青春期全程的生活事件軌跡與自殺意念：一項來自德國、法國、愛爾蘭和英國的前瞻性隊列研究

Life event trajectories and suicidal ideation throughout adolescence: a prospective cohort study from Germany, France, Ireland, and the UK

——《柳葉刀·精神病學》第13卷，第3期，2026年3月——

<The Lancet Psychiatry> Volume 13, Issue 3, March 2026

【摘要】背景：青春期是一個敏感時期，自殺意念在此期間可能達到峰值。儘管創傷性生活事件已被公認為自殺意念的一個既定風險因素，但跨越家庭、自主性、性等多個維度的累積性日常瑣碎生活事件所扮演的角色，目前仍未得到充分的探索。至關重要的是，目前尚無證據表明此類事件的累積暴露在多維度上的發展軌跡，與整個青春期期間的自殺意念之間存在何種關聯。本研究旨在考察青春期期間累積性及特定領域的生活事件暴露軌跡，與自殺意念之間存在何種關聯。方法：在這項多國參與的前瞻性隊列研究中，我們利用了來自IMAGEN隊列的縱向數據；這些數據於2008年1月至2010年1月期間，在德國、法國、愛爾蘭和英國的八個中心收集而成。我們利用這些數據對青春期期間的生活事件暴露軌跡進行了建模，並量化了不同軌跡組別與自殺意念之間的關聯。參與者分別在14、16、19和23歲時接受了評估；主要納入標準包括：具備提供知情同意或知情認可的能力，且其父母已完成關於參與者圍產期及發育史的問卷填寫。研究採用《生活事件問卷》（LEQ）對參與者在七個維度（包括家庭、意外事故、心理困擾、自主性、越軌行為、性相關事件及搬遷）上對39項生活事件的暴露情況進行了評估；該問卷在上述每一個研究時間點均進行了施測。此外，研究還利用《童年創傷問卷》對參與者的童年期受虐待經歷進行了評估；該問卷僅在參與者19歲時施測一次。本研究的主要結局指標為：在不同生活事件暴露軌跡組別中，出現自殺意念的參與者人數；該指標通過LEQ問卷中專門針對自殺意念設置的條目進行評估，評估時間點涵蓋前三個研究時間點。此外，我們還對參與者在前三個研究時間點通過《發育與福祉評估》（DAWBA）所填報的關於自傷行為及自殺意念的應答結果進行了比對分析。研究採用“潛在軌跡分析”方法，根據多次評估結果將累積性生活事件暴露情況劃分為不同的類別（即軌跡組別）：高暴露組、中高暴露組、中低暴露組及低暴露組。隨後，研究利用邏輯混合模型回歸分析方法，對不同軌跡組別與自殺意念之間的關聯進行了量化；在進行回歸分析時，已對童年期受虐待經歷及人口學協變量進行了統計學校正。值得注意的是，在本次研究的設計、實施及成果報告過程中，未曾邀請任何具有自殺經歷或精神健康障礙經歷的個體參與其中。研究結果：在基線期，共有2161名於2008年1月至2010年1月期間入組的青少年被納入該隊列研究（其中女性1106人 [51.2%]，男性1055人 [48.8%]）。後續各波隨訪的樣本量分別為：第一次隨訪（2011年1月至2012年1月進行）時為1581人；第二次隨訪（2013年1月至2015年1月進行）時為1474人；第三次隨訪（2016年1月至2019年1月進行）時為1331人。在每一個時間點上，“高軌跡組”（占全部2161名參與者的1125人 [52.1%]）均擁有最高比例的具有自殺意念的參與者（具體比例分別為：基線前1125人中有90人 [8.0%]；14歲時1125人中有127人 [11.3%]；16歲時759人中有102人 [13.4%]；19歲時709人中有78人 [11.0%]）。在控制了人口學特徵及童年期受虐待經歷等混雜因素後，該“高軌跡組”在每一個時間點上仍表現出最高的自殺意念預測概率。在預測青少年自殺意念方面，家庭維度的生活事件所具有的預測力（邊際 R²GLMM = 0.078）高於所有其他維度生活事件的預測力之和（邊際 R²GLMM = 0.073）。研究解讀：本研究發現，在多個維度上累積暴露於日常普通生活事件的程度越高，青少年期出現自殺意念的風險也就越高；其中，發生在家庭環境內的生活事件所帶來的風險最高。這些結果提示我們，在評估青少年自殺風險時，不僅應關注童年期創傷或受虐待經歷，還必須重視對不同類型日常普通生活事件暴露情況的全面評估。

[Summary] Background: Adolescence is a sensitive period when suicidal ideation can peak. Although traumatic life events are a well established risk factor for suicidal ideation, the role of cumulative ordinary life events across multiple dimensions, such as family, autonomy, and sexuality, remains underexplored. Crucially, no evidence is available on how multidimensional trajectories of cumulative exposure to such events relate to suicidal ideation throughout adolescence. We aimed to examine how cumulative and domain-specific trajectories of ordinary life events during adolescence relate to suicidal ideation. Methods: In this multinational, prospective cohort study, we used longitudinal data from the IMAGEN cohort, gathered from eight centres in Germany, France, Ireland, and the UK between January, 2008, and January, 2010, to model trajectories of exposure to life events during adolescence, and to quantify the association between trajectory group and suicidal ideation. Participants were assessed at ages 14, 16, 19, and 23 years, and key inclusion criteria included having the capacity to provide informed assent or consent, and having parental completion of perinatal and developmental history. Exposure to 39 life events across seven dimensions (family, accidents, distress, autonomy, deviance, sexuality, and relocation) were assessed using the Life Events Questionnaire (LEQ), administered at each of the study timepoints. Childhood maltreatment was also assessed, using the Childhood Trauma Questionnaire, administered once at age 19 years. The primary outcome was the number of participants with suicidal ideation across trajectories, assessed via a dedicated item in the LEQ at the first three timepoints. We also compared self-harm and suicidal ideation responses from the Developmental and Well-Being Assessment at the first three timepoints. Latent trajectory analysis was used to identify classes of cumulative life event exposure across repeated assessments: high, mid-high, mid-low, and low. The association between trajectory group and suicidal ideation was quantified using logistic mixed model regressions, adjusting for childhood maltreatment and demographic covariates. No individuals with lived experience of suicidality or mental health conditions were involved in the design, conduct, or reporting of this research. Findings: At baseline, 2161 adolescents, enrolled between January, 2008, and January, 2010, were included in the cohort (1106 [51·2%] female and 1055 [48·8%] male). Sample sizes at subsequent waves were 1581 at first follow-up (which took place between January, 2011, and January, 2012), 1474 at second follow-up (between January, 2013, and January, 2015), and 1331 at third follow-up (between January, 2016, and January, 2019). At each timepoint, the high trajectory group (1125 [52·1%] of 2161 participants) had the highest proportion of participants with suicidal ideation (90 [8·0%] of 1125 at pre-baseline, 127 [11·3%] of 1125 at age 14 years, 102 [13·4%] of 759 at age 16 years, and 78 [11·0%] of 709 at age 19 years). After controlling for demographics and childhood maltreatment, the high trajectory group had the highest predicted probability of suicidal ideation at each timepoint. Life events in the family dimension predicted adolescent suicidal ideation (marginal R2GLMM=0·078) more than those in all remaining dimensions combined (marginal R2GLMM=0·073). Interpretation: We found that higher cumulative exposure to ordinary life events across multiple dimensions is associated with higher suicidal ideation in adolescence, with life events occurring within the family environment carrying the highest risk. These results point to the importance of evaluating different types of everyday life event exposure, not just childhood trauma or maltreatment, when assessing suicidal risk in adolescents.

論文原文：Pei-Jung Chen, Andrew J Lawrence, Xuemei Ma, et al. (2026). Life event trajectories and suicidal ideation throughout adolescence: a prospective cohort study from Germany, France, Ireland, and the UK. The Lancet Psychiatry, Volume 13, Issue 3, Pages190-199. March 2026.

https://doi.org/10.1016/S2215-0366(25)00359-1

（翻譯兼責任編輯：MARY）

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