Hjern Anders, Vinnerljung Bo, Brännström Lars
Clinical Epidemiology/Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Social Work, Stockholm University, Stockholm, Sweden.
Nord J Psychiatry. 2025 Jul;79(5):380-386. doi: 10.1080/08039488.2025.2507734. Epub 2025 May 27.
Exposure to childhood out-of-home care (OHC, foster family and residential care) is associated with an increased risk of suicide in youth and young adulthood, but the life course and clinical psychiatric implications of this risk have not yet been well elucidated.
This was a national cohort study generated from linkage of a range of population-based registers, resulting in a national cohort of 838 714 where 24 628 (2.9%) had a history of OHC. The study population, born 1972-1981, was followed from age 18 to age 39-48 years for suicide death and hospitalized self-harm.
Exposure to OHC accounted for 14% of all suicide deaths in the cohort. The age-adjusted Hazard Ratios (HRs) for exposure to OHC on suicide death were 5.04 (95% C.I. 4.50-5.64) for men and 7.21 (6.13-8.48) for women compared with the same gender in the general population. After adjusting for year of birth, childhood SES and parental morbidity these risks were attenuated to 3.39 (2.99-3.85) for men and 4.23 (3.50-5.12) for women. For hospitalized self-harm the adjusted HRs were 4.47 (4.18-4.79) for men and 4.25 (4.00-4.52) for women. These risks remained similarly high from age 18 years to 48 years. Exposure to childhood OHC carried a higher risk of suicide also among psychiatric inpatients, age-adjusted HR 1.70 (1.50-1.94).
Exposure to OHC during childhood is a major predictor for suicide and self-harm in young and middle-aged adults as well as among adult psychiatric patients.
童年时期接受家庭外照料（OHC，寄养家庭和寄宿照料）与青少年和青年期自杀风险增加有关，但这种风险对生命历程和临床精神疾病的影响尚未得到充分阐明。
这是一项全国队列研究，通过一系列基于人群的登记册进行关联，形成了一个838714人的全国队列，其中24628人（2.9%）有OHC病史。该研究人群出生于1972年至1981年，从18岁开始随访至39 - 48岁，观察自杀死亡和住院自残情况。
OHC暴露占队列中所有自杀死亡人数的14%。与一般人群中相同性别的人相比，OHC暴露对自杀死亡的年龄调整风险比（HR）男性为5.04（95%置信区间4.50 - 5.64），女性为7.21（6.13 - 8.48）。在调整出生年份、童年社会经济地位和父母发病率后，这些风险男性降至3.39（2.99 - 3.85），女性降至4.23（3.50 - 5.12）。对于住院自残，调整后的HR男性为4.47（4.18 - 4.79），女性为4.25（4.00 - 4.52）。从18岁到48岁，这些风险同样居高不下。在成年精神病患者中，童年OHC暴露也具有较高的自杀风险，年龄调整后的HR为1.70（1.50 - 1.94）。
童年时期接受OHC是中青年以及成年精神病患者自杀和自残的主要预测因素。
