Abstract：
BACKGROUND: Childhood adversity is associated with increased later mental health problems and suicidal behaviour. Opportunities for earlier healthcare identification and intervention are needed.
OBJECTIVE: To determine associations between hospital admissions for childhood adversity and mental health in children who later die by suicide.
METHODS: 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: aORmale = 8.17 (95% CI, 5.02-13.29), aORfemale = 15.08 (95% CI, 8.07-28.17). We estimated that each type of childhood adversity multiplied odds of suicide by aORmale = 1.90 (95% CI, 1.64-2.21), aORfemale = 2.65 (95% CI, 1.94-3.62), and each mental health admission by aORmale = 2.06 (95% CI, 1.81-2.34), aORfemale = 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.
OBJECTIVE: To determine associations between hospital admissions for childhood adversity and mental health in children who later die by suicide.
METHODS: 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: aORmale = 8.17 (95% CI, 5.02-13.29), aORfemale = 15.08 (95% CI, 8.07-28.17). We estimated that each type of childhood adversity multiplied odds of suicide by aORmale = 1.90 (95% CI, 1.64-2.21), aORfemale = 2.65 (95% CI, 1.94-3.62), and each mental health admission by aORmale = 2.06 (95% CI, 1.81-2.34), aORfemale = 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.
摘要：
背景：儿童时期的逆境与以后心理健康问题和自杀行为的增加有关。需要早期医疗保健识别和干预的机会。
目的：确定因儿童逆境入院与后来因自杀而死亡的儿童的心理健康之间的关联。
方法：基于人群的纵向病例对照研究。总结了1981年或以后在1991年至2017年之间因自杀而死亡的人的苏格兰住院一般和精神病记录（病例）。和匹配的控件(1:10)，儿童逆境和心理健康（广义上定义为精神病诊断和因自残和药物使用而入院）。
结果：提取了2477例“病例”和24777例“对照”的记录；2106例（85％）和13589例对照（55％）的住院寿命。平均死亡年龄为23.7；75.9%为男性。10-17岁（160/2106）的儿童遭受虐待或与暴力有关的儿童逆境代码记录为7.6％，对照组为2.7％（371/13589）。比值比=2.9（95％CI，2.4-3.6）；记录了与心理健康相关的21.7％病例（458/2106），与4.1%的对照(560/13589)相比，比值比=6.5(95%CI,5.7-7.4);80%的精神健康住院患者在综合医院.使用条件逻辑模型，我们发现心理健康入院<18y的剂量-反应效应，三个或三个以上心理健康入院的调整比值比（aOR）最高：aORmale=8.17（95％CI，5.02-13.29），aORfemale=15.08(95%CI,8.07-28.17)。我们估计每种类型的儿童逆境的自杀几率乘以一个男性=1.90（95％CI，1.64-2.21），aORfemale=2.65(95%CI,1.94-3.62),每次精神健康入院时，男性=2.06(95%CI，1.81-2.34)，aORfemale=1.78(95%CI,1.50-2.10)。
结论：我们的寿命研究发现，经历童年逆境（主要是虐待或与暴力有关的入院）或心理健康入院会增加年轻人自杀的几率，对两者都经历过的人来说几率最高。医疗保健从业人员应识别并标记潜在的“高危”青少年，以防止未来的自杀行为，尤其是那些在综合医院。
目的：确定因儿童逆境入院与后来因自杀而死亡的儿童的心理健康之间的关联。
方法：基于人群的纵向病例对照研究。总结了1981年或以后在1991年至2017年之间因自杀而死亡的人的苏格兰住院一般和精神病记录（病例）。和匹配的控件(1:10)，儿童逆境和心理健康（广义上定义为精神病诊断和因自残和药物使用而入院）。
结果：提取了2477例“病例”和24777例“对照”的记录；2106例（85％）和13589例对照（55％）的住院寿命。平均死亡年龄为23.7；75.9%为男性。10-17岁（160/2106）的儿童遭受虐待或与暴力有关的儿童逆境代码记录为7.6％，对照组为2.7％（371/13589）。比值比=2.9（95％CI，2.4-3.6）；记录了与心理健康相关的21.7％病例（458/2106），与4.1%的对照(560/13589)相比，比值比=6.5(95%CI,5.7-7.4);80%的精神健康住院患者在综合医院.使用条件逻辑模型，我们发现心理健康入院<18y的剂量-反应效应，三个或三个以上心理健康入院的调整比值比（aOR）最高：aORmale=8.17（95％CI，5.02-13.29），aORfemale=15.08(95%CI,8.07-28.17)。我们估计每种类型的儿童逆境的自杀几率乘以一个男性=1.90（95％CI，1.64-2.21），aORfemale=2.65(95%CI,1.94-3.62),每次精神健康入院时，男性=2.06(95%CI，1.81-2.34)，aORfemale=1.78(95%CI,1.50-2.10)。
结论：我们的寿命研究发现，经历童年逆境（主要是虐待或与暴力有关的入院）或心理健康入院会增加年轻人自杀的几率，对两者都经历过的人来说几率最高。医疗保健从业人员应识别并标记潜在的“高危”青少年，以防止未来的自杀行为，尤其是那些在综合医院。
