Berny Lauren M, Tanner-Smith Emily E
University of Oregon, Department of Counseling Psychology and Human Services, USA.
University of Oregon, Prevention Science Institute, USA.
Child Youth Serv Rev. 2024 Feb;157. doi: 10.1016/j.childyouth.2023.107405. Epub 2023 Dec 16.
Exposure to interpersonal violence is associated with elevated suicide risk. Preventing suicide among high-risk adolescents is most often discussed from a clinical treatment perspective, resulting in a gap in research examining whether school and community connectedness can buffer the relationships between forms of interpersonal violence and suicide risk in clinical samples of adolescents.
Baseline data from 294 adolescents who received substance use treatment were analyzed to help fill this gap in research. Adolescents in this sample were at greater risk for suicidal thoughts and behaviors given their histories of substance use disorders and high rates of interpersonal violence, with 57% reporting experiencing at least one form of abuse/violence. Independent variables included lifetime exposure to physical abuse, sexual abuse, and weapon violence; moderators included various measures of school and community connectedness. Multinomial logistic regression models were estimated to examine the main and interaction effects predicting a three-category measure of suicide risk: non-suicidal, suicidal ideation only, and prior suicide attempts.
Sexual abuse survivors had the highest predicted probability of a prior suicide attempt when reporting lower levels of teacher support, school-based positive peer interactions, or neighborhood social connection, but at higher levels of these protective factors, their predicted probability was similar to those not exposed to sexual abuse. The same protective pattern was observed for physical abuse survivors with high neighborhood social connection.
The buffering effects observed in this study identified dimensions of school and community social connectedness as protective factors for youth exposed to abuse. Although promoting social connectedness is often cited as a universal suicide prevention approach, tailored efforts to enhance connectedness within this population may also be a promising secondary prevention strategy. Thus, in addition to clinical treatment, more emphasis should be placed on systems-level approaches to reducing risk among youth most vulnerable to suicide.
遭受人际暴力与自杀风险升高有关。预防高危青少年自杀大多是从临床治疗角度进行讨论的，这导致在研究学校和社区联系是否能缓冲人际暴力形式与青少年临床样本中自杀风险之间的关系方面存在空白。
对294名接受物质使用治疗的青少年的基线数据进行分析，以填补这一研究空白。鉴于该样本中的青少年有物质使用障碍病史且人际暴力发生率高，他们有更高的自杀想法和行为风险，57%的人报告至少经历过一种形式的虐待/暴力。自变量包括一生中遭受身体虐待、性虐待和武器暴力的经历；调节变量包括学校和社区联系的各种衡量指标。估计多项逻辑回归模型，以检验预测自杀风险三类指标（非自杀、仅有自杀意念和既往自杀未遂）的主效应和交互效应。
当性虐待幸存者报告教师支持、基于学校的积极同伴互动或邻里社会联系水平较低时，他们既往自杀未遂的预测概率最高，但在这些保护因素水平较高时，他们的预测概率与未遭受性虐待的人相似。邻里社会联系高的身体虐待幸存者也观察到同样的保护模式。
本研究中观察到的缓冲效应确定了学校和社区社会联系的维度是遭受虐待青少年的保护因素。虽然促进社会联系常被视为一种普遍的自杀预防方法，但针对这一人群加强联系的针对性努力也可能是一种有前景的二级预防策略。因此，除了临床治疗外，应更加强调系统层面的方法，以降低最易自杀的青少年的风险。
