Can life events predict first-time suicide attempts? A nationwide longitudinal study.

The prevention paradox describes circumstances in which the majority of cases with a suicide attempt come from a population of low or moderate risk, and only a few from a 'high-risk' group. The assumption is that a low base rate in combination with multiple causes makes it impossible to identify a high-risk group with all suicide attempts. The best way to study events such as first-time suicide attempts and their causes is to collect event history data. Administrative registers were used to identify a group at higher risk of suicidal behaviour within a population of six national birth cohorts (N = 300,000) born between 1980 and 1985 and followed from age 15 to 29 years. Estimation of risk parameters is based on the discrete-time logistic odds-ratio model. Lifetime prevalence was 4.5% for first-time suicide attempts. Family background and family child-rearing factors were predicative of later first-time suicide attempts. A young person's diagnosis with psychiatric or neurodevelopmental disorders (ADHD, anxiety, depression, PTSD), and being a victim of violence or sex offences contributed to the explanatory model. Contrary to the prevention paradox, results suggest that it is possible to identify a discrete high-risk group (<12%) among the population from whom two thirds of all first-time suicide attempts occur, but one third of observed suicide attempts derived from low- to moderate-risk groups. Findings confirm the need for a combined strategy of universal, targeted and indicated prevention approaches in policy development and in strategic and practice responses, and some promising prevention strategies are presented.

Post-traumatic Stress Disorder in School-age Children: A Nationwide Prospective Birth Cohort Study.

Traumatic childhood events are some of the few identifiable and to some extent preventable causes of psychiatric illness. Children exposed to severely stressful events may react with post-traumatic stress disorder (PTSD) and this may impact their level of function in daily life, their future development and mental health. The traumatic stress model suggests that traumatic stress in the family, community violence, and other traumas are regarded as additive environmental factors that can outweigh protective compensatory factors and thus interact with individual vulnerabilities. This study is based on prospective panel data including the whole population of children born in Denmark from 1984 to 1994, who are followed from age 7 to age 18 (N = 679,000) in the window between 2001 and 2012. Risk factors for first-time diagnose with PTSD are analyzed by the discrete time log-odd model. We found a lifetime prevalence of 2.3% PTSD in school-age children (n = 15,636). In accordance with the model, indicators of traumatic stress in the family, family disintegration, community violence, and individual vulnerabilities predicted later diagnose with PTSD. Individual neurodevelopmental disorder - especially autism (adjusted Odds Ratio (OR 7.1) and ADHD (OR 10.7) - were predicative of PTSD. The results cooperated the traumatic stress model. Some results were inconsistent with the traumatic stress model e.g., parental substance abuse were associated with less than expected PTSD in school-age children when adjusted for other risk factors. This indicates that PTSD may be underestimated in these groups. PTSD diagnoses in administrative records underestimate the prevalence, systematically. Efforts to increase PTSD screening may allow for better management.

Overcoming the Odds: Does Social Support Make a Difference for Young People With ADHD Symptoms?

OBJECTIVES: Young adults with ADHD symptoms have a risk of negative outcomes in cognitive development, emotional development, and social developmental problems. The research question is: Does social support make a difference for children with ADHD symptoms? METHOD: Children born in 1984 were interviewed at age 25. The survey then obtained a 67% response rate which measures up to 2,980 interviewed persons. Validated constructs were used to measure outcomes, mediator, and ADHD symptoms. RESULTS: Young people with ADHD symptoms have an increased rate of low educational achievement, low self-esteem, loneliness, suicide considerations, PTSD symptoms, behavioral problems, criminal behavior, peer problems, and substance abuse. Social support is a partial mediator for the negative outcomes except for criminal behavior and substance abuse problems. CONCLUSIONS: Loss of social support partly explains the mentioned negative outcomes and we would suggest that future research also look for other mediators. These results indicate potential interventions.

Sexual Crime Against Schoolchildren With Disabilities: A Nationwide Prospective Birth Cohort Study.

Numerous studies have shown that the rate of sexual victimization against children with disabilities is higher than the rate for children without disabilities. The study focuses on examining sexual crime against children with disabilities and explaining differences in victimization to elucidate to what extent types of disability, family disadvantages, gender, high-risk behavior, and location influence adolescents' risk of sexual victimization. Data are based on a national study of reported sexual crime against children in Denmark aged between 7 and 18 years using total birth cohorts (N = 679,683). The statistical analysis is a discrete-time Cox model. An extended list of potential risk factors was included in the analysis to adjust for confounding. The potentially confounding risk factors were collected independently from various population-based registers, for example, employment statistics, housing statistics, education statistics, income compensation benefits, and population statistics (e.g., gender, age, location). Hospital records with information on types of disability based on the national inpatient register and national psychiatric register were collected independently of the collection of law enforcement records about reported sexual offenses under the Danish Central Crime Register. Among total birth cohorts, 8,039 persons or 1.18%. were victims of a reported sexual crime once or several times. Children with intellectual disabilities were more likely to be victimized of a reported sexual crime than non-disabled children were: attention-deficit/hyperactivity disorder (ADHD), odds ratio: 3.7 (3.5-3.9); mental retardation, odds ratio: 3.8 (3.6-4.0); and autism, odds ratio: 3.8 (3.6-4.0). This contrasts with children with speech disability, stuttering, and dyslexia who were less likely to be victimized when adjusted for family vulnerability and other confounding risk factors. Intellectual disability and family vulnerability, for example, parental substance abuse, parental violence, family separation, the child in care, and parental unemployment, indicate an increased risk of being a victim of a sexual crime, while speech disability seems to be ensuring protection.

Violent crime against children with disabilities: A nationwide prospective birth cohort-study.

BACKGROUND: The rate of violent victimization against children with disabilities is thought to be lower than the rate for children without disabilities but several studies shows otherwise. OBJECTIVE: The study focuses on examining violent crime against children with disabilities and explaining differences in victimization, in order to elucidate to what extent types of disability, family disadvantages, gender, high-risk behavior, location and indicator of ethnic minority (e.g. non-Danish citizens) influence adolescents' risk of violent victimization. Previous population studies in this area lack scientifically sound research methodology and results are weak or inconclusive. METHOD: Data is based on a national study of reported violent crime against children in Denmark aged between 7 and 18 years, using total birth cohorts (N = 678,000). Data on types of disability were collected from the Danish national inpatient register. Violent-crime data were extracted from Danish police records. Within the birth cohorts studied, 3.5% of children had experienced a violent crime. A discrete-time Cox model was used for the statistical analysis, which included an extended list of potential risk factors to adjust for confounding. RESULTS: Children with disabilities are more likely to be victims of a reported violent crime than non-disabled children - ADHD odds ratio: 2.7 (2.6-2.8), mental retardation: 2.7 (2.6-2.7), autism 2.6 (2.5-2.7), loss of hearing 1.4 (1.2-1.5), brain injury: 1.8 (1.7-1.9), physical disabilities 1.4 (1.2-1.5), and blindness 2.0 (1.4-2.8). Speech disability, epilepsy, stuttering, and dyslexia were not associated with increased risk of violent victimization, when adjusted for confounding risk factors and age. CONCLUSIONS: The results of our study provide empirical insight into the first-time prevalence of victimization among children with disability, and into the predicative association between family disadvantages and victimization.

Non-Suicidal Self-Injury--Does social support make a difference? An epidemiological investigation of a Danish national sample.

Teenagers and young adults who had experienced child maltreatment, being bullied in school and other serious life events have an increased risk of Non-Suicidal Self-Injury (NSSI), but some individuals manage to escape serious stressful life events. The research question is: does social support make a difference? A national representative sample of 4,718 persons born in 1984 were selected for an interview about their childhood, maltreatment, serious life events and social support in order to test if social support during childhood is a statistical mediator between childhood disadvantages and NSSI. The survey obtained a 67% response rate (N=2,980). The incidence rate of NSSI among this sample was estimated at 2.7% among young adult respondents. Participants with a history of child maltreatment, being bullied in school or other traumatic life events reported a rate of NSSI 6 times greater than participants without this history (odds ratio: 6.0). The correlation between traumatic life events during adolescence and NSSI is reduced when low social support is accounted for in the statistical model (p<0.01). The results indicate that social support is a partial mediator for NSSI. The reported low self-esteem indicates the importance of treating adolescents who are engaged in NSSI with respect and dignity when they are treated in the health care system. Results further imply that increasing social support may reduce the likelihood of NSSI.

Risk factors for a first-time drink-driving conviction among young men: a birth cohort study of all men born in Denmark in 1966.

Using a complete birth cohort of all young men born in 1966 in Denmark (N = 43,403), the prevalence of a first-time drink-driving conviction among young men is estimated. More than 7% of the total male birth cohort was so convicted before the age of 27 years. In an examination of risk factors for a first-time drink-driving conviction, young adults coming from potentially vulnerable groups have an increased risk. Earlier criminal convictions of various types were also significant predictors of drink driving. Situational pressures also play a part and are controlled for, with the risk of a drink-driving conviction increased substantially in rural areas compared to metropolitan areas. The study concludes that disadvantages during adolescence, including parental substance abuse, having a teenage mother, and domestic violence, are associated with a first-time drink-driving conviction.

The long-term consequences of parental alcohol abuse: a cohort study of children in Denmark.

The aim of this study is to consider whether parents' abuse of alcohol has an impact on children during their formative years. The research is based on data from 84,765 children born in Denmark in 1966. These children and their parents were followed between 1979 and 1993. Information was analyzed from government registers covering health, education, family separation, suicidal behavior, criminality, and unemployment, using a discrete time Cox-regression model. Results showed that the parents' alcohol abuse may frame the childhood with parental violence, very high occurrence of family separations, and often foster care. The parental abuse of alcohol may influence several long-term consequences for their 15- to 27-year-old children such as increased mortality, self-destructive behaviors (e.g. attempted suicide or drug addiction). Hospitalization due to violence, an increased risk of teenage pregnancy and unemployment were also seen more frequently among cases where the parents were alcohol abusers. Mothers' alcohol abuse seemed to be associated with higher occurrences of all the mentioned disadvantages.

[Morbidity of Danish infants during their first months of life. Incidence and risk factors]. / Danske spaedbørns sygelighed i de første levemåneder. Forekomst og risikofaktorer.

INTRODUCTION: The purpose of the study was to describe accumulated incidences of common diseases among Danish children during their first months of life, and identify risks and protective factors. MATERIAL AND METHODS: In 1995, mothers with Danish citizenship of 5998 randomly selected newborn children in Denmark were asked to participate in a national prospective study, representative of children of mothers with Danish citizenship. Mothers of 5429 infants participated and were interviewed when on an average their babies were 4 1/2 months old. RESULTS: At the time of the interview, 85% of all infants had had a cold, 23% had been wheezing, 22% had had rash/eczema, 13% had had vomits, 11% had had diarrhoea, 11% had had high fever without other symptoms, 5% had suffered from middle ear infection, 5% had had pneumonia, 1% had had blood in stools and 1% had had convulsions, and 13% had suffered from other diseases. Maternal age and breastfeeding protected against diseases. Siblings, damp/cold housing, and the psychological stress of the mother increased the risks, whereas maternal smoking and low birth weight had no effect on most of the outcomes. DISCUSSION: This study underpins the significant importance of breastfeeding against morbidity and the augmented risks from siblings.