Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.
Södertörn University School of Social Sciences, Huddinge, Sweden.
JAMA Netw Open. 2020 Jun 1;3(6):e206639. doi: 10.1001/jamanetworkopen.2020.6639.
Children placed in out-of-home care (OHC) have higher rates of suicidal behaviors, including suicide attempts, compared with those who grow up in their family of origin. Several studies have shown that this elevated risk persists into young adulthood. Yet, our knowledge about any longer-term associations of OHC with suicide attempts is limited.
To examine how childhood experiences of placement in OHC are associated with trajectories of hospitalization because of suicide attempts (HSA) from early into late adulthood.
DESIGN, SETTING, AND PARTICIPANTS: This prospective birth cohort study that was conducted in Stockholm, Sweden, and analyzed in March 2020 included 14 559 individuals born in 1953 who were living in the greater metropolitan of Stockholm in November 1963 and followed through registers up until December 2016.
Childhood experiences of OHC based on information from the Social Register (age 0-19 years).
Hospitalization because of suicide attempts based on in-patient care data from the National Patient Register. Group-based trajectory modeling was used to cluster individuals according to their probabilities of HSA across adulthood (age 20-63 years).
In this cohort of 14 559 individuals (7146 women [49.1%]), 1320 individuals (9.1%) had childhood experiences of OHC, whereas 525 individuals ( 3.6%) had HSA. A Cox regression analysis showed a substantially higher risk of HSA among those with childhood experiences of OHC (hazard ratio, 3.58; 95% CI, 2.93-4.36) and after adjusting for a range of adverse childhood living conditions (hazard ratio, 2.51; 95% CI, 2.00-3.15). Those with at least 1 HSA were grouped into 4 trajectories: (1) peak in middle adulthood (66 [12.6%]), (2) stable low across adulthood (167 [31.8%]), (3) peak in early adulthood (210 [40.0%]), and (4) peak in emerging adulthood (82 [15.6%]). A multinomial regression analysis suggested that those with experiences of OHC had higher risks of following any of these trajectories (trajectory 1: relative risk ratio [RRR], 2.91; 95% CI, 1.61-5.26; trajectory 2: RRR, 3.18; 95% CI, 2.21-4.59; trajectory 3: RRR, 4.32; 95% CI, 3.18-5.86; trajectory 4: RRR, 3.26; 95% CI, 1.94-5.46). The estimates were reduced after adjusting for adverse childhood living conditions.
The findings suggest that the elevated risk of suicide attempts among former child welfare clients does not cease after young adulthood, indicating the necessity for clinical attention to childhood experiences of OHC as a risk marker for suicidal behavior across the life span.
与在原生家庭中长大的儿童相比，被安置在家庭以外照料（OHC）中的儿童出现自杀行为（包括自杀未遂）的比率更高。有几项研究表明，这种风险升高持续到成年早期。然而，我们对 OHC 与自杀未遂之间的任何长期关联的了解是有限的。
探讨儿童时期被安置在 OHC 中的经历与因自杀未遂而住院（HSA）的轨迹之间的关系，这些 HSA 发生在成年早期至晚期。
设计、地点和参与者：这是一项在瑞典斯德哥尔摩进行的前瞻性出生队列研究，于 2020 年 3 月进行分析，纳入了 1953 年出生且在 1963 年 11 月居住在斯德哥尔摩大都市区的 14559 人，并通过登记处进行了随访，直至 2016 年 12 月。
根据社会登记处（0-19 岁）的信息，儿童时期的 OHC 经历。
根据国家患者登记处的住院治疗数据，因自杀未遂而住院。采用基于群组的轨迹建模方法，根据个体在成年期（20-63 岁）发生 HSA 的概率对其进行聚类。
在这一队列中，有 14559 名个体（7146 名女性[49.1%]），有 1320 名（9.1%）个体有 OHC 经历，而有 525 名（3.6%）个体有 HSA 经历。Cox 回归分析显示，有 OHC 经历的个体发生 HSA 的风险显著更高（风险比，3.58；95%CI，2.93-4.36），且在调整了一系列不良的儿童生活条件后（风险比，2.51；95%CI，2.00-3.15）。至少发生过一次 HSA 的个体被分为 4 种轨迹：（1）成年中期高峰（66[12.6%]）；（2）成年期始终处于低水平（167[31.8%]）；（3）成年早期高峰（210[40.0%]）；（4）成年早期高峰（82[15.6%]）。多变量回归分析表明，有 OHC 经历的个体发生这些轨迹的风险更高（轨迹 1：相对风险比[RRR]，2.91；95%CI，1.61-5.26；轨迹 2：RRR，3.18；95%CI，2.21-4.59；轨迹 3：RRR，4.32；95%CI，3.18-5.86；轨迹 4：RRR，3.26；95%CI，1.94-5.46）。在调整了不良的儿童生活条件后，这些估计值有所降低。
研究结果表明，前儿童福利客户的自杀未遂风险在成年早期后并未停止，这表明需要临床关注 OHC 作为整个生命周期自杀行为的风险标志物。
