Thompson Martie P, Kingree J B, Lamis Dorian
Department of Youth, Family, and Community Studies, Clemson University, Clemson, South Carolina.
Department of Public Health Sciences, Clemson University, Clemson, South Carolina.
Child Care Health Dev. 2019 Jan;45(1):121-128. doi: 10.1111/cch.12617. Epub 2018 Sep 2.
Suicide is a leading cause of death among adolescents and young adults. The current study extends the research linking adverse childhood experiences (ACEs) to suicidal behaviors by testing these associations using a nationally representative sample, assessing for suicide ideation and attempts in adulthood, controlling for established risk factors for suicidality, and measuring a broad array of ACEs.
The sample included 9,421 participants from the National Longitudinal Study of Adolescent Health who participated in four waves of assessments spanning 13 years. We examined longitudinal associations between eight different ACEs (physical, sexual, and emotional abuse, neglect, parental death, incarceration, alcoholism, and family suicidality) with suicidal ideation and suicide attempts in adulthood, while controlling for depression, problem alcohol use, drug use, delinquency, impulsivity, gender, race, age, and urbanicity. We also tested for cumulative associations of ACEs with suicide ideation and attempts.
Logistic regression analyses indicated that physical, sexual, and emotional abuse, parental incarceration, and family history of suicidality each increased the risk by 1.4 to 2.7 times for suicidal ideation and suicide attempts in adulthood. The accumulation of ACEs increased the odds of suicide ideation and attempts. Compared with those with no ACEs, the odds of seriously considering suicide or attempting suicide in adulthood increased more than threefold among those with three or more ACEs.
Intervention strategies need to prevent ACEs from occurring and, if they do occur, should take into account the impact of cumulative ACEs on suicide risk. Future research should focus on identifying mediating mechanisms for the ACEs-suicidality association using longitudinal research designs and determine which ACEs are most important to include in a cumulative ACE measure.
自杀是青少年和青年成年人死亡的主要原因。当前的研究通过使用具有全国代表性的样本进行测试这些关联、评估成年期的自杀意念和自杀未遂情况、控制既定的自杀风险因素以及测量一系列广泛的童年不良经历（ACEs），扩展了将童年不良经历与自杀行为联系起来的研究。
样本包括来自青少年健康全国纵向研究的9421名参与者，他们参加了跨越13年的四轮评估。我们研究了八种不同的童年不良经历（身体虐待、性虐待、情感虐待、忽视、父母死亡、监禁、酗酒和家族自杀史）与成年期自杀意念和自杀未遂之间的纵向关联，同时控制抑郁、问题饮酒、药物使用、犯罪、冲动性、性别、种族、年龄和城市化程度。我们还测试了童年不良经历与自杀意念和未遂的累积关联。
逻辑回归分析表明，身体虐待、性虐待、情感虐待、父母监禁和家族自杀史各自使成年期自杀意念和自杀未遂的风险增加1.4至2.7倍。童年不良经历的累积增加了自杀意念和未遂的几率。与没有童年不良经历的人相比，有三种或更多童年不良经历的人在成年期认真考虑自杀或尝试自杀的几率增加了三倍多。
干预策略需要预防童年不良经历的发生，如果这些经历确实发生，应考虑累积童年不良经历对自杀风险的影响。未来的研究应侧重于使用纵向研究设计确定童年不良经历与自杀之间关联的中介机制，并确定在累积童年不良经历测量中纳入哪些童年不良经历最为重要。
