Finding effective suicide risk-reduction interventions remains a challenge

Childhood abuse, whether sexual, emotional, or physical in nature, is significantly associated with higher rates of suicide attempts, according to researchers.

Their systematic review and meta-analysis of 79 studies involving more than 300,000 young persons found that core types of childhood maltreatment were also associated with greater odds of suicidal ideation and suicide planning.

The study, by Ioannis Angelakis, PhD, and colleagues was published in JAMA Network Open: Pediatrics.

According to the study authors, an estimated 12.5% of children in the United States experience maltreatment (sexual, physical and emotional abuse or neglect) by the time they reach the age of 18. The percentages are even higher in the United Kingdom.

And, evidence shows that this abuse is associated with adverse outcomes, including self-harm, suicidal behavior, and susceptibility to mental health issues and substance abuse. In this study, the authors sought to quantify the association between core types of childhood maltreatment — including sexual, physical, and emotional abuse and/or neglect — and suicidal behaviors in children and young adults.

The studies included in the meta-analysis and review involved 337,185 young persons with a mean age of 15.67 years. The authors found that, regarding the links between maltreatment and suicide attempts:

  • Sexual abuse was associated with 3.5-fold increased odds for suicide attempts (odds ratio (OR) 3.42; 95% CI, 2.90-4.00).
  • Physical abuse was associated with a 2-fold increase in the odds for suicide attempts (OR, 2.18; 95% CI, 1.75-2.71).
  • Emotional abuse was associated with 2-fold increased odds for suicide attempts (OR, 2.21; 95% CI, 1.37-3.57).
  • Emotional neglect was associated with increased odds for suicide attempts (OR, 1.93; 95% CI, 1.36-2.74).
  • physical neglect was also associated with increased odds for suicide attempts (OR 1.79; 95% CI, 1.27-2.53).
  • Combined abuse was associated with higher rates of suicide attempts (OR, 3.38; 95% CI, 2.09-5.47).

In addition, sexual abuse was associated with 2.5 fold increased odds of suicide ideation (OR, 2.46; 95% CI, 2.08-2.90), while physical abuse (OR, 1.95; 95% CI, 1.67-2.27) emotional abuse (OR, 1.82; 95% CI, 1.47-2.25) and overall child abuse (OR, 2.36; 95% CI, 1.98-2.82) were also significantly associated with increased odds for suicide ideation.

Studies exploring the link between sexual abuse and suicide planning in children found that sexual abuse was associated with 4-fold increased odds for suicide plans (OR, 4.12; 95% CI, 2.44-6.95).

“Overall, these are important findings because suicide plans, especially when they occur during peak suicide ideation, can lead to suicide attempts and deaths by suicide,” wrote Angelakis and colleagues. They suggested that more research is needed to examine those links between suicide ideation and planning and core types of childhood maltreatment.

The data suggest childhood maltreatment “is a central social welfare problem that may lead to suicide behaviors,” the authors concluded. “Therefore, research, clinical, and policy actions should be taken with a particular focus on (1) raising public awareness, (2) informing existing policies, and (3) amending treatment protocols for achieving optimal results with respect to childhood maltreatment.”

In a commentary accompanying the study, Brett Burstein, MDCM, PhD, MPH, and Brian Greenfield, MD, both of the McGill University Health Centre, Montreal, Quebec, Canada, wrote that the work by Angelakis and colleagues “should be recognized as a landmark study.” However, they added, the challenge of translating those findings into effective suicide risk-reduction interventions remains.

Burstein and Greenfield noted that many children who attempt suicide or exhibit suicide ideation first present to an emergency department. And while the progression from ideation to attempt can be contained once a child is in the ED, “future studies must focus on developing interventions well upstream of suicidality, when [adverse childhood experiences] have first been identified, and that orient suicide prevention care to community resources temporally closer to the abuse before the ED presentation,” they wrote.

For example, they suggested, community and school authors should be empowered to identify at-risk children and adolescents and refer them mental health clinicians, who should be aware of the association between childhood maltreatment and suicide risk.

  1. Childhood abuse (sexual, physical, and emotional) is associated with an increased risk of suicide attempts in young people, a meta-analysis found.

  2. The study also found that child maltreatment is also associated with increased odds of suicide ideation, while sexual abuse specifically is associated with 4-fold increased odds of suicide planning.

Michael Bassett, Contributing Writer, BreakingMED™

None of the experts quoted in this article had any relevant disclosures.

Cat ID: 138

Topic ID: 85,138,285,138,139,43,513,192,146,151,925