青少年早期自殺企圖和青少年晚期與成人早期負面情緒與行為預後的關聯性：世代研究

Abstract

研究背景：青少年的自殺企圖預示著將來更高的自殺風險。過去研究發現曾經嘗試自殺的青少年不僅未來再次嘗試自殺的風險更高，還可能會出現多種情緒及行為問題。青少年早期便已嘗試過自殺的青少年，他們在之後的成長階段，例如：青少年後期、成年早期，會經歷什麼樣的情緒及行為問題，對於我們而言仍然知之甚少。 研究目的：本研究旨在調查在青少年早期經歷過自殺企圖的青少年，進入到青少年後期、成年早期時，是否會在負面情緒或行為問題上存在著較高的風險。 研究方法:資料來源為兒童與青少年行為之長期發展研究計畫(CABLE)，在青少年早期(12-14歲)、青少年後期(15-17歲)和成年早期(18-21歲)測量了自殺企圖、自殺意念以及多項情緒和行為問題，並利用廣義估計式來執行羅吉斯迴歸調查青少年早期的自殺企圖與青少年晚期及成年早期的負面情緒及行為結果之間的關聯性。 結果:青少年早期的自殺企圖與青少年後期、成年早期的多種負面情緒和行為預後有關，包含自殺意念、自殺企圖、反社會行為、抽煙、飲酒、嚼檳榔和使用非法藥物，其中，青少年早期的自殺企圖更是之後自殺企圖的強力預測因子，青少年早期的自殺企圖與之後兩個時間段的關聯性在不同的負面結果上呈現了不同的趨勢，在自殺意念、憂鬱、社交焦慮、抽煙和嚼食檳榔方面在兩個時間段的關聯性差異不大，相比之下，從青少年晚期到成年早期，自殺企圖和飲酒的關聯性減弱，而反社會行為和使用非法藥物方面則變得更強，並且這些關聯不能夠由社會經濟因素和家庭支持來解釋，而是主要被研究基線時的情緒和行為變量所解釋。 結論:青少年自殺企圖者可能會在往後的學生生涯中遇到情緒或行為問題，甚至會重新出現自殺念頭和企圖。

Background: Suicide attempts in adolescents indicate increased risk of suicide. Several previous studies from a few countries suggested that adolescents who were engaged in suicide attempts had increased risk of not only future suicide attempts but also multiple emotional and behavioral problems. However, little is known about the association of suicide attempt in early adolescence with suicidal behavior and emotional and behavioral problems in late adolescence and early adulthood in other settings. Aim: To investigate whether adolescents who engaged in suicide attempts in early adolescence were at increased risk for adverse emotional or behavioral problems in later adolescence and early adulthood. Methods: Data were extracted from the Child and Adolescent Behaviors in Long-term Evolution (CABLE) (n = 4466). Suicide attempt, suicide ideation, and multiple emotional and behavioral problems were measured in early adolescence (aged 12-14 years), late adolescence (15-17 years), and early adulthood (18-21 years). We conducted logistic regression analysis by applying the generalized estimating equations to investigate the associations between suicide attempts in early adolescence and later emotional and behavioral outcomes in late adolescence and early adulthood. Results: Suicide attempts in early adolescence were associated with multiple adverse emotional and behavioral outcomes in late adolescence and early adulthood, including suicide ideation, suicide attempt, anti-social behavior, smoking, drinking, areca nut chewing, and illicit drug use. Noticeably, suicide attempt in early adolescence was a strong predictor for later suicide attempts (adjusted odds ratio [aOR] = 10.62, 95% confidence internal [CI] 7.11, 15.85 in late adolescence and aOR = 6.78, 95% CI 3.68, 12.51 in early adulthood). The strengths of associations between suicide attempt in early adolescence and future outcomes in the two follow-up periods varied by the outcome – they were of similar strengths for suicide ideation, depression, social anxiety, smoking, and areca nut chewing in the two follow-up periods; by contrast, they became weaker for suicide attempt and drinking while became stronger for anti-social behavior and illicit drug use from late adolescence to early adulthood. The associations between suicide attempt in early adolescence and outcomes in later periods were not explained by socioeconomic factors and family support, while most of them were partially accounted for by emotional and behavioral variables at baseline. Conclusion: Adolescent suicide attempters have an increased risk of suicide ideation and attempt and multiple emotional or behavioral problems later in life.