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Citation
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Dougall N, Savinc J, Maxwell M, Karatzias T, O'Connor RC, Williams B, John A, Cheyne H, Fyvie C, Bisson JI, Hibberd C, Abbott-Smith S, Nolan L, Murray J. BJPsych Open 2024; 10(4): e124. |
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Abstract
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BACKGROUND: Childhood adversity is associated with increased later mental health problems and suicidal behaviour. Opportunities for earlier healthcare identification and intervention are needed.
AIM: To determine associations between hospital admissions for childhood adversity and mental health in children who later die by suicide.
METHOD: Population-based longitudinal case-control study. Scottish in-patient general and psychiatric records were summarised for individuals born 1981 or later who died by suicide between 1991 and 2017 (cases), and matched controls (1:10), for childhood adversity and mental health (broadly defined as psychiatric diagnoses and general hospital admissions for self-harm and substance use).
RESULTS: Records were extracted for 2477 'cases' and 24 777 'controls'; 2106 cases (85%) and 13 589 controls (55%) had lifespan hospitalisations. Mean age at death was 23.7; 75.9% were male. Maltreatment or violence-related childhood adversity codes were recorded for 7.6% cases aged 10-17 (160/2106) versus 2.7% controls (371/13 589), odds ratio = 2.9 (95% CI, 2.4-3.6); mental health-related admissions were recorded for 21.7% cases (458/2106), versus 4.1% controls (560/13 589), odds ratio = 6.5 (95% CI, 5.7-7.4); 80% of mental health admissions were in general hospitals. Using conditional logistic models, we found a dose-response effect of mental health admissions <18y, with highest adjusted odds ratio (aOR) for three or more mental health admissions: aOR(male) = 8.17 (95% CI, 5.02-13.29), aOR(female) = 15.08 (95% CI, 8.07-28.17). We estimated that each type of childhood adversity multiplied odds of suicide by aOR(male) = 1.90 (95% CI, 1.64-2.21), aOR(female) = 2.65 (95% CI, 1.94-3.62), and each mental health admission by aOR(male) = 2.06 (95% CI, 1.81-2.34), aOR(female) = 1.78 (95% CI, 1.50-2.10).
CONCLUSIONS: Our lifespan study found that experiencing childhood adversity (primarily maltreatment or violence-related admissions) or mental health admissions increased odds of young person suicide, with highest odds for those experiencing both. Healthcare practitioners should identify and flag potential 'at-risk' adolescents to prevent future suicidal acts, especially those in general hospitals.
Language: en |