@article{ref1,
title="Long-term exposure to ambient fine particulate pollution, sleep disturbance and their interaction effects on suicide attempts among Chinese adolescents",
journal="Journal of affective disorders",
year="2019",
author="Fan, Beifang and Wang, Tian and Wang, Wanxin and Zhang, Sheng and Gong, Meiqian and Li, Wenyan and Lu, Ciyong and Guo, Lan",
volume="258",
number="",
pages="89-95",
abstract="BACKGROUND: There is a lack of literature about the joint effects of PM<sub>2.5</sub> exposure and sleep disturbance on suicide attempts. This study aimed to estimate the association of PM<sub>2.5</sub> exposure or sleep disturbance with suicide attempts among Chinese adolescents and to test their interaction effects on both additive and multiplicative scales. <br><br>METHODS: Data was drawn from a subsample of the School-based Chinese Adolescents Health Survey (SCAHS) during 2014-2015 in Guangdong province, including 21,780 eligible participants. The 3-year (2011-2013) annual average concentration of PM<sub>2.5</sub> was estimated using satellite data. Multi-level logistic regression models with weights were fitted, and both multiplicative and additive interactions for PM<sub>2.5</sub> and sleep disturbance were tested. <br><br>RESULTS: A total of 608 students (2.8%) reported having suicide attempts. After adjusting for significant demographics and depressive symptoms, PM<sub>2.5</sub> exposure (Adjusted odds ratio [AOR] = 1.25, 95% CI = 1.03-1.56) and sleep disturbance (AOR = 1.69, 95% CI = 1.41-2.02) were positively associated with suicide attempts, respectively. The adjusted additive interaction effect of PM<sub>2.5</sub> and sleep disturbance was 2.42 (95% CI = 1.80-3.26) with a synergistic index of 1.31. The multivariable multi-level logistic regression models did not find any significant multiplicative interaction item (P > 0.05). LIMITATION: The school-based cross-sectional study design CONCLUSION: Long-term exposure to PM<sub>2.5</sub> may elevate the risks of suicide attempts among Chinese adolescents. Moreover, the significant interaction effects of PM<sub>2.5</sub> exposure and sleep disturbance on suicide attempts were found in the additive model, suggesting decreasing long-term exposure to a higher level of PM<sub>2.5</sub> may be helpful to reduce the risk of suicide attempts among adolescents with sleep disturbance.<br><br>Copyright © 2019 Elsevier B.V. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0165-0327",
doi="10.1016/j.jad.2019.08.004",
url="http://dx.doi.org/10.1016/j.jad.2019.08.004"
}