Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.
Department of Population Health Sciences and National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK.
Acta Psychiatr Scand. 2018 Feb;137(2):116-124. doi: 10.1111/acps.12844. Epub 2017 Dec 22.
To establish whether previously identified early-life antecedents of suicide mortality (i.e. low birthweight, younger maternal age, higher birth order, externalizing problems and adversities) are associated with proximal psychiatric disorders and suicidal ideation, which are themselves associated with an increased risk of suicide.
Participants were from the 1958 British birth-cohort (N = 8905) with information on prenatal/childhood experiences and the Clinical Interview Schedule-Revised at age 45 years. Outcomes were as follows: any internalizing disorder (anxiety disorder/depressive episode), depressive episode, alcohol use disorder and suicidal ideation.
After adjustment, higher birth order (P = 0.043), younger maternal age (P = 0.017) and increased number of childhood adversities (P = 0.026) were associated with an increased risk of internalizing disorders. For example, the OR (95% CI) in fourth- or later-born children was 1.48 (1.06-2.07) and for young maternal age (<19 years) was 1.31 (0.89-1.91). Effect sizes were similar in magnitude for depressive episode and suicidal ideation, although associations did not reach conventional significance levels. No associations were found for low birthweight and externalizing problems (in males) and investigated outcomes.
Associations for younger maternal age, higher birth order and adversities with adult internalizing disorders suggest that psychiatric disorders may be on the pathway linking some early-life factors and suicide.
确定自杀死亡率的先前确定的早期生活前因（即低出生体重、母亲年龄较小、较高的出生顺序、外化问题和逆境）是否与近期精神障碍和自杀意念相关，而这些本身又与自杀风险增加相关。
参与者来自 1958 年英国出生队列（N=8905），有关于产前/儿童时期经历和 45 岁时临床访谈表修订版的信息。结果如下：任何一种内化障碍（焦虑障碍/抑郁发作）、抑郁发作、酒精使用障碍和自杀意念。
调整后，较高的出生顺序（P=0.043）、母亲年龄较小（P=0.017）和儿童期逆境增加（P=0.026）与内化障碍的风险增加相关。例如，第四胎或以后出生的儿童的 OR（95%CI）为 1.48（1.06-2.07），母亲年龄较小（<19 岁）的 OR 为 1.31（0.89-1.91）。对于抑郁发作和自杀意念，效应大小相似，尽管关联没有达到常规显著性水平。对于低出生体重和外化问题（男性）以及研究结果，没有发现关联。
母亲年龄较小、出生顺序较高和逆境与成年内化障碍的关联表明，精神障碍可能是一些早期生活因素和自杀之间的途径。
