Chen P J, Mackes N, Sacchi C, Lawrence A J, Ma X, Pollard R, Matter M, Morgan C, Harding S, Schumann G, Pariante C, Mehta M A, Montana G, Nosarti C, Dazzan P
Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
Department of Psychiatry, Chang Gung Memorial Hospital at Taoyuan and Chang Gung University, Taoyuan, Taiwan.
Epidemiol Psychiatr Sci. 2022 Mar 30;31:e19. doi: 10.1017/S204579602200004X.
Lower parental education has been linked to adverse youth mental health outcomes. However, the relationship between parental education and youth suicidal behaviours remains unclear. We explored the association between parental education and youth suicidal ideation and attempts, and examined whether sociocultural contexts moderate such associations.
We conducted a systematic review and meta-analysis with a systematic literature search in PubMed, PsycINFO, Medline and Embase from 1900 to December 2020 for studies with participants aged 0-18, and provided quantitative data on the association between parental education and youth suicidal ideation and attempts (death included). Only articles published in English in peer-reviewed journals were considered. Two authors independently assessed eligibility of the articles. One author extracted data [e.g. number of cases and non-cases in each parental education level, effect sizes in forms of odds ratios (ORs) or beta coefficients]. We then calculated pooled ORs using a random-effects model and used moderator analysis to investigate heterogeneity.
We included a total of 59 articles (63 study samples, totalling 2 738 374 subjects) in the meta-analysis. Lower parental education was associated with youth suicidal attempts [OR = 1.12, 95% Confidence Interval (CI) = 1.04-1.21] but not with suicidal ideation (OR = 1.05, 95% CI = 0.98-1.12). Geographical region and country income level moderated the associations. Lower parental education was associated with an increased risk of youth suicidal attempts in Northern America (OR = 1.26, 95% CI = 1.10-1.45), but with a decreased risk in Eastern and South-Eastern Asia (OR = 0.72, 95% CI = 0.54-0.96). An association of lower parental education and increased risk of youth suicidal ideation was present in high- income countries (HICs) (OR = 1.14, 95% CI = 1.05-1.25), and absent in low- and middle-income countries (LMICs) (OR = 0.91, 95% CI = 0.77-1.08).
The association between youth suicidal behaviours and parental education seems to differ across geographical and economical contexts, suggesting that cultural, psychosocial or biological factors may play a role in explaining this association. Although there was high heterogeneity in the studies reviewed, this evidence suggests that the role of familial sociodemographic characteristics in youth suicidality may not be universal. This highlights the need to consider cultural, as well as familial factors in the clinical assessment and management of youth's suicidal behaviours in our increasingly multicultural societies, as well as in developing prevention and intervention strategies for youth suicide.
较低的父母教育水平与青少年不良心理健康结果相关。然而，父母教育与青少年自杀行为之间的关系仍不明确。我们探讨了父母教育与青少年自杀意念及自杀未遂之间的关联，并研究了社会文化背景是否会调节这种关联。
我们进行了一项系统综述和荟萃分析，通过在PubMed、PsycINFO、Medline和Embase数据库中对1900年至2020年12月期间的文献进行系统检索，纳入研究对象为0至18岁参与者的研究，并提供关于父母教育与青少年自杀意念及自杀未遂（包括死亡）之间关联的定量数据。仅考虑发表在同行评审期刊上的英文文章。两位作者独立评估文章的 eligibility。一位作者提取数据[例如每个父母教育水平下的病例数和非病例数、以比值比（OR）或β系数形式表示的效应量]。然后我们使用随机效应模型计算合并OR，并使用调节分析来研究异质性。
我们在荟萃分析中总共纳入了59篇文章（63个研究样本，共2738374名受试者）。较低的父母教育水平与青少年自杀未遂相关[OR = 1.12，95%置信区间（CI）= 1.04 - 1.21]，但与自杀意念无关（OR = 1.05，95% CI = 0.98 - 1.12）。地理区域和国家收入水平调节了这种关联。在北美，较低的父母教育水平与青少年自杀未遂风险增加相关（OR = 1.26，95% CI = 1.10 - 1.45），而在东亚和东南亚则与风险降低相关（OR = 0.72，95% CI = 0.54 - 0.96）。在高收入国家（HICs），较低的父母教育水平与青少年自杀意念风险增加相关（OR = 1.14，95% CI = 1.05 - 1.25），而在低收入和中等收入国家（LMICs）则不存在这种关联（OR = 0.91，95% CI = 0.77 - 1.08）。
青少年自杀行为与父母教育之间的关联似乎因地理和经济背景而异，这表明文化、心理社会或生物学因素可能在解释这种关联中起作用。尽管在所审查的研究中存在高度异质性，但这一证据表明家庭社会人口学特征在青少年自杀行为中的作用可能并非普遍适用。这凸显了在我们日益多元文化的社会中，在对青少年自杀行为进行临床评估和管理以及制定青少年自杀预防和干预策略时，需要考虑文化以及家庭因素。
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