MedicalResearch.com Interview with:
Charlotte Björkenstam PhD
Dept of Clinical Neuroscience
Division of Insurance Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In a prior study we revealed that exposure to childhood adversities were associated with a substantial risk increase for self-harm. The risk was even higher for those exposed to accumulated childhood adversities. This finding together with the fact that the suicide rate among young adults is increasing (as opposed to decreasing in the general population) lead us to want to examine the relationship between childhood adversities and death by suicide.
We investigated 7 different childhood adversities, including familial death (suicide analyzed separately), parental substance abuse, parental psychiatric disorder, substantial parental criminality, parental separation/single-parent household, public assistance recipiency, and residential instability occurring between birth and age 14. We then followed the individuals up until age 24 at most. All adversities were entailed with an increased suicide risk from IRR: 1.6 (95% CI: 1.1 to 2.4) for residential instability to IRR: 2.9 (95% CI; 1.4 to 5.9) for familial suicide. We also found a dose-response relationship between accumulating CA and suicide risk where IRR ranged between 1.1 (95% CI: 0.9 to 1.4) for those exposed to 1 CA, to 2.6 (95% CI: 1.9 to 3.4) for those exposed to 3 or more adversities.
MedicalResearch.com: What should readers take away from your report?
Response: Our study provides clear evidence that childhood adversities, which are very common in the general population, are associated with an elevated suicide risk in adolescents and young adults, especially among youth who were exposed to cumulative adversities. These results emphasize the importance of understanding the social mechanisms of mental health morbidity and suicide and the need of developing effective interventions, aiming to alleviate the suicide risk in disadvantaged children. This should be done in parallel with wider societal efforts to reduce the size of social disadvantage.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: This study has several strengths, including the large cohort size, the longitudinal population-based design and use of national registers with high completeness and validity. However, relying solely on register data, there are indicators of CA that we were not able to study, including abuse and neglect. These are of course important for future studies. We were also not able to assess the severity, duration, or sequencing of any of the adversities, something that is also of high interest for other studies to take into account. Finally it would be of value to examine how the detrimental effect of childhood adversity on suicide risk can be reversed- if it can be reversed, and which interventions are most effective.
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BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1334 (Published 19 April 2017)Cite this as: BMJ 2017;357:j1334
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