Association between childhood maltreatment and suicide among rural adolescents
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摘要:
目的 探讨童年期虐待与青少年自杀行为的关联，为制定自杀预防策略提供科学依据。 方法 采用多阶段分层整群随机抽样方法，从安徽、广东、云南、黑龙江和湖北农村地区共纳入16 271名中学生。采用结构化问卷收集研究对象一般情况、童年期忽视、虐待情况以及调查前1年内的自杀意念、自杀计划、自杀未遂情况，运用多因素Logistic回归模型分析童年期忽视、虐待与自杀意念、自杀计划和自杀未遂的关联。 结果 农村青少年自杀意念、自杀计划和自杀未遂的发生人数分别为2 453(15.1%)、1 164(7.2%)和572(3.5%)人，童年期忽视、中度和重度躯体虐待的发生人数分别为10 756(66.1%)，4 311(26.5%)和703(4.3%)人。单因素分析显示，童年期忽视、虐待与自杀意念、自杀计划、自杀未遂相关均有统计学意义(P值均 < 0.05)。在控制年龄、性别、独生子女、父母文化程度、经济收入、情绪管理和社会支持因素后，童年期忽视、虐待与自杀意念、自杀计划、自杀未遂差异均有统计学意义(OR=1.62~5.14，P值均 < 0.05)，其中重度躯体虐待的OR值(95%CI)分别为3.00(2.49~3.62)，3.52(2.81~4.40), 5.14(3.87~6.83)。 结论 童年期忽视和虐待可能会增加农村青少年自杀行为发生风险，应积极采取有效措施减少童年期忽视虐待，预防自杀。 Abstract:Objective This study explored the relationship between childhood maltreatment and adolescent suicide provides a scientific basis for suicide prevention strategies. Methods A total of 16 271 middle and high school students from rural areas in Anhui, Guangdong, Yunnan, Heilongjiang and Hubei provinces were enrolled through multi-stage stratified cluster random sampling. Structured questionnaires were used to collect information on participants' general information, childhood neglect, abuse, suicide ideation, suicide plans and suicide attempts in the 12 months prior to the survey. Multivariate Logistic regression models were used to analyze the associations of childhood neglect and childhood maltreatment with suicide ideation, suicide plans and suicide attempts. Results The number of suicide ideations, suicide plans and suicide attempts among rural adolescents were 2 453(15.1%), 1 164(7.2%) and 572(3.5%), respectively. The number of cases of childhood neglect, moderate physical abuse and severe physical abuse were 10 756(66.1%), 4 311(26.5%) and 703(4.3%), respectively. Univariate analysis showed that childhood neglect and abuse were significantly associated with suicide ideation, suicide plans and suicide attempts(P < 0.05). After controlling for age, gender, only children, parental education level, income, emotional management and social support, childhood neglect and abuse remained significantly correlated with suicide ideation, suicide plans and suicide attempts(OR=1.62-5.14, P < 0.05); the OR(OR 95%CI) for severe physical abuse were 3.00(2.49-3.62), 3.52(2.81-4.40), 5.14(3.87-6.83) respectively. Conclusion Childhood neglect and abuse may increase the risk of suicide among adolescents in rural China, and effective measures should be taken to reduce childhood neglect and abuse and prevent suicide. -
Key words:
- Child abuse /
- Suicide /
- Mental heatlh /
- Regression analysis /
- Adolescent /
- Rural population
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表 1 不同组别农村青少年遭受儿童期忽视或虐待报告率比较
Table 1. Comparison of reported rates of childhood neglect or abuse among different groups of rural adolescents
组别 选项 人数 遭受儿童期忽视或虐待 χ2值 P值 性别 男 8 434 6 378(75.6) 3.33 0.07 女 7 837 6 022(76.8) 省份 安徽 3 319 2 683(80.8) 264.64 < 0.01 云南 3 400 2 666(78.4) 广东 3 252 2 403(73.9) 黑龙江 3 087 2 047(66.3) 湖北 3 213 2 601(81.0) 独生子女 否 10 653 8 322(78.1) 62.06 < 0.01 是 5 618 4 078(72.6) 父亲文化程度 小学及以下 3 263 2 631(80.6) 67.60 < 0.01 初中 8 355 6 326(75.9) 高中 2 924 2 194(75.0) 大学及以上 1 337 934(69.9) 母亲文化程度 小学及以下 5 467 4 362(79.8) 78.08 < 0.01 初中 7 252 5 479(75.6) 高中 2 198 1 595(72.6) 大学及以上 928 647(69.7) 家庭人均月 较低 2 922 2 218(75.9) 2.91 0.23 收入 中等 11 191 8 568(76.6) 较高 2 144 1 606(74.9) 情绪管理 低 2 372 2 019(85.1) 490.54 < 0.01 中 11 983 9 292(77.5) 高 1 826 1 040(57.0) 社会支持 低 2 544 2 145(84.3) 392.48 < 0.01 中 10 760 8 384(77.9) 高 2 967 1 871(63.1) 注： ()内数字为报告率/%；父/母文化程度、家庭收入、社会支持数据有缺失项。 
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表 2 农村青少年自杀意念与童年期忽视和躯体虐待的相关性分析[n = 16 271, OR值(OR值95%CI)]
Table 2. Association of suicide ideation with childhood neglect and maltreatment in rural adolescents [n = 16 271, OR(OR 95%CI)]
自变量 模型1 模型2 模型3 忽视 无 1.00 1.00 1.00 有 2.25(2.02~2.50)* 1.95(1.74~2.18)* 1.62(1.44~1.82)* 躯体虐待 无 1.00 1.00 1.00 轻度 1.28(1.12~1.46)* 1.13(0.98~1.29) 1.13(0.98~1.30) 中度 2.20(1.99~2.43)* 1.97(1.77~2.19)* 1.78(1.59~1.99)* 重度 4.42(3.73~5.23)* 3.80(3.18~4.55)* 3.00(2.49~3.62)* 注：模型1未调整变量；模型2调整年龄、性别、独生子女、父母文化程度、经济收入；模型3在模型2基础上调整情绪管理、社会支持。*P < 0.05。
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表 3 农村青少年自杀计划与童年期忽视和躯体虐待的相关性分析[n = 16 271, OR值(OR值95%CI)]
Table 3. Association of suicide plans with childhood neglect and maltreatment in rural adolescents [n = 16 271, OR(OR 95%CI)]
自变量 模型1 模型2 模型3 忽视 无 1.00 1.00 1.00 有 2.40(2.06~2.80)* 2.04(1.73~2.40)* 1.66(1.40~1.97)* 躯体虐待 无 1.00 1.00 1.00 轻度 1.29(1.07~1.56)* 1.13(0.93~1.38) 1.14(0.93~1.39) 中度 2.19(1.90~2.52)* 1.88(1.62~2.19)* 1.67(1.43~1.95)* 重度 5.65(4.61~6.93)* 4.58(3.69~5.69)* 3.52(2.81~4.40)* 注：模型1未调整变量；模型2调整年龄、性别、独生子女、父母文化程度、经济收入；模型3在模型2基础上调整情绪管理、社会支持。*P < 0.05。
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表 4 农村青少年自杀未遂与童年期忽视和躯体虐待的相关性分析[n = 16 271, OR值(OR值95%CI)]
Table 4. Association of suicide attempts with childhood neglect and maltreatment in rural adolescents [n = 16 271, OR(OR 95%CI)]
自变量 模型1 模型2 模型3 忽视 无 1.00 1.00 1.00 有 2.15(1.68~2.75)* 1.93(1.51~2.48)* 1.82(1.42~2.34)* 躯体虐待 无 1.00 1.00 1.00 轻度 1.03(0.76~1.40) 1.02(0.75~1.39) 1.04(0.76~1.42) 中度 2.39(1.93~2.96)* 2.23(1.80~2.77)* 2.18(1.75~2.71)* 重度 6.65(5.04~8.77)* 5.53(4.17~7.33)* 5.14(3.87~6.83)* 注：模型1未调整变量；模型2调整年龄、性别、独生子女、父母文化程度、经济收入；模型3在模型2基础上调整情绪管理、社会支持。*P < 0.05。
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