Vidal-Ribas Pablo, Govender Theemeshni, Sundaram Rajeshwari, Perlis Roy H, Gilman Stephen E
Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
Biostatistics and Bioinformatics Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
Transl Psychiatry. 2022 Jan 10;12(1):14. doi: 10.1038/s41398-021-01777-x.
Most suicide research focuses on acute precipitants and is conducted in high-risk populations. Yet, vulnerability to suicide is likely established years prior to its occurrence. In this study, we aimed to investigate the risk of suicide mortality conferred by prenatal sociodemographic and pregnancy-related factors. Offspring of participants (N = 49,853) of the Collaborative Perinatal Project, a U.S. population-based cohort of pregnancies enrolled between 1959 and 1966, were linked to the U.S. National Death Index to determine their vital status by the end 2016. We examined associations between sociodemographic factors during pregnancy, pregnancy complications, labor and delivery complications, and neonatal complications with suicide death coded according to ICD-9/10 criteria. By the end of 2016, 3,555 participants had died. Of these, 288 (214 males, 74 females) died by suicide (incidence rate = 15.6 per 100,000 person-years, 95% Confidence Interval [CI] = 13.9-17.5). In adjusted models, male sex (Hazard Ratio [HR] = 2.98, CI: 2.26-3.93), White race (HR = 2.14, CI = 1.63-2.83), low parental education (HR = 2.23, CI = 1.38-3.62), manual parental occupation (HR = 1.38, CI = 1.05-1.82), being a younger sibling (HR = 1.52, CI = 1.10-2.11), higher rates of pregnancy complications (HR = 2.36, CI = 1.08-5.16), and smoking during pregnancy (HR = 1,28, CI = 0.99-1.66) were independently associated with suicide risk, whereas birth and neonatal complications were not. Consistent with the developmental origins of psychiatric disorders, vulnerability to suicide mortality is established early in development. Both sociodemographic and pregnancy factors play a role in this risk, which underscores the importance of considering life course approaches to suicide prevention, possibly including provision of high-quality prenatal care, and alleviating the socioeconomic burdens of mothers and families.
大多数自杀研究聚焦于急性诱发因素，且是在高危人群中开展的。然而，自杀易感性很可能在自杀发生前数年就已形成。在本研究中，我们旨在调查产前社会人口统计学因素及与妊娠相关的因素所赋予的自杀死亡风险。协作围产期项目的参与者（N = 49853）为美国一个基于人群的妊娠队列，该队列于1959年至1966年期间登记入组，其后代与美国国家死亡索引相链接，以确定截至2016年底他们的生命状态。我们根据ICD - 9/10标准，研究了妊娠期间的社会人口统计学因素、妊娠并发症、分娩并发症及新生儿并发症与自杀死亡之间的关联。截至2016年底，3555名参与者已经死亡。其中，288人（214名男性，74名女性）死于自杀（发病率为每10万人年15.6例，95%置信区间[CI] = 13.9 - 17.5）。在调整模型中，男性（风险比[HR] = 2.98，CI：2.26 - 3.93）、白人种族（HR = 2.14，CI = 1.63 - 2.83）、父母教育程度低（HR = 2.23，CI = 1.38 - 3.62）、父母从事体力劳动职业（HR = 1.38，CI = 1.05 - 1.82）、是弟弟妹妹（HR = 1.52，CI = 1.10 - 2.11）、妊娠并发症发生率较高（HR = 2.36，CI = 1.08 - 5.16）以及孕期吸烟（HR = 1.28，CI = 0.99 - 1.66）均与自杀风险独立相关，而出生及新生儿并发症则不然。与精神疾病的发育起源一致，自杀死亡易感性在发育早期就已确立。社会人口统计学因素和妊娠因素在这种风险中均起作用，这凸显了考虑采用生命历程方法预防自杀的重要性，可能包括提供高质量的产前护理，以及减轻母亲和家庭的社会经济负担。
