School of Psychology, University of South Wales,Pontypridd,UK.
NIHR School for Primary Care Research, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester,Manchester,UK.
Psychol Med. 2019 May;49(7):1057-1078. doi: 10.1017/S0033291718003823. Epub 2019 Jan 4.
This comprehensive systematic review and meta-analysis aims to quantify the association between different types of childhood maltreatment and suicidality. We searched five bibliographic databases, including Medline, PsychINFO, Embase, Web of Science and CINAHL, until January 2018. Random-effects meta-analysis was employed followed by univariable and multivariable meta-regressions. Heterogeneity was quantified using the I2 statistic and formal publication bias tests were undertaken. The methodological quality of the studies was critically appraised and accounted in the meta-regression analyses. Data from 68 studies based on n = 261.660 adults were pooled. All different types of childhood maltreatment including sexual abuse [odds ratio (OR) 3.17, 95% confidence interval (CI) 2.76-3.64], physical abuse (OR 2.52, 95% CI 2.09-3.04) and emotional abuse (OR 2.49, 95% CI 1.64-3.77) were associated with two- to three-fold increased risk for suicide attempts. Similar results were found for the association between childhood maltreatment and suicidal ideation. Complex childhood abuse was associated with a particularly high risk for suicide attempts in adults (OR 5.18, 95% CI 2.52-10.63). Variations across the studies in terms of demographic and clinical characteristics of the participants and other core methodological factors did not affect the findings of the main analyses. We conclude that there is solid evidence that childhood maltreatment is associated with increased odds for suicidality in adults. The main outstanding challenge is to better understand the mechanisms which underpin the development of suicidality in people exposed to childhood maltreatment because current evidence is scarce.
本全面的系统评价和荟萃分析旨在量化不同类型的儿童期虐待与自杀意念之间的关联。我们检索了五个文献数据库，包括 Medline、PsychINFO、Embase、Web of Science 和 CINAHL，检索时间截至 2018 年 1 月。采用随机效应荟萃分析，然后进行单变量和多变量荟萃回归。使用 I2 统计量量化异质性，并进行正式的发表偏倚检验。批判性评估研究的方法学质量，并在荟萃回归分析中加以考虑。汇总了 68 项研究的数据，共纳入 n = 261660 名成年人。所有不同类型的儿童期虐待，包括性虐待[比值比 (OR) 3.17，95%置信区间 (CI) 2.76-3.64]、身体虐待 (OR 2.52，95% CI 2.09-3.04) 和情感虐待 (OR 2.49，95% CI 1.64-3.77)，均与自杀未遂的风险增加两到三倍相关。同样的结果也发现了儿童期虐待与自杀意念之间的关联。复杂的儿童期虐待与成年人自杀未遂的风险特别高相关 (OR 5.18，95% CI 2.52-10.63)。研究参与者的人口统计学和临床特征以及其他核心方法学因素的差异并没有影响主要分析的结果。我们的结论是，有确凿的证据表明儿童期虐待与成年人自杀意念的几率增加有关。目前的主要挑战是更好地理解儿童期虐待暴露人群中自杀意念发展的机制，因为目前的证据很少。
