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美国青少年向成年过渡期的自杀轨迹和心理健康治疗中的种族/民族、性别、性取向和社会经济差异:一项基于人群的队列研究。

Racial/Ethnic, Sex, Sexual Orientation, and Socioeconomic Disparities in Suicidal Trajectories and Mental Health Treatment Among Adolescents Transitioning to Young Adulthood in the USA: A Population-Based Cohort Study.

机构信息

School of Social Work, Indiana University-Purdue University Indianapolis, Indianapolis, IN, 46202, USA.

School of Social Work, Indiana University Bloomington, Bloomington, IN, 47401, USA.

出版信息

Adm Policy Ment Health. 2021 Sep;48(5):742-756. doi: 10.1007/s10488-021-01122-w. Epub 2021 Feb 24.

Abstract

Suicide is the second leading cause of death for people aged 10-34 years old. Limited research has documented extant heterogeneities in suicide across the life course and among diverse sociodemographic groups. There is also limited research on the influences of mental health utilization on suicidal trajectories across the life course. This study aims to: (1) identify racial/ethnic, sex, sexual orientation, socioeconomic status, and intersectional differences in suicidal trajectories among adolescents transitioning to adulthood; and (2) examine influences of mental health service utilization on disparities in suicidal trajectories. The study included 9421 respondents (M = 14.99 [SD = 1.61]) from Waves I-IV National Longitudinal Study of Adolescent to Adult Health (1994-2008). Latent class growth analyses were used to identify trajectories of suicidal ideation and suicide attempts. Multivariate multinomial logistic regression was used to examine the influences of mental health treatment and sociodemographic characteristics on suicidal trajectories. Three suicidal ideation (low-stable, high-decreasing, moderate-decreasing-increasing) and two suicide attempt (low-stable, moderate-decreasing) trajectories were identified. Compared with the low-stable trajectories, the risks of being in high-decreasing suicidal ideation trajectories were higher among females (AOR = 1.45, 95% CI 1.01-2.13) and sexual minorities (AOR = 1.82, 95% CI 1.21-2.74). Sexual minorities (AOR = 2.63, 95% CI 1.69-4.08) and low-SES adolescents (AOR = 1.79, 95% CI 1.08-2.98) were more likely to be in the moderate-decreasing suicide attempt group. Mental health service utilization predicted engagement in high-risk suicidal trajectories. Sociodemographic disparities in suicidal trajectories initiate early and persist over time. Individuals in high-risk trajectories received mental health treatment during adolescence. Suicide prevention should target vulnerable subpopulations and mental health service utilization in the early stage.

摘要

自杀是 10-34 岁人群的第二大死因。有限的研究记录了整个生命过程中和不同社会人口群体中现存的自杀异质性。关于心理健康服务利用对整个生命过程中自杀轨迹的影响,研究也很有限。本研究旨在:(1) 确定青少年向成年过渡期间种族/民族、性别、性取向、社会经济地位和交叉差异的自杀轨迹;(2) 研究心理健康服务利用对自杀轨迹差异的影响。该研究纳入了 9421 名来自青少年至成人健康纵向研究(1994-2008 年)第 I-IV 波的受访者(M=14.99[SD=1.61])。潜类别增长分析用于确定自杀意念和自杀企图的轨迹。多变量多项逻辑回归用于检验心理健康治疗和社会人口特征对自杀轨迹的影响。确定了三种自杀意念(低稳定、高下降、中下降-增加)和两种自杀企图(低稳定、中下降)轨迹。与低稳定轨迹相比,女性(AOR=1.45,95%CI 1.01-2.13)和性少数群体(AOR=1.82,95%CI 1.21-2.74)更有可能处于高下降自杀意念轨迹。性少数群体(AOR=2.63,95%CI 1.69-4.08)和低 SES 青少年(AOR=1.79,95%CI 1.08-2.98)更有可能处于中下降自杀企图组。心理健康服务利用预测了高风险自杀轨迹的参与。自杀轨迹的社会人口差异很早就开始存在,并持续存在。处于高风险轨迹中的个体在青少年时期接受了心理健康治疗。自杀预防应针对弱势亚群和早期的心理健康服务利用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f818/7904031/b55cdc9e5c98/10488_2021_1122_Fig1_HTML.jpg

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