Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States; Department of Psychology, University of Illinois Urbana-Champaign, Champaign, IL 61820, United States.
Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States; Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.
J Affect Disord. 2025 Jan 15;369:1201-1208. doi: 10.1016/j.jad.2024.10.085. Epub 2024 Oct 28.
Few studies have prospectively examined whether adverse childhood experiences contribute to suicide or substance-related mortality. Moreover, children are often exposed to multiple adversities making it critical to identify which clusters of adversities are most harmful for these outcomes. Accordingly, we investigated risk for suicide and substance-related mortality based on the number and clusters of adversities children were exposed to.
Identifying information from 49,853 offspring born between 1959 and 1966 to participants in the Collaborative Perinatal Project was linked to the National Death Index to determine vital status by the end of 2016. We examined associations of the total number of adversities and five clusters of adversity (Low Adversity, Parental Harshness & Neglect, Family Instability, Poverty & Crowded Housing, Poverty & Parental Separation) with suicide and substance-related mortality.
Of the 45,207 participants in the analysis sample, 267 died by suicide and 338 by substance use. Participants who experienced Family Instability had a higher risk of dying by suicide (hazard ratio [HR] = 1.92, 95% CI: 1.32, 2.79) and substance use (HR = 1.50, 95% CI: 1.02, 2.19). Participants who experienced Poverty & Parental Separation were at higher risk of dying by substance use (HR = 1.85, 95% CI: 1.40, 2.45).
Adversities with documented harm including physical and sexual abuse were not assessed in the study.
Childhood adversity is associated with multiple types of self-injury mortality, suggesting shared etiology of risk for suicide and substance-related mortality. Research on interventions that target shared pathways linking childhood vulnerability to multiple causes of death may help reduce the long-term impact of adversities.
很少有研究前瞻性地检查不良的童年经历是否会导致自杀或与物质相关的死亡。此外，儿童通常会受到多种逆境的影响，因此确定儿童所经历的逆境集群中哪些对这些结果危害最大至关重要。因此，我们根据儿童所经历的逆境数量和集群来研究自杀和与物质相关的死亡率的风险。
将 1959 年至 1966 年期间参加合作围产期项目的参与者的 49853 名后代的识别信息与国家死亡指数相关联，以确定截至 2016 年底的生存状态。我们检查了总逆境数量和五个逆境集群（低逆境、父母严厉与忽视、家庭不稳定、贫困与拥挤住房、贫困与父母分离）与自杀和与物质相关的死亡率之间的关联。
在分析样本的 45207 名参与者中，有 267 人自杀死亡，338 人死于物质使用。经历家庭不稳定的参与者自杀死亡的风险更高（危险比[HR] = 1.92，95%置信区间：1.32，2.79）和物质使用（HR = 1.50，95%置信区间：1.02，2.19）。经历贫困与父母分离的参与者死于物质使用的风险更高（HR = 1.85，95%置信区间：1.40，2.45）。
本研究未评估有记录的伤害性逆境，包括身体和性虐待。
童年逆境与多种自我伤害死亡率相关，表明自杀和与物质相关的死亡率的风险存在共同病因。研究针对干预措施，这些措施可能有助于减少童年脆弱性与多种死亡原因之间共享途径的长期影响。
