Citation

Björkenstam E, Kosidou K, Björkenstam C. Int. J. Epidemiol. 2016; 45(2): 501-511.

Affiliation

Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.

Copyright

(Copyright © 2016, International Epidemiological Association, Publisher Oxford University Press)

DOI

10.1093/ije/dyw012

PMID

27032414

Abstract

BACKGROUND: Childhood household dysfunction (CHD) is a risk indicator for self- harm in young adulthood. However, less is known about the effects of cumulative exposure to CHD and the role of school performance and childhood psychopathology in the relationship.

METHODS: We used a Swedish cohort of 107 518 individuals born in 1987-91. Register-based CHD indicators included familial death, parental substance abuse and psychiatric morbidity, parental somatic disease, parental criminality, parental separation/single-parent household, public assistance receipt and residential instability. Estimates of risk of self-harm from age 15 [measured as registered diagnosis of self-harm according to the International Classification of Disease (ICD)] were calculated as hazard ratios (HR) with 95% confidence intervals (CIs).

RESULTS: CHD indicators, with exceptions of familial death and parental somatic disease, were associated with an increased risk of self-harm. Accumulating CHD indicators increased the risk of self-harm in a graded manner, and individuals exposed to five or more indicators had a f5-fold risk [hazard ratio (HR): 4.9, 95% CI 3.8-6.4) after adjustment for school performance, childhood psychopathology and confounders. Exposure to five or more CHD indicators and poor school performance conferred a 20-fold increased risk, compared with non-exposed individuals in the highest grade group. The risk was elevated by 9-fold for those with five or more CHD indicators and a history of childhood psychopathology.

CONCLUSION: Childhood household dysfunction is associated with the risk of self-harm in young adults, particularly when accumulated. The risk is markedly increased in the subgroup of disadvantaged children that fail in school or develop childhood psychopathology.

© The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

Language: en