McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Canada.
Bordeaux Population Health Research Centre, Inserm U1219, University of Bordeaux, Bordeaux, France.
PLoS Med. 2022 Mar 15;19(3):e1003946. doi: 10.1371/journal.pmed.1003946. eCollection 2022 Mar.
Although early life factors are associated with increased suicide risk in youth, there is a dearth of research on these associations for individuals growing up in disadvantaged socioeconomic contexts, particularly in low- and middle-income countries (LMICs). We documented the association between individual, familial, and environmental factors in childhood with suicidal ideation among South African youth.
We used data from 2,020 participants in the Birth to Twenty Plus (Bt20+) study, a South African cohort following children born in Soweto, Johannesburg from birth (1990) to age 28 years (2018). Suicidal ideation was self-reported at ages 14, 17, 22, and 28 years, and the primary outcome of interest was suicidal ideation reported at any age. We assessed individual, familial, and socioeconomic characteristics at childbirth and during infancy, adverse childhood experiences (ACEs) between ages 5 and 13 years, and externalizing and internalizing problems between 5 and 10 years. We estimated odds ratios (ORs) of suicidal ideation for individuals exposed to selected childhood factors using logistic regression. Lifetime suicidal ideation was reported by 469 (23.2%) participants, with a 1.7:1 female/male ratio. Suicidal ideation rates peaked at age 17 and decreased thereafter. Socioeconomic adversity, low birth weight, higher birth order (i.e., increase in the order of birth in the family: first, second, third, fourth, or later born child), ACEs, and childhood externalizing problems were associated with suicidal ideation, differently patterned among males and females. Socioeconomic adversity (OR 1.13, CI 1.01 to 1.27, P = 0.031) was significantly associated with suicidal ideation among males only, while birth weight (OR 1.20, CI 1.02 to 1.41, P = 0.03), ACEs (OR 1.11, CI 1.01 to 1.21, P = 0.030), and higher birth order (OR 1.15, CI 1.07 to 1.243, P < 0.001) were significantly associated with suicidal ideation among females only. Externalizing problems in childhood were significantly associated with suicidal ideation among both males (OR 1.23, 1.08 to 1.40, P = 0.002) and females (OR 1.16, CI 1.03 to 1.30, P = 0.011). Main limitations of the study are the high attrition rate (62% of the original sample was included in this analysis) and the heterogeneity in the measurements of suicidal ideation.
In this study from South Africa, we observed that early life social and environmental adversities as well as childhood externalizing problems are associated with increased risk of suicidal ideation during adolescence and early adulthood.
尽管早期生活因素与青少年自杀风险增加有关，但在社会经济处于不利地位的环境中成长的个体（尤其是在中低收入国家），针对这些关联的研究却很少。我们记录了南非青少年在儿童时期的个体、家庭和环境因素与自杀意念之间的关联。
我们使用了来自南非队列研究 Birth to Twenty Plus（Bt20+）的 2020 名参与者的数据，该研究从约翰内斯堡索韦托出生的儿童开始（1990 年）到 28 岁（2018 年）。14 岁、17 岁、22 岁和 28 岁时报告自杀意念，主要观察结果是任何年龄报告的自杀意念。我们评估了分娩时和婴儿期的个体、家庭和社会经济特征、5 至 13 岁之间的不良童年经历（ACEs）以及 5 至 10 岁之间的外化和内化问题。我们使用逻辑回归估计了暴露于选定的儿童时期因素的个体自杀意念的比值比（OR）。469 名（23.2%）参与者报告了终生自杀意念，女性/男性比例为 1.7:1。自杀意念的发生率在 17 岁时达到峰值，此后逐渐下降。社会经济逆境、低出生体重、较高的出生顺序（即在家庭中的出生顺序增加：第一、第二、第三、第四或以后出生的孩子）、ACEs 和儿童期外化问题与自杀意念有关，其模式在男性和女性中有所不同。社会经济逆境（OR 1.13，CI 1.01 至 1.27，P = 0.031）仅与男性自杀意念显著相关，而出生体重（OR 1.20，CI 1.02 至 1.41，P = 0.03）、ACEs（OR 1.11，CI 1.01 至 1.21，P = 0.030）和较高的出生顺序（OR 1.15，CI 1.07 至 1.243，P < 0.001）仅与女性自杀意念显著相关。儿童期的外化问题与男性（OR 1.23，1.08 至 1.40，P = 0.002）和女性（OR 1.16，CI 1.03 至 1.30，P = 0.011）自杀意念均显著相关。研究的主要局限性是高流失率（原始样本中有 62%被纳入分析）和自杀意念测量的异质性。
在这项来自南非的研究中，我们观察到早期的社会和环境逆境以及儿童时期的外化问题与青春期和成年早期自杀意念风险增加有关。
