TY - JOUR
T1 - Impact of childhood abuse on suicide-related behavior: Analysis using marginal structural models
JF - J Affect Disord
Y1 - 2018
A1 - Obikane, E.
A1 - Shinozaki, T.
A1 - Takagi, D.
A1 - Kawakami, N.
KW - *Child Abuse
KW - *Mental health, marginal structural model
KW - *Suicidal behaviors
KW - *Suicidal Ideation
KW - *Suicide
KW - Adaptation, Psychological
KW - Adolescent
KW - Adult
KW - Adult Survivors of Child Abuse/psychology/*statistics & numerical data
KW - Age of Onset
KW - Child
KW - Cross-Sectional Studies
KW - Female
KW - Humans
KW - Male
KW - Mental Disorders/*epidemiology/psychology
KW - Middle Aged
KW - Odds Ratio
KW - Risk Factors
KW - Suicide, Attempted/psychology/*statistics & numerical data
KW - Tokyo
AB - BACKGROUND: Childhood abuse is associated with adult suicidal behaviors, partially mediated by mental disorders. However, the direct effect of childhood abuse not mediated by mental disorders is uncertain because the same risk factors serve as mediators and confounders of mental disorders and suicidal behaviors. The aim of the study was to estimate the direct effect of childhood abuse not mediated by mental disorders on suicidal behaviors using marginal structural models. METHODS: We used cross-sectional data of Japanese adults in Tokyo and neighboring prefectures (The Japanese Study on Stratification, Health, Income, and Neighborhood). We developed a causal diagram of childhood abuse and suicidal behaviors, and defined exposures (childhood abuse), confounders (age, childhood social characteristics), mediators (mental disorders), risk factors (coping, smoking, alcohol consumption, education, physical health), and outcome (suicidal behaviors). We estimated the direct effect of childhood abuse according to sex using inverse-probability weighting at 2 points and compared to total and direct effects estimated by conventional regression models. RESULTS: Of 1776 male and 2016 female participants, childhood abuse showed significant total effects on suicidal behaviors. Physical abuse was associated with suicidal ideation (risk ratio: males 2.11 [95% confidence interval: 1.59-2.82], females 2.15 [1.69-2.72]), suicidal plan (risk ratio: males 2.18 [1.21-3.92], females 2.14 [1.24-3.74]), and suicidal attempt (risk ratio: males 2.11 [1.14-5.10], females 4.79 [2.93-7.83]) through direct effect. LIMITATIONS: Childhood abuse was measured according to self-report of the past experiences. CONCLUSIONS: Our study suggests that childhood abuse is associated with adult suicidal behaviors through direct effects not mediated by mental disorders.
VL - 234
SN - 0165-0327
N1 - 1573-2517
Obikane, Erika
Shinozaki, Tomohiro
Takagi, Daisuke
Kawakami, Norito
Journal Article
Research Support, Non-U.S. Gov't
Netherlands
J Affect Disord. 2018 Jul;234:224-230. doi: 10.1016/j.jad.2018.02.034. Epub 2018 Feb 22.
JO - Journal of affective disordersJournal of affective disorders
ER -