儿童期外化问题、内化问题和共病问题：区分有自杀意念的年轻成年人和尝试自杀的年轻成年人。

Childhood externalizing, internalizing and comorbid problems: distinguishing young adults who think about suicide from those who attempt suicide.

机构信息

Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, Quebec, Canada.

Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada.

出版信息

Psychol Med. 2023 Feb;53(3):1030-1037. doi: 10.1017/S0033291721002464. Epub 2021 Jun 29.

DOI:10.1017/S0033291721002464

PMID:34183077

Abstract

BACKGROUND

While childhood externalizing, internalizing and comorbid problems have been associated with suicidal risk, little is known about their specific associations with suicidal ideation and attempts. We examined associations between childhood externalizing, internalizing and comorbid problems and suicidal ideation (without attempts) and attempts by early adulthood, in males and females.

METHOD

Participants were from the Quebec Longitudinal Study of Kindergarten Children, a population-based study of kindergarteners in Quebec from 1986 to 1988 and followed-up until 2005. We captured the co-development of teacher-rated externalizing and internalizing problems at age 6-12 using multitrajectories. Using the Diagnostic Interview Schedule administered at age 15 and 22, we identified individuals (1) who never experienced suicidal ideation/attempts, (2) experienced suicidal ideation but never attempted suicide and (3) attempted suicide.

RESULTS

The identified profiles were no/low problems (45%), externalizing (29%), internalizing (11%) and comorbid problems (13%). After adjusting for socioeconomic and familial characteristics, children with externalizing (OR 2.00, CI 1.39-2.88), internalizing (OR 2.34, CI 1.51-3.64) and comorbid (OR 3.29, CI 2.05-5.29) problems were at higher risk of attempting suicide ( non-suicidal) by age 22 than those with low/no problems. Females with comorbid problems were at higher risk of attempting suicide than females with one problem. Childhood problems were not associated with suicidal ideation. Externalizing (OR 2.01, CI 1.29-3.12) and comorbid problems (OR 2.28, CI 1.29-4.03) distinguished individuals who attempted suicide from those who thought about suicide without attempting.

CONCLUSION

Childhood externalizing problems alone or combined with internalizing problems were associated with suicide attempts, but not ideation (without attempts), suggesting that these problems confer a specific risk for suicide attempts.

摘要

背景

虽然儿童期的外化问题、内化问题和共病问题与自杀风险有关，但对于它们与自杀意念和自杀未遂的具体关联知之甚少。我们研究了儿童期外化问题、内化问题和共病问题与青少年早期自杀意念（无未遂）和自杀未遂之间的关联，分别在男性和女性中进行。

方法

参与者来自魁北克幼儿园纵向研究，这是一项针对 1986 年至 1988 年魁北克幼儿园的基于人群的研究，并一直随访到 2005 年。我们使用多轨迹方法来捕捉 6-12 岁时教师评定的外化和内化问题的共同发展。使用在 15 岁和 22 岁时进行的诊断访谈表，我们确定了（1）从未经历过自杀意念/尝试的个体，（2）经历过自杀意念但从未试图自杀的个体，以及（3）试图自杀的个体。

结果

确定的特征包括无/低问题（45%）、外化问题（29%）、内化问题（11%）和共病问题（13%）。在校正了社会经济和家庭特征后，与低/无问题相比，有外化（OR 2.00，95%CI 1.39-2.88）、内化（OR 2.34，95%CI 1.51-3.64）和共病（OR 3.29，95%CI 2.05-5.29）问题的儿童在 22 岁时有更高的自杀未遂风险（非自杀）。有共病问题的女性比有单一问题的女性更有可能自杀。童年问题与自杀意念无关。外化（OR 2.01，95%CI 1.29-3.12）和共病问题（OR 2.28，95%CI 1.29-4.03）将尝试自杀的个体与仅考虑自杀而未尝试的个体区分开来。