Mayo Clinic, Rochester, MN.
University of California, San Diego.
J Am Acad Child Adolesc Psychiatry. 2018 Oct;57(10):786-791. doi: 10.1016/j.jaac.2018.04.021. Epub 2018 Aug 22.
Although suicide is the second most frequent cause of death in American youth, suicide research has heretofore been confined to convenience samples that represent neither psychiatric nor general populations and that fail to include individuals dying at their first attempts. These limitations were addressed by assembling a youth cohort followed from the first medically recorded attempt (index attempt [IA]). It was hypothesized this approach would more accurately represent the prevalence of completed suicide after an attempt and underscore lethality based on method.
This study draws from a previously reported retrospective-prospective all-age cohort identified through the Rochester Epidemiology Project. The original 1,490-subject sample included 813 Olmsted County youth 10 to 24 years old (n = 258 male, n = 555 female; 54.6% of total cohort) with IAs from January 1, 1986 through December 31, 2007 and followed until December 31, 2010.
Twenty-nine of 813 subjects (3.6%) killed themselves during the study period, with 28 of 29 dying before their 25th birthday and 20 of 28 (71.4%) dying at their first attempt. Despite composing only 31.7% of the cohort (258 of 813), male subjects composed most suicides: 23 of 29 (79.3% of suicides; 8.9% of male subjects) versus 6 of 29 female subjects (20.7% of suicides; 1.1% of female subjects). Eighty-five percent of all IA deaths involved firearms. More than a third of youth-41.2%-lacked a psychiatric history prior to IA.
These data show that more than half the IAs occurred in youth, with approximately three-fourths of completed youth suicides occurring at the IAs. In parsing cause of IA death in the all-age cohort, the contribution of firearms figured even more prominently in the subsample of youth (85.0%) than in those at least 25 years old (64.3%). The high IA lethality suggests that prevention efforts commencing after the IA are too late for most victims.
尽管自杀是美国青少年人群中第二大常见死因，但自杀研究迄今为止仅限于方便取样，这些样本既不能代表精神病患者，也不能代表一般人群，而且没有包括首次尝试自杀就死亡的个体。通过组建一个从首次有记录的自杀尝试（索引尝试[IA]）开始就进行随访的青年队列，解决了这些限制。研究假设，这种方法将更准确地代表尝试后完成自杀的流行率，并根据方法强调其致命性。
本研究来源于先前报道的一项回顾性前瞻性全年龄段队列研究，该研究通过罗切斯特流行病学项目确定。最初的 1490 名受试者样本包括奥姆斯特德县 10 至 24 岁的 813 名青少年（n=258 名男性，n=555 名女性；总队列的 54.6%），IA 时间为 1986 年 1 月 1 日至 2007 年 12 月 31 日，随访至 2010 年 12 月 31 日。
在研究期间，813 名受试者中有 29 人（3.6%）自杀，其中 28 人在 25 岁生日之前死亡，20 人（71.4%）在首次尝试时死亡。尽管男性受试者仅占队列的 31.7%（813 名中的 258 名），但他们构成了大多数自杀事件：29 名自杀者中有 23 名（79.3%的自杀者；8.9%的男性），而 29 名女性中有 6 名（20.7%的自杀者；1.1%的女性）。所有 IA 死亡中有 85%涉及枪支。超过三分之一的青年（41.2%）在 IA 之前没有精神病史。
这些数据表明，超过一半的 IA 发生在青少年中，大约四分之三的青少年自杀死亡发生在 IA 时。在解析全年龄段队列中 IA 死亡的原因时，枪支的作用在青年亚组（85.0%）中比在至少 25 岁的人群（64.3%）中更为突出。IA 的高致命性表明，大多数受害者在 IA 后开始的预防工作为时已晚。
