PDF(Pubmed)
Abstract：
Childhood out-of-home care is associated with premature death in adulthood, in particular death by suicide, accidents and violence. However, little is known about the mortality risk in the much larger population of adults that had contact with social services in childhood but never entered out-of-home care. We determine the association between all tiers of contact with children\'s social services and risk of suicide and other sudden deaths in young adulthood.
This population-wide, longitudinal, record-linkage study of adults in Northern Ireland born between 1985 and 1997 (n=437 008) followed each individual from age 18 years to July 2021 (maximum age 36 years). Cox regression models estimated the association between level of contact with social services in childhood (no contact; referred but assessed as not in need (NIN); child in need (CIN) and child in care (CIC)) and risk of death by suicide and sudden death in young adulthood.
Individuals with childhood social care contact (n=51 097) comprised 11.7% of the cohort yet accounted for 35.3% of sudden deaths and 39.7% of suicide deaths. Risk of suicide or sudden death increased stepwise with level of childhood contact and was highest in adults with a history of out-of-home care (suicide HR 8.85 (95% CI 6.83 to 11.4)). Individuals assessed as NIN, and those deemed a CIN, had four times the risk of death by suicide in young adulthood compared with unexposed peers (HR 4.25 (95% CI 3.26 to 5.53) and HR 4.49 (95% CI 3.75 to 5.39), respectively).
Childhood contact with social services is a risk marker for death by suicide and sudden death in young adulthood. Risk is not confined to adults with a history of out-of-home care but extends to the much larger population that had contact with social services but never entered care.
This population-wide, longitudinal, record-linkage study of adults in Northern Ireland born between 1985 and 1997 (n=437 008) followed each individual from age 18 years to July 2021 (maximum age 36 years). Cox regression models estimated the association between level of contact with social services in childhood (no contact; referred but assessed as not in need (NIN); child in need (CIN) and child in care (CIC)) and risk of death by suicide and sudden death in young adulthood.
Individuals with childhood social care contact (n=51 097) comprised 11.7% of the cohort yet accounted for 35.3% of sudden deaths and 39.7% of suicide deaths. Risk of suicide or sudden death increased stepwise with level of childhood contact and was highest in adults with a history of out-of-home care (suicide HR 8.85 (95% CI 6.83 to 11.4)). Individuals assessed as NIN, and those deemed a CIN, had four times the risk of death by suicide in young adulthood compared with unexposed peers (HR 4.25 (95% CI 3.26 to 5.53) and HR 4.49 (95% CI 3.75 to 5.39), respectively).
Childhood contact with social services is a risk marker for death by suicide and sudden death in young adulthood. Risk is not confined to adults with a history of out-of-home care but extends to the much larger population that had contact with social services but never entered care.
摘要：
背景：儿童家庭外护理与成年后过早死亡有关，尤其是自杀死亡,事故和暴力。然而,对于在童年时期接触过社会服务但从未进入过家庭外护理的更多成年人的死亡风险知之甚少。我们确定与儿童社会服务的所有层次的接触与青年时期自杀和其他猝死的风险之间的关联。
方法：这种全人群，纵向,对1985年至1997年出生的北爱尔兰成年人(n=437008)进行记录连锁研究,随访18岁至2021年7月(最大年龄36岁)的每个人.Cox回归模型估计了儿童期与社会服务的接触水平（无接触；被提及但被评估为不需要（NIN）；有需要的儿童（CIN）和儿童护理（CIC））与成年后自杀和猝死的风险之间的关联。
结果：有儿童社会关怀接触者（n=51097）占队列的11.7％，但占猝死的35.3％和自杀死亡的39.7％。自杀或猝死的风险随着儿童接触水平而逐步增加，并且在有家庭外护理史的成年人中最高（自杀HR8.85（95％CI6.83至11.4））。被评估为NIN的个人，那些被认为是aCIN的，与未暴露的同龄人相比，年轻成年期自杀死亡的风险是其四倍（HR4.25（95％CI3.26至5.53）和HR4.49（95％CI3.75至5.39），分别)。
结论：儿童与社会服务机构的接触是青年时期自杀死亡和猝死的风险标志。风险不仅限于有家庭外护理史的成年人，还延伸到与社会服务机构接触但从未接受护理的更多人群。
方法：这种全人群，纵向,对1985年至1997年出生的北爱尔兰成年人(n=437008)进行记录连锁研究,随访18岁至2021年7月(最大年龄36岁)的每个人.Cox回归模型估计了儿童期与社会服务的接触水平（无接触；被提及但被评估为不需要（NIN）；有需要的儿童（CIN）和儿童护理（CIC））与成年后自杀和猝死的风险之间的关联。
结果：有儿童社会关怀接触者（n=51097）占队列的11.7％，但占猝死的35.3％和自杀死亡的39.7％。自杀或猝死的风险随着儿童接触水平而逐步增加，并且在有家庭外护理史的成年人中最高（自杀HR8.85（95％CI6.83至11.4））。被评估为NIN的个人，那些被认为是aCIN的，与未暴露的同龄人相比，年轻成年期自杀死亡的风险是其四倍（HR4.25（95％CI3.26至5.53）和HR4.49（95％CI3.75至5.39），分别)。
结论：儿童与社会服务机构的接触是青年时期自杀死亡和猝死的风险标志。风险不仅限于有家庭外护理史的成年人，还延伸到与社会服务机构接触但从未接受护理的更多人群。
