Edinburgh Napier University

  Background
Childhood adversity (CA) is associated with increased later mental health (MH) problems and suicidal behaviour. Opportunities for earlier healthcare identification and intervention are needed.

Aim
To determine associations between hospital admissions for CA and MH in children who later die by suicide.

Method
Population-based longitudinal case-control study. Scottish inpatient general and psychiatric records were summarised for individuals born 1981 or later who died by suicide between 1991-2017 (cases), and matched controls (1:10), for CA and MH (broadly defined as psychiatric diagnoses and general hospital admissions for self-harm and substance use).

Results
Records were extracted for 2,477 ‘cases’ and 24,777 ‘controls’; 2,106 cases (85%) and 13,589 controls (55%) had lifespan hospitalisations. Mean age at death was 23.7; 75.9% were male. Maltreatment or violence-related CA codes were recorded for 7.6% cases aged 10-17 (160/2,106) versus 2.7% controls (371/13,589), OR=2.9 (95%CI,2.4-3.6); MH-related admissions were recorded for 21.7% cases (458/2,106), versus 4.1% controls (560/13,589), OR=6.5 (95%CI, 5.7-7.4), 80% of MH admissions were in general hospital. Using conditional logistic models we found a dose-response effect of MH admissions <18y, with highest aOR for three or more MH admissions: aORmale=8.17 (95%CI,5.02-13.29), aORfemale=15.08 (95%CI,8.07-28.17). We estimated each type of CA multiplied odds of suicide by aORmale=1.90 (95%CI,1.64-2.21), aORfemale=2.65 (95%CI,1.94-3.62), and each MH admission by aORmale=2.06 (95%CI,1.81-2.34), aORfemale=1.78 (95%CI,1.50-2.10).

Conclusions
Our lifespan study found that experiencing CA (primarily maltreatment or violence-related admissions) or MH admissions increased odds of young person suicide, with highest odds for those experiencing both. Healthcare practitioners should identify and flag potential ‘at-risk’ adolescents to prevent future suicidal acts, especially those in general hospitals.