目的 探讨不同形式的童年期虐待与中学生自杀行为的关系。方法 采用分层整群抽样的方法,以广州、新乡、沈阳和重庆4个地区14221名中学生为研究对象,使用问卷调查了解一般人口统计学指标、心理问题症状、童年期虐待经历及自杀行为等信息,建立多因素logistic回归模型,分析不同形式的童年期虐待对自杀行为发生的影响。结果 中学生童年期总体虐待、躯体虐待、情感虐待、性虐待、自杀意念、自杀计划和自杀未遂的检出人数(率)分别为7246(51.0%)、5824(41.0%)、5409(38.0%)、1039(7.3%)、2042(14.4%)、1174(8.3%)和548(3.9%)。男生躯体虐待的检出率高于女生,女生情感虐待和自杀意念的检出率高于男生,组间差异有统计学意义(P〈0.01);童年期性虐待、自杀计划和自杀未遂的检出率在不同性别间的差异无统计学意义(P〉0.01)。控制相关混杂因素的作用后,童年期虐待经历会增加男生自杀意念(OR=2.03,95%CI:1.72-2.40)和自杀计划(OR=1.93,95%CI:1.57-2.37)的发生风险,增加女生自杀意念(OR=2.45,95%CI:2.12-2.82)、自杀计划(OR=2.46,95%CI:2.02-3.00)和自杀未遂(OR=2.12,95%CI:1.61-2.78)的发生风险。除童年期躯体虐待与男生自杀未遂外,不同类型的童年期虐待均是男女中学生自杀行为发生的危险因素(P〈0.01)。随着童年期虐待种类数的增加,男女生自杀行为的发生风险亦呈增高趋势(P〈0.01)。持续受虐以及施虐人为父母/其他的中学生,自杀行为的发生风险显著增加。结论 童年期虐待经历是中学生自杀行为发生的重要危险因素。
Objective To study the relationship between various forms of childhood abuse and suicidal behaviors among middle school students. Methods A total of 14221 cases were retained from an epidemiological study, involving students from junior and senior middle schools in Guangzhou, Xinxiang, Shenyang and Chongqing. Information related to the demographic characteristics, types, number, timing and perpetrators of exposure to childhood abuse and suicidal behaviors was obtained. Logistic regression was used to analyze the relationships of each form of childhood abuse and suicidal behaviors. Results Number of cases(rates) of childhood abuse, physical abuse, emotional abuse, sexual abuse, suicidal ideation, suicidal planning and suicidal attempts among middle school students appeared as 7246(51.0%), 5824(41.0%), 5409(38.0%), 1039(7.3%), 2042(14.4%), 1174(8.3%) and 548(3.9%), respectively. Boys reported more physical abuse than girls, while girls reported more emotional abuse and suicide ideation than boys(P〈0.01). However, no gender differences were found in cases as sexual abuse, suicide planning or attempted suicide(P〉0.01). After controlling for confounding variables, experiences on childhood abuse were significantly associated with suicidal ideation(OR=2.03, 95%CI:1.72-2.40) and suicidal planning(OR=1.93, 95%CI:1.57-2.37) among boys but significantly associated with suicidal ideation(OR=2.45, 95%CI:2.12-2.82), suicidal planning(OR=2.46, 95%CI:2.02-3.00) and attempted suicide(OR=2.12, 95%CI:1.61-2.78) among girls. Results from multivariable logistic regression analysis showed that each type of childhood abuse, occurring at any time within the first 16 years of life, especially with continuous exposure, was significantly associated with suicidal behaviors. A significant graded-relationship was found between number of abusive childhood experiences and suicidal behaviors. Students that had been maltreated by parents or others were at high risk of engag