Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, St. Goran, 112 81, Stockholm, Sweden.
National Board of Forensic Medicine, Alfred Nobels Allé 41, 141 52, Huddinge, Sweden.
Soc Psychiatry Psychiatr Epidemiol. 2019 Apr;54(4):437-444. doi: 10.1007/s00127-018-1618-7. Epub 2018 Nov 7.
Gender differences in youth self-harm are sparsely studied regarding long-term prognoses. We aimed to study the gender differences in effects of adolescent self-harm in early adult life in four domains: 1/family situation, 2/education and employment, 3/mental illness and suicidal behaviour, and 4/suicide and all-cause mortality.
A register-based cohort study including all Swedish residents aged 20 during 2001-2005 was performed. Exposure was self-harm at ages 10-20, and outcomes were death and suicide and past-year records of self-harm, marital status/children, education/employment, and mental health at age 30. We used logistic regression for dichotomous outcomes, and Cox regression models for time-dependent outcomes. An interaction term was introduced to detect significant gender effects, in which case we performed stratified analyses.
Subjects with self-harm before age 20 had a poorer prognosis for all studied outcomes, and risk estimates were similar for men and women for most outcomes including suicide. Significant interaction terms (ITs) were found, revealing gender differences, for being married (p 0.0003; OR 0.6, OR 0.9), being a parent (p < 0.0001; OR 0.7, OR 1.1), receiving unemployment support (p < 0.0001; OR 2.4, OR 1.8), and death from any cause (p 0.006; OR 10.6, OR 7.4).
Adolescent self-harm was associated with later life adversities and affected men more than women regarding prognoses for unemployment and certain aspects of the family situation. We found no gender difference for the effect of self-harm on the risk of suicide. Future suicide risk should not be underestimated in young self-harming women.
关于青少年自残行为的长期预后，关于其在性别差异方面的研究很少。我们旨在研究青少年自残行为在成年早期的四个方面对预后的影响：1/家庭状况、2/教育和就业、3/精神疾病和自杀行为以及 4/自杀和全因死亡率。
我们进行了一项基于登记的队列研究，该研究包括所有在 2001-2005 年期间年龄为 20 岁的瑞典居民。暴露因素是 10-20 岁时的自残行为，结局是 30 岁时的死亡和自杀以及过去一年的自残记录、婚姻状况/子女、教育/就业和心理健康。我们使用逻辑回归分析二分类结局，使用 Cox 回归模型分析时间依赖性结局。引入交互项以检测显著的性别效应，如果存在交互效应，则进行分层分析。
在 20 岁之前有自残行为的受试者在所有研究结局方面预后较差，且大多数结局（包括自杀）的风险估计在男性和女性之间相似。发现存在显著的交互项（ITs），表明存在性别差异，表现在结婚（p<0.0003；OR 0.6，OR 0.9）、为人父母（p<0.0001；OR 0.7，OR 1.1）、接受失业支持（p<0.0001；OR 2.4，OR 1.8）和任何原因导致的死亡（p=0.006；OR 10.6，OR 7.4）。
青少年自残行为与以后的生活逆境有关，且对男性的影响大于女性，涉及失业和家庭状况的某些方面。我们没有发现自残行为对自杀风险的影响存在性别差异。在年轻的自残女性中，未来的自杀风险不应被低估。
