Philippe Mortier1,2,3, Jordi Alonso4,5,6, Randy P Auerbach7, Jason Bantjes8, Corina Benjet9, Ronny Bruffaerts10,11, Pim Cuijpers12, David D Ebert12, Jennifer Greif Green13, Penelope Hasking14, Eirini Karyotaki12, Glenn Kiekens10,15,16, Arthur Mak17, Matthew K Nock18, Siobhan O'Neill19, Stephanie Pinder-Amaker20,21, Nancy A Sampson22, Dan J Stein23, Gemma Vilagut4,5, Chelsey Wilks24, Alan M Zaslavsky22, Patrick Mair18, Ronald C Kessler22. 1. Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Dr. Aiguader, 88, 08003, Barcelona, Spain. pmortier@imim.es. 2. CIBER en Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain. pmortier@imim.es. 3. Department of Neurosciences, Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium. pmortier@imim.es. 4. Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Dr. Aiguader, 88, 08003, Barcelona, Spain. 5. CIBER en Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain. 6. Pompeu Fabra University (UPF), Barcelona, Spain. 7. Department of Psychiatry, Columbia University, New York, USA. 8. Department of Global Health, Faculty of Medicine and Health Sciences, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa. 9. Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de La Fuente Muñiz, Mexico City, Mexico. 10. Department of Neurosciences, Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium. 11. Institute for Social Research, Population Studies Center, University of Michigan, Ann Arbor, MI, USA. 12. Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. 13. Wheelock College of Education and Human Development, Boston University, Boston, USA. 14. School of Population Health, Curtin University, Perth, Australia. 15. Faculty of Psychology and Educational Sciences, Clinical Psychology, KU Leuven, Leuven, Belgium. 16. Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium. 17. Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, People's Republic of China. 18. Department of Psychology, Harvard University, Cambridge, MA, USA. 19. School of Psychology, Ulster University, Derry-Londonderry, Northern Ireland. 20. Department of Psychiatry, Harvard Medical School, Boston, MA, USA. 21. McLean Hospital, Belmont, MA, USA. 22. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. 23. Department of Psychiatry and Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town and Groote Schuur Hospital, Cape Town, Republic of South Africa. 24. Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA.
Abstract
PURPOSE: To investigate the associations of childhood adversities (CAs) with lifetime onset and transitions across suicidal thoughts and behaviors (STB) among incoming college students. METHODS: Web-based self-report surveys administered to 20,842 incoming college students from nine countries (response rate 45.6%) assessed lifetime suicidal ideation, plans and attempts along with seven CAs: parental psychopathology, three types of abuse (emotional, physical, sexual), neglect, bully victimization, and dating violence. Logistic regression estimated individual- and population-level associations using CA operationalizations for type, number, severity, and frequency. RESULTS: Associations of CAs with lifetime ideation and the transition from ideation to plan were best explained by the exact number of CA types (OR range 1.32-52.30 for exactly two to seven CAs). Associations of CAs with a transition to attempts were best explained by the frequency of specific CA types (scaled 0-4). Attempts among ideators with a plan were significantly associated with all seven CAs (OR range 1.16-1.59) and associations remained significant in adjusted analyses with the frequency of sexual abuse (OR = 1.42), dating violence (OR = 1.29), physical abuse (OR = 1.17) and bully victimization (OR = 1.17). Attempts among ideators without plan were significantly associated with frequency of emotional abuse (OR = 1.29) and bully victimization (OR = 1.36), in both unadjusted and adjusted analyses. Population attributable risk simulations found 63% of ideation and 30-47% of STB transitions associated with CAs. CONCLUSION: Early-life adversities represent a potentially important driver in explaining lifetime STB among incoming college students. Comprehensive intervention strategies that prevent or reduce the negative effects of CAs may reduce subsequent onset of STB.
PURPOSE: To investigate the associations of childhood adversities (CAs) with lifetime onset and transitions across suicidal thoughts and behaviors (STB) among incoming college students. METHODS: Web-based self-report surveys administered to 20,842 incoming college students from nine countries (response rate 45.6%) assessed lifetime suicidal ideation, plans and attempts along with seven CAs: parental psychopathology, three types of abuse (emotional, physical, sexual), neglect, bully victimization, and dating violence. Logistic regression estimated individual- and population-level associations using CA operationalizations for type, number, severity, and frequency. RESULTS: Associations of CAs with lifetime ideation and the transition from ideation to plan were best explained by the exact number of CA types (OR range 1.32-52.30 for exactly two to seven CAs). Associations of CAs with a transition to attempts were best explained by the frequency of specific CA types (scaled 0-4). Attempts among ideators with a plan were significantly associated with all seven CAs (OR range 1.16-1.59) and associations remained significant in adjusted analyses with the frequency of sexual abuse (OR = 1.42), dating violence (OR = 1.29), physical abuse (OR = 1.17) and bully victimization (OR = 1.17). Attempts among ideators without plan were significantly associated with frequency of emotional abuse (OR = 1.29) and bully victimization (OR = 1.36), in both unadjusted and adjusted analyses. Population attributable risk simulations found 63% of ideation and 30-47% of STB transitions associated with CAs. CONCLUSION: Early-life adversities represent a potentially important driver in explaining lifetime STB among incoming college students. Comprehensive intervention strategies that prevent or reduce the negative effects of CAs may reduce subsequent onset of STB.
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