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Abstract：
BACKGROUND: Existing evidence suggests that children and adolescents who had experienced childhood maltreatment (CM) are at higher suicidal risk. However, the mediation role of resilience in this association remains unclear. We aim to investigate the mediation via resilience in the associations between CM and three suicidal risk indicators (suicidal ideation, SI; suicidal plan, SP; suicidal attempt, SA) among a large sample of Chinese children and adolescents.
METHODS: A population-based cross-sectional survey was conducted in southwestern China Yunnan province. A total of 9723 children and adolescents were included and analyzed by using a multi-stage stratified cluster sampling design. Univariate and multivariate logistic regression models were fitted to explore the associations between CM, resilience, and the three suicidal risk indicators, dose-response trends further elucidated by using the restricted cubic splines. Path models were adopted to estimate the mediation of resilience.
RESULTS: The estimated prevalence rates for one-year SI, SP and SA were 32.86% (95% CI: 31.93-33.80%), 19.36% (95% CI: 18.57-20.16%) and 9.07% (95% CI: 8.51-9.66%). After adjustment, CM significantly associated with all 3 suicidal risk indicators, and the odds ratios (ORs) were 2.13 (95% CI: 1.91-2.37), 2.45 (95% CI: 2.13-2.81), and 3.61 (95% CI: 2.90-4.52) for one-year SI, SP, and SA, respectively. Path models revealed that resilience significantly mediated the associations between CM and the three suicidal risk indicators, and among all dimensions of resilience, family support presented the strongest mediation consistently.
CONCLUSIONS: Our study results suggest that intervention measures which focusing on improving psychological resilience might be effective in reducing suicidal risk for children and adolescents who had experienced maltreatment. Prospective studies should be done to corroborate our findings.
METHODS: A population-based cross-sectional survey was conducted in southwestern China Yunnan province. A total of 9723 children and adolescents were included and analyzed by using a multi-stage stratified cluster sampling design. Univariate and multivariate logistic regression models were fitted to explore the associations between CM, resilience, and the three suicidal risk indicators, dose-response trends further elucidated by using the restricted cubic splines. Path models were adopted to estimate the mediation of resilience.
RESULTS: The estimated prevalence rates for one-year SI, SP and SA were 32.86% (95% CI: 31.93-33.80%), 19.36% (95% CI: 18.57-20.16%) and 9.07% (95% CI: 8.51-9.66%). After adjustment, CM significantly associated with all 3 suicidal risk indicators, and the odds ratios (ORs) were 2.13 (95% CI: 1.91-2.37), 2.45 (95% CI: 2.13-2.81), and 3.61 (95% CI: 2.90-4.52) for one-year SI, SP, and SA, respectively. Path models revealed that resilience significantly mediated the associations between CM and the three suicidal risk indicators, and among all dimensions of resilience, family support presented the strongest mediation consistently.
CONCLUSIONS: Our study results suggest that intervention measures which focusing on improving psychological resilience might be effective in reducing suicidal risk for children and adolescents who had experienced maltreatment. Prospective studies should be done to corroborate our findings.
摘要：
背景：现有证据表明，经历过童年虐待（CM）的儿童和青少年有更高的自杀风险。然而,复原力在这种关联中的中介作用尚不清楚.我们的目的是调查CM和三个自杀风险指标(自杀意念，自杀计划，SP；自杀企图，SA)在大量中国儿童和青少年样本中。
方法：在中国西南部云南省进行了基于人群的横断面调查。共纳入9723名儿童和青少年，并采用多阶段分层整群抽样设计进行分析。单变量和多变量逻辑回归模型拟合，以探讨CM，弹性，和三个自杀风险指标，剂量反应趋势通过使用有限的三次样条进一步阐明。采用路径模型来估计弹性的中介作用。
结果：一年SI的估计患病率，SP和SA为32.86%（95%CI：31.93-33.80%），19.36%（95%CI：18.57-20.16%）和9.07%（95%CI：8.51-9.66%）。调整后,CM与所有3个自杀风险指标显着相关，比值比(OR)为2.13(95%CI：1.91-2.37)，2.45（95%CI：2.13-2.81），一年期SI为3.61（95%CI：2.90-4.52），SP,SA,分别。路径模型显示，韧性显著介导了CM和三个自杀风险指标之间的关联，在韧性的所有维度中，家庭支持始终是最强有力的调解。
结论：我们的研究结果表明，以提高心理韧性为重点的干预措施可能有效降低遭受虐待的儿童和青少年的自杀风险。应该进行前瞻性研究以证实我们的发现。
方法：在中国西南部云南省进行了基于人群的横断面调查。共纳入9723名儿童和青少年，并采用多阶段分层整群抽样设计进行分析。单变量和多变量逻辑回归模型拟合，以探讨CM，弹性，和三个自杀风险指标，剂量反应趋势通过使用有限的三次样条进一步阐明。采用路径模型来估计弹性的中介作用。
结果：一年SI的估计患病率，SP和SA为32.86%（95%CI：31.93-33.80%），19.36%（95%CI：18.57-20.16%）和9.07%（95%CI：8.51-9.66%）。调整后,CM与所有3个自杀风险指标显着相关，比值比(OR)为2.13(95%CI：1.91-2.37)，2.45（95%CI：2.13-2.81），一年期SI为3.61（95%CI：2.90-4.52），SP,SA,分别。路径模型显示，韧性显著介导了CM和三个自杀风险指标之间的关联，在韧性的所有维度中，家庭支持始终是最强有力的调解。
结论：我们的研究结果表明，以提高心理韧性为重点的干预措施可能有效降低遭受虐待的儿童和青少年的自杀风险。应该进行前瞻性研究以证实我们的发现。
