Risk of common psychiatric disorders, suicidal behaviours, and premature mortality following violent victimisation: A matched cohort and sibling-comparison study of 127,628 people who experienced violence in Finland and Sweden.

IF 15.8 1区 医学 Q1 Medicine
PLoS Medicine Pub Date : 2024-10-18 eCollection Date: 2024-10-01 DOI:10.1371/journal.pmed.1004410
Amir Sariaslan, Joonas Pitkänen, Jonas Forsman, Ralf Kuja-Halkola, Isabell Brikell, Brian M D'Onofrio, Mikko Aaltonen, Henrik Larsson, Pekka Martikainen, Paul Lichtenstein, Seena Fazel
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引用次数: 0

Abstract

Background: Associations between violent victimisation and psychiatric disorders are hypothesised to be bidirectional, but the role of violent victimisation in the aetiologies of psychiatric disorders and other adverse outcomes remains unclear. We aimed to estimate associations between violent victimisation and subsequent common psychiatric disorders, suicidal behaviours, and premature mortality while accounting for unmeasured familial confounders.

Methods and findings: Using nationwide registers, we identified a total of 127,628 individuals born in Finland (1987 to 2004) and Sweden (1973 to 2004) who had experienced violent victimisation, defined as either hospital admissions or secondary care outpatient visits for assault-related injuries. These were age- and sex-matched with up to 10 individuals in the general population (n = 1,276,215). Additionally, we matched those who had experienced violent victimisation with their unaffected siblings (n = 132,408). Outcomes included depression, anxiety, personality disorders, alcohol use disorders, drug use disorders, suicidal behaviours, and premature mortality. Participants were followed from the victimisation date until the date of the outcome, emigration, death, or December 31, 2020, whichever occurred first. Country-specific associations were estimated using stratified Cox regression models, which also accounted for unmeasured familial confounders via sibling comparisons. The country-specific associations were then pooled using meta-analytic models. Among 127,628 patients (69.0% male) who had experienced violent victimisation, the median age at first violent victimisation was 21 (interquartile range: 18 to 26) years. Incidence of all outcomes was larger in those who were exposed to violent victimisation compared to population controls, ranging from 2.3 (95% confidence interval (CI) [2.2; 2.4]) per 1,000 person-years for premature mortality (compared with 0.6, 95% CI [0.6; 0.6], in controls) to 22.5 (95% CI [22.3; 22.8]) per 1,000 person-years for anxiety (compared with 7.3, 95% CI [7.3; 7.4], in controls). In adjusted models, people who had experienced violent victimisation were between 2 to 3 times as likely as their siblings to develop any of the outcomes, ranging from adjusted hazard ratio [aHR] 1.7 (95% CI [1.7; 1.8]) for depression to 3.0 (95% CI [2.9; 3.1]) for drug use disorders. Risks remained elevated 2 years post-victimisation, ranging from aHR 1.4 (95% CI [1.3; 1.5]) for depression to 2.3 (95% CI [2.2; 2.4]) for drug use disorders. Our reliance on secondary care data likely excluded individuals with milder assault-related injuries and less severe psychiatric symptoms, thus suggesting that our estimates may be conservative. Another limitation is the possibility of residual genetic confounding, as full siblings share on average about half of their co-segregating genes. However, the associations remained robust even after adjusting for both measured and unmeasured familial confounders.

Conclusions: In this longitudinal cross-national cohort study, we observed that those who had experienced violent victimisation were at least twice as likely as their unaffected siblings to develop common psychiatric disorders (i.e., depression, anxiety, personality disorder, and alcohol and drug use disorders), engage in suicidal behaviours, and to die prematurely. Importantly, these risk elevations remained 2 years after the first victimisation event. Improving clinical assessment, management, and aftercare psychosocial support could therefore potentially reduce rates of common psychiatric disorders, suicidality, and premature mortality in individuals experiencing violent victimisation.

遭受暴力侵害后出现常见精神障碍、自杀行为和过早死亡的风险:对芬兰和瑞典 127,628 名遭受暴力的人进行的匹配队列和兄弟姐妹比较研究。
背景:暴力受害与精神障碍之间的关系被认为是双向的,但暴力受害在精神障碍和其他不良后果的病因中的作用仍不清楚。我们的目的是在考虑未测量的家庭混杂因素的情况下,估计暴力受害与随后的常见精神障碍、自杀行为和过早死亡之间的关联:通过全国范围的登记,我们共发现了127628名出生于芬兰(1987年至2004年)和瑞典(1973年至2004年)、曾遭受暴力伤害的人,暴力伤害的定义是因与攻击相关的伤害而入院或接受二级护理门诊治疗。这些人的年龄和性别与普通人群(n = 1,276,215)中最多 10 人的年龄和性别相匹配。此外,我们还将经历过暴力伤害的人与其未受影响的兄弟姐妹进行了配对(n = 132,408 人)。研究结果包括抑郁、焦虑、人格障碍、酒精使用障碍、药物使用障碍、自杀行为和过早死亡。从受害日期开始对参与者进行随访,直至出现结果、移民、死亡或 2020 年 12 月 31 日(以先发生者为准)。使用分层考克斯回归模型估算了各国的相关性,该模型还通过同胞比较考虑了未测量的家族混杂因素。然后使用荟萃分析模型对各国的相关性进行汇总。在127628名遭受过暴力侵害的患者(69.0%为男性)中,首次遭受暴力侵害的中位年龄为21岁(四分位间范围:18至26岁)。与人群对照组相比,遭受过暴力侵害的患者所有结果的发生率都更高,从过早死亡的每千人年 2.3 例(95% 置信区间 [2.2; 2.4])(对照组为 0.6 例,95% 置信区间 [0.6; 0.6])到焦虑的每千人年 22.5 例(95% 置信区间 [22.3; 22.8])(对照组为 7.3 例,95% 置信区间 [7.3; 7.4])不等。在调整后的模型中,遭受过暴力侵害的人出现任何一种结果的几率是其兄弟姐妹的2至3倍,从抑郁症的调整危险比[aHR]1.7(95% CI [1.7;1.8])到药物使用障碍的3.0(95% CI [2.9;3.1])不等。受害后 2 年的风险仍然较高,抑郁症的 aHR 为 1.4 (95% CI [1.3; 1.5]),药物使用障碍的风险为 2.3 (95% CI [2.2; 2.4])。我们对二级护理数据的依赖可能排除了与攻击相关的伤害较轻、精神症状较轻的个体,因此表明我们的估计可能比较保守。另一个局限性是可能存在残余遗传混杂,因为全同胞兄弟姐妹平均共享约一半的共分离基因。然而,即使对已测量和未测量的家族混杂因素进行调整后,相关性仍然很强:在这项纵向跨国队列研究中,我们观察到曾遭受暴力侵害的人患常见精神疾病(即抑郁症、焦虑症、人格障碍、酒精和药物使用障碍)、自杀行为和过早死亡的几率至少是未受影响的兄弟姐妹的两倍。重要的是,这些风险在首次受害事件发生两年后仍然存在。因此,改善临床评估、管理和善后心理支持有可能降低遭受暴力伤害者的常见精神障碍、自杀率和过早死亡率。
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来源期刊
PLoS Medicine
PLoS Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
17.60
自引率
0.60%
发文量
227
审稿时长
4-8 weeks
期刊介绍: PLOS Medicine is a prominent platform for discussing and researching global health challenges. The journal covers a wide range of topics, including biomedical, environmental, social, and political factors affecting health. It prioritizes articles that contribute to clinical practice, health policy, or a better understanding of pathophysiology, ultimately aiming to improve health outcomes across different settings. The journal is unwavering in its commitment to uphold the highest ethical standards in medical publishing. This includes actively managing and disclosing any conflicts of interest related to reporting, reviewing, and publishing. PLOS Medicine promotes transparency in the entire review and publication process. The journal also encourages data sharing and encourages the reuse of published work. Additionally, authors retain copyright for their work, and the publication is made accessible through Open Access with no restrictions on availability and dissemination. PLOS Medicine takes measures to avoid conflicts of interest associated with advertising drugs and medical devices or engaging in the exclusive sale of reprints.
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