Journal
JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY
Volume 58, Issue 5, Pages 506-513Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jaac.2018.07.903
Keywords
victimization; suicidal ideation; self-harm; suicide attempt; adolescence
Categories
Funding
- Medical Research Council [G1002190]
- National Institute of Child Health and Human Development [HD077482]
- Jacobs Foundation
- Nuffield Foundation
- National Society for Prevention of Cruelty to Children
- Economic and Social Research Council (ESRC)
- ESRC
- MD Fellows Award [MO14F40]
- Japan Society for the Promotion of Science [JP16H05653]
- Royal Society
- British Academy as a Newton international Fellow Alumnus
- ESRC [ES/P010113/1] Funding Source: UKRI
- MRC [G1002190, MR/P005918/1] Funding Source: UKRI
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Objective: Victimized adolescents have an increased risk of self-injurious thoughts and behaviors. However, poor understanding of causal and noncausal mechanisms underlying this observed risk limits the development of interventions to prevent premature death in adolescents. This study tested whether pre-existing family-wide and individual vulnerabilities account for victimized adolescents' increased risk of self-injurious thoughts and behaviors. Method: Participants were 2,232 British children followed from birth to 18 years of age as part of the Environmental Risk Longitudinal Twin Study. Adolescent victimization (maltreatment, neglect, sexual victimization, family violence, peer/sibling victimization, cyber victimization, and crime victimization) was assessed through interviews with participants and co-informant questionnaires at the 18-year assessment. Suicidal ideation, self-harm, and suicide attempt in adolescence were assessed through interviews with participants at 18 years. Results: Victimized adolescents had an increased risk of suicidal ideation (odds ratio [OR] 2.40, 95% CI 2.11-2.74), self-harm (OR 2.38, 95% CI 2.10-2.69), and suicide attempt (OR 3.14, 95% CI 2.54-3.88). Co-twin control and propensity score matching analyses showed that these associations were largely accounted for by pre-existing familial and individual vulnerabilities, respectively. Over and above their prior vulnerabilities, victimized adolescents still showed a modest increase in risk for suicidal ideation (OR 1.45, 95%CI 1.10-1.91) and self-harm (OR 1.50, 95% CI 1.18-1.91) but not for suicide attempt (OR 1.28, 95% CI 0.83-1.98). Conclusion: Risk for self-injurious thoughts and behaviors in victimized adolescents is explained only in part by the experience of victimization. Preexisting vulnerabilities account for a large proportion of the risk. Therefore, effective interventions to prevent premature death in victimized adolescents should not only target the experience of victimization but also address pre-existing vulnerabilities.
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