Risk and protective factors for childhood suicidality: a US population-based study

읽은 날	2020.08.27	학술지	The Lancet Psychiatry
제목	Risk and protective factors for childhood suicidality: a US population-based study
저자	Delfina Janiri*, Gaelle E Doucet*, Maurizio Pompili, Gabriele Sani, Beatriz Luna, David A Brent, Sophia Frangou
한줄요약	아이들의 sucidal ideation,attempt에 중요 risk factor는 child behavior checklist, family conflict, screen usage, 그리고 parental supervision이다.
초록	-Background   Childhood suicidal ideation and behaviours are poorly understood. We examined correlates of suicidality in a US population-based sample of children participating in the Adolescent Brain and Cognitive Development (ABCD) study. The ABCD study aims to examine trajectories of mental health from childhood to adulthood and collects information on multiple domains, including mental and physical wellbeing, brain imaging, behavioural and cognitive characteristics, and social and family environment. We sought to identify and rank risk and protective factors for childhood suicidal thoughts and behaviours across these multiple domains and evaluate their association with self-agreement and caregiver agreement in reporting suicidality. -Methods   The ABCD sample comprises a cohort of 11 875 children aged 9–10 years. The sociodemographic factors on which the sample was recruited were age, sex, race, socioeconomic status, and urbanicity. Participants were enrolled at 22 sites, the catchment area of which encompassed over 20% of the entire US population in this age group. Multistage sampling was used to ensure both local randomisation and representativeness of sociodemographic variation of the ABCD sample. The data used in this study were accessed from the ABCD Study Curated Annual Release 2.0. Suicidal thoughts and behaviours (suicidality) in each child were evaluated through independent child and caregiver reports based on the computerized Kiddie Schedule for Affective Disorders and Schizophrenia for DSM-5 (KSADS-5). We used bootstrapped logistic regression to quantify the association between suicidal ideation and behaviours, with measures of mental and physical wellbeing, behaviour, cognition, and social and family environment in participants from the ABCD study. -Findings   Our study sample comprised 7994 unrelated children (mean age 9·9 years [SD 0·5]; 4234 [53%] male participants) with complete data on child-reported and caregiver-reported suicidal ideas and behaviours. Overall, 673 (8·4%) children reported any past or current suicidal ideation, 75 (0·9%) had any past or current suicidal plans, and 107 (1·3%) had any past or current suicidal attempts. According to caregivers, 650 (8·1%) of the children reported any past or current suicidal ideation, 46 (0·6%) reported any past or current suicidal plans, and 39 (0·5%) reported past or current suicidal attempts. However, inter-informant agreement was low (Cohen's κ range 0·0–0·2). Regardless of informant, child psychopathology (odds ratio [OR] 1·7–4·8, 95% CI 1·5–7·4) and child-reported family conflict (OR 1·4–1·8, 95% CI 1·1–2·5) were the most robust risk factors for suicidality. The risk of child-reported suicidality increased with higher weekend screen use time (OR 1·3, 95% CI 1·2–1·7) and reduced with greater parental supervision and positive school involvement (for both OR 0·8, 95% CI 0·7–0·9). Additionally, caregiver-reported suicidality was positively associated with caregiver educational level (OR 1·3, 95% CI 1·1–1·5) and male sex in children (1·5, 1·1–2·0), and inversely associated with the number of household cohabitants (0·8, 0·7–1·0). -Interpretation   We identified risk and protective factors that show robust and generalisable associations with childhood suicidality. These factors provide actionable targets for optimising prevention and intervention strategies, support the need to identify and treat psychopathology in school-age children, and underscore the importance of school and family interventions for childhood suicidality.
키워드	ABCD, children suicide, adolescent suicide, risk factor
의의	ABCD 데이터를 Logistic Regression을 사용하여 sucidal 행동에 중요한 예측 지표로 사용 가능한 factor들을 추려냄.
비판점	이러한 risk factor를 줄여 sucidal activity를 줄이기 위해 어떠한 방법을 사용할 수 있을 지 논의가 필요함.