个体中的暴力犯罪（累积发病率25.0%[95%CI 21.2 - 28.9]）。对于年轻成年女性，绝对风险最高的是童年时期自残后住院的人群中的反复自残（累积发病率21.4%[95%CI 19.8 - 23.1]）。童年时期更频繁的与创伤相关的住院，以及因多种原因多次住院，会使年轻人的风险大幅增加，在女性中尤其观察到这种性质的陡峭梯度。
生命早期与创伤相关的住院可能是童年困扰的一个有用指标，随后可预测青少年和年轻成年人的内化和外化破坏性行为，并可能为启动以家庭为导向的干预提供一个及时的机会。
欧洲研究理事会。
