افکار خودکشی در میان افرادی که والدین آن ها طلاق گرفته اند: یافته های حاصل از یک بررسی جامعه نماینده کانادا
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|37132||2011||6 صفحه PDF||سفارش دهید||6205 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Psychiatry Research, Volume 187, Issues 1–2, 15 May 2011, Pages 150–155
Abstract This study used a large, nationally representative sample to examine the gender-specific association between parental divorce and the cumulative lifetime incidence of suicidal ideation. Known risk factors for suicidal ideation, such as childhood stressors, socioeconomic factors, adult health behaviors and stressors, marital status, and any history of mood and/or anxiety disorders were controlled. Gender-specific analyses revealed that for men, the parental divorce–suicidal ideation relationship remained statistically significant even when the above-listed cluster of risk factors were included in the analyses (odds ratio (OR) = 2.36, 95% confidence interval (CI) = 1.56, 3.58). For women, the association between parental divorce and suicidal ideation was reduced to non-significance when other adverse childhood experiences were included in the analyses (full adjustment OR = 1.04, 95% CI = 0.72, 1.50). These findings indicate a need for screening of suicidal ideation among individuals, particularly men and those with mood and/or anxiety disorders, who have experienced parental divorce. Future research should focus on the mechanisms linking parental divorce and suicidal ideation.
. Introduction 1.1. Parental divorce A number of studies have examined the effects of childhood parental divorce on adult well-being. The purpose of this study is to examine the gender-specific association between parental divorce and the cumulative lifetime incidence of suicidal ideation in a population-based sample. Parental divorce in childhood is associated with a number of adverse mental health issues in adulthood. Adult children of divorced parents experience higher psychological distress than their peers with non-separated parents (Rodgers et al., 1997 and Storksen et al., 2007), regardless of the child's age at the time of the parent's divorce (Rodgers et al., 1997). Of particular concern, adults who experienced parental divorce are at risk for suicidal attempts and ideation (de Goede and Spruijt, 1996, D'Onofrio et al., 2006, Donald et al., 2006, Park et al., 2006, Hardt et al., 2008 and Lizardi et al., 2009). 1.2. Suicidality: attempts and ideation Suicidality encompasses suicide completion, suicide attempts, and suicidal ideation. Suicidal ideation is a risk factor for, and often precedes, suicidal attempts (Brezo et al., 2006 and Nock et al., 2008). Previous links have been found between parental divorce and suicide attempts. For example, using a clinical sample, Hardt et al. (2008) reported that those who had experienced parental separation or divorce were more likely to attempt suicide than those who had not experienced this childhood stressor. Gender-specific analyses were not conducted. Lizardi et al.'s (2009) large, population-based study reported that individuals with a history of parental divorce had almost twice the odds of attempting suicide during their lifetime (unadjusted odds = 1.95, confidence interval (CI) = 1.58–2.40) than those with no history of parental divorce. This association decreased but remained significant even when sociodemographic factors and parental depression were controlled (adjusted odds = 1.33, CI = 1.06–1.67). Gender-specific analyses conducted in Lizardi et al.'s (2009) study revealed that both males and females who had experienced parental divorce had elevated unadjusted odds of lifetime suicide attempts in comparison to their same-sex peers. However, only females but not males had statistically significant odds of suicide attempts once parental depression and sociodemographic variables were controlled (O.R. = 1.50 and 1.01 respectively). In sharp contrast to these findings, Donald et al.'s (2006) case–control study found that males who had experienced parental divorce had ten times the odds of attempting suicide compared to their male peers who had not experienced parental divorce. For females, the association between parental divorce and suicidal ideation was not statistically significant ( Donald et al., 2006). The different outcomes between Lizardi and colleagues' and Donald and colleagues' studies may stem from differing control variables. Both Lizardi et al. (2009) and Donald et al. (2006) controlled for parental divorce, sex, ethnicity, and marital status. However, Lizardi and colleagues controlled for age, family income, parental depression, and sex of the parent the respondent lived with following the divorce, while Donald and colleagues did not. Control of any of these factors could contribute to the conflicting findings. Other childhood adversities may play a role in the link between parental divorce and suicide attempts. Afifi et al.'s (2009) population-based data indicate that parental divorce in the absence of childhood abuse is not significantly associated with lifetime suicide attempts nor suicidal ideation. However, for individuals who experienced both parental divorce and abuse during childhood, the odds of suicidal ideation and suicide attempts were more than twice that of their peers who experienced neither of these childhood stressors. Thus, other factors may contribute to a link between parental divorce and suicide attempts. Afifi et al.'s analyses were also adjusted for sociodemographic characteristics. When suicidal ideation, as opposed to suicidal attempts, was examined, most studies also report a strong link with parental divorce. D'Onofrio et al. (2006) found that parental divorce in childhood increases the risk of ever having experienced suicidal ideation. Additionally, the increase in suicidal ideation was accompanied by an increased risk for depressed mood ( D'Onofrio et al., 2006). This increased risk of suicidal ideation following parental divorce has been shown elsewhere ( de Goede and Spruijt, 1996 and Park et al., 2006), however, gender-specific analyses reveal conflicting results. Park et al. (2006) found an increased risk of suicidal ideation in male but not female South Korean adolescents following parental divorce. However, de Goede and Spruijt's (1996) analysis of 18–24 year olds found increases in suicidal ideation among females but not males of divorced families. Thus, the gender-specific effects of parental divorce on offspring's suicidal ideation are not clear nor do we understand the mechanisms underlying these associations. Levant's (1996) research examining the male gender role may provide insight into gender differences in suicidal ideation in adult children of divorce. Levant proposes that during childhood, boys experience male gender role socialization processes that can influence later life through gender role conflict (Levant, 1996). Fatherhood plays a key role in male gender role development (Levant, 1996). Furthermore, Jakupcak et al. (2003) suggests that emotional regulation in men is related to masculine ideology and masculine gender role stress, which are developed, in part, during childhood (Levant, 1996) and are therefore vulnerable to modeling from parents, specifically fathers. Gender role conflict has been associated with mental health problems such as anxiety and depression (Levant, 1996). The vast majority of divorced children are raised by their mothers and many children have limited or no contact with their fathers (Cooney, 1994). Thus, we anticipate that males may be more vulnerable to suicidal ideation and other problems related to parental divorce than females. In order to effectively determine the independent association between parental divorce and suicidal ideation, it is important to consider other factors which may play a role in the relationship. We hypothesize that the parental divorce–suicidal ideation link may be explained by the following cluster of risk factors 1) other childhood adversities; 2) adult socioeconomic status; 3) adult stressors and marital status; 4) health behaviors; 5) mental health. 1) Other childhood adversities: Parental divorce is associated with other childhood adversities such as parental addiction, parental unemployment, and childhood physical abuse ( Turner et al., 2007). In turn, childhood adversities are associated with elevated rates of suicidal ideation (e.g. Park et al., 2006). 2) Adult socioeconomic status: Students who experience parental divorce in childhood are more likely to experience academic problems in school ( Storksen et al., 2006), are less likely to complete high school ( Zill et al., 1993 and Furstenberg and Teitler, 1994) or attend college ( Furstenberg and Teitler, 1994), and have lower rates of college or university graduation ( Huurre et al., 2006) resulting in lower education levels in adulthood ( Keith and Finlay, 1988, Ross and Mirowsky, 1999, Martin et al., 2005 and Huurre et al., 2006). Concomitantly, children of divorced parents are at increased risk of unemployment ( Furstenberg and Teitler, 1994 and Huurre et al., 2006) and earn less in adulthood ( Ross and Mirowsky, 1999) than their peers who were did not have divorced parents. In the general population, risk of suicidal ideation is associated with lower education levels ( Nock et al., 2008) and financial hardship ( Vilhjalmsson et al., 1998). 3) Adult stressors and marital status: Parental divorce is associated with a variety of negative physical health outcomes ( Amato and Keith, 1991). Those who experience stress ( Vilhjalmsson et al., 1998) and multiple chronic conditions ( Vilhjalmsson et al., 1998) have increased risk of suicidal ideation. Adult children of divorced parents are less likely to be married or be in common law relationships (Huurre et al., 2006 and Storksen et al., 2007). Divorce rates are higher among those who have divorced parents (Keith and Finlay, 1988, Amato, 1996, Ross and Mirowsky, 1999 and Huurre et al., 2006). In turn, being unmarried (Pirkis et al., 2000 and Nock et al., 2008) is associated with higher rates of suicidal ideation in the general population. 4) Health behaviors: Rates of cigarette smoking and heavy alcohol consumption are higher among those who have experienced parental divorce ( Huurre et al., 2006 and Kestilä et al., 2006). The parental divorce–obesity link is less clear, where some studies suggest that parental divorce is a risk factor for obesity ( Yannakoulia et al., 2008) while others find no association between the two factors ( Kestilä et al., 2009). Increased odds of suicidal ideation are related to substance use disorders ( Pirkis et al., 2000, Sareen et al., 2005 and Nock et al., 2008) in both genders. Higher body mass indexes (BMI) in women and lower body mass indexes in men ( Carpenter et al., 2000) are associated with suicidal ideation. Park et al.'s (2006) survey found that smoking and drinking were associated with suicidal ideation in men but not in women. 5) Mental health: Individuals whose parents have divorced are more likely to have elevated anxiety levels ( Jekielek, 1998, Strohschein, 2005 and Storksen et al., 2006) and are at increased risk for experiencing psychological distress ( Rodgers et al., 1997 and Storksen et al., 2007) and developing mood disorders ( Zill et al., 1993, Gilman et al., 2003, Huurre et al., 2006, Storksen et al., 2006 and Afifi et al., 2009). The prevalence of suicidal ideation is higher among those with anxiety disorders ( Vilhjalmsson et al., 1998, Pirkis et al., 2000 and Nock et al., 2008) and mood disorders, including depression ( Vilhjalmsson et al., 1998, Pirkis et al., 2000, Sareen et al., 2005, D'Onofrio et al., 2006 and Nock et al., 2008). Control variables: Research is unclear with regard to age, with some studies indicating that younger age is a risk factor for suicidal ideation (Pirkis et al., 2000 and Nock et al., 2008) while others have found older age to be a risk factor (Ladwig et al., 2008). To our knowledge, this is the first study to provide a gender-specific multivariate analysis of the association between parental divorce and suicidal ideation in a North American population-based sample of adults. Although Park and colleagues (Park et al., 2006) have examined the bivariate association between parental divorce and suicidal ideation in their South Korean sample of high school students, they did not include parental divorce in multivariate analyses of suicidal ideation or include adult respondents. Furthermore, the context and ramifications of parental divorce may be substantially different between South Korea and North America. Based on the above-mentioned literature, it was hypothesized that parental divorce would be associated with the cumulative lifetime incidence of suicidal ideation. Given that several studies suggest gender disparities in suicidal ideation exist among children of divorced parents (Glenn and Kramer, 1985, Chase-Lansdale et al., 1995, de Goede and Spruijt, 1996, Martin et al., 2005, Huurre et al., 2006 and Storksen et al., 2006) an investigation into gender differences is merited. It was hypothesized that parental divorce would affect men and women differently with regard to suicidal ideation, where males would be more vulnerable to the effects of parental divorce and would therefore have higher rates of suicidal ideation than their female counterparts.
نتیجه گیری انگلیسی
. Results As shown in Fig. 1, women who had experienced parental divorce had significantly elevated age-race adjusted odds of cumulative lifetime incidence of suicidal ideation in comparison to women who were not from divorced families (odds ratio (OR) = 1.83, 95% CI = 1.36, 2.45). These odds were substantially lower than the age-race adjusted odds for males who had experienced parental divorce (see Fig. 2; OR = 3.27, 95% CI = 2.38, 4.48). Odds ratio and 95% confidence interval of suicide ideation among females ... Fig. 1. Odds ratio and 95% confidence interval of suicide ideation among females reporting parental divorce vs. females not reporting parental divorce. All data are adjusted for age and race. Sample sizes range from n=3,755 in the first model to n=3,565 in the fully adjusted model. Figure options Odds ratio and 95% confidence interval of suicide ideation among males reporting ... Fig. 2. Odds ratio and 95% confidence interval of suicide ideation among males reporting parental divorce vs. males not reporting parental divorce. All data are adjusted for age gender and race. Sample sizes range from n=2,835 in the first model to n=2,643 in the fully adjusted model. Figure options For women, adjusting for childhood stressors reduced to non-significance the association between the experience of parental divorce and suicidal ideation (OR = 0.94; 95% CI = 0.68, 1.32). Inclusion of each of the other clusters of risk factors did not substantially change the odds of suicidal ideation among women who had experienced divorce from the original age-race adjusted odds. When the model for women was fully adjusted with other adverse childhood experiences and all the other clusters of factors, the odds of suicidal ideation among those women who had experienced parental divorce was no longer statistically nor clinically significant (OR = 1.04, 95% CI = 0.72, 1.50) (see Table 1). Table 1 reports the fully adjusted gender-specific models. Table 1. Logistic regression analyses of suicidal ideation in a regional sample of males and females from Saskatchewan. Male Female OR 95% CI OR 95% CI Exposure variable Parental divorce No divorce 1.00 Referent 1.00 Referent Divorced 2.36 (1.56, 3.58) 1.04 (0.72, 1.50) Demographic variables Age Age by decade 0.93 (0.82, 1.04) 0.84 (0.76, 0.92) Race White 1.00 Referent 1.00 Referent Visible minority 1.06 (0.62, 1.79) 1.55 (1.05, 2.27) Childhood stressors Number of childhood adverse conditions 1.58 (1.25, 1.98) 2.03 (1.71, 2.40) Adult socioeconomic status Household income Missing data 1.70 (1.01, 2.87) 0.89 (0.55, 1.45) No or <$15,000 3.10 (1.61, 5.95) 1.24 (0.74, 2.08) $15,000–$29,999 1.50 (0.88, 2.57) 1.09 (0.72, 1.64) $30,000–$49,999 1.34 (0.88, 2.05) 1.12 (0.78, 1.60) $50,000 or more 1.00 Referent 1.00 Referent Education < high school 1.00 Referent 1.00 Referent High school graduate 2.16 (1.28, 3.62) 1.76 (1.15, 2.70) Post-secondary graduate 2.08 (1.28, 3.40) 1.10 (0.73, 1.66) Adult stressors and marital status Stress level No stress 1.00 Referent 1.00 Referent Low stress 1.35 (0.71, 2.58) 1.17 (0.64, 2.16) High stress 1.19 (0.58, 2.45) 2.08 (1.10, 3.94) Chronic conditions 0 or 1 1.00 Referent 1.00 Referent 2 1.28 (0.87, 1.88) 1.66 (1.18, 2.34) 3 or more 1.21 (0.78, 1.87) 2.45 (1.74, 3.45) Marital status Married/common law 0.66 (0.46, 0.94) 0.78 (0.57, 1.05) Separated/divorced 1.00 Referent 1.00 Referent Current health behaviors Body mass index category Underweight or normal 1.00 Referent 1.00 Referent Overweight 0.90 (0.63, 1.29) 1.35 (0.99, 1.85) Obese 0.87 (0.56, 1.33) 1.04 (0.72, 1.50) Missing data 7.42 (0.85, 65.01) 0.63 (0.32, 1.27) Physical activity level Active 1.00 Referent 1.00 Referent Moderate 1.43 (0.88, 2.32) 1.09 (0.74, 1.59) Inactive 1.91 (1.26, 2.91) 0.86 (0.61, 1.22) Smoking status Current or former smoker 1.81 (1.20, 2.74) 2.15 (1.57, 2.96) Never smoker 1.00 Referent 1.00 Referent Alcohol use Abstainer/very light drinker 1.58 (0.80, 3.13) 2.22 (1.11, 4.45) Lower consumption 0.91 (0.44, 1.87) 2.39 (1.12, 5.07) Higher consumption 1.00 Referent 1.00 Referent Mental health History of mood disorder No 1.00 Referent 1.00 Referent Yes 2.67 (1.48, 4.82) 5.28 (3.59, 7.75) History of anxiety disorder No 1.00 Referent 1.00 Referent Yes 2.35 (1.22, 4.56) 1.78 (1.13, 2.81) Current depression No 1.00 Referent 1.00 Referent Yes 5.71 (3.38, 9.65) 1.33 (0.87, 2.05) Table options In contrast, for men, the parental divorce–suicidal ideation relationship remained statistically significant regardless of the cluster of risk factors included in the analyses (see Fig. 2). Males who had experienced parental divorce had 2.36 (95% CI = 1.56, 3.58) higher odds of having suicidal ideation in comparison to males from non-divorced families when adjusting for age, race, childhood stressors, adult socioeconomic status, current health behaviors, adult stressors and marital status, and mental health (see Table 1). Table 1 indicates the cumulative lifetime incidence of suicidal ideation is associated for both sexes with a wide range of known risk factors including education level, smoking status, childhood stressors, and history of mood and anxiety disorders. Visible minority status was associated with suicidal ideation for women but not men. Abstaining from, or having low levels of alcohol consumption, as well as having 2 or more chronic conditions and high stress levels also were associated with suicidal ideation for women but not men. Conversely, for men, but not women, being in a low socioeconomic status (<$15,000 per year) increased the odds of suicidal ideation threefold in comparison to those with household incomes of $50,000 or more. Further, having a post-secondary education, physical inactivity, and being unmarried increased odds of suicidal ideation for men but not women. Our gender-specific analysis of the subsample of respondents who had not experienced parental addictions, parental abuse nor long-term parental unemployment identified men as more vulnerable than women in the context of parental divorce. The age-race adjusted odds of lifetime suicidal ideation were significantly elevated for males who had experienced parental divorce (OR = 2.39; 95% CI = 1.39, 4.12) in comparison to males from intact families. For females, the parental divorce–suicidal ideation link was not statistically significant (OR = 1.43, 95% CI = 0.82, 2.49) (analyses not shown).