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Additive Impact of Childhood Emotional, Physical, and Sexual Abuse on Suicide Attempts among Low-Income African American Women
Abstract
This study examines the association between exposures to multiple forms of childhood abuse (emotional, physical, sexual) and adult suicidal behavior in a sample of low-income, African American women. We hypothesized a linear relation between childhood abuse and risk for making a suicide attempt, such that the more forms of childhood abuse to which a woman was exposed, the greater her risk would be to make a suicide attempt. Logistic regression analyses revealed that, compared to women who did not report any experiences of childhood abuse, women who experienced one, two, or three forms of abuse were 1.83, 2.29, or 7.75 times more likely to attempt suicide, respectively (all statistically significant). Furthermore, compared to women who reported one or two types of abuse, women who reported all three types of abuse were statistically more likely to attempt suicide. These findings have implications for clinicians working with African American women who report either childhood abuse or exhibit suicidal behavior.
... The vulnerability to suicidal behavior after abuse has been validated cross culturally and validated for immigrant populations [33,59,65]. Salander Renberg, Lindgren and Osterberg [59] established the association of sexual abuse to suicidal behavior in ten European countries, whereas Anderson, Tiro Price, Bender and Kaslow [65] validated the impact of sexual and physical abuse on suicidal behavior of African American women. ...
... The vulnerability to suicidal behavior after abuse has been validated cross culturally and validated for immigrant populations [33,59,65]. Salander Renberg, Lindgren and Osterberg [59] established the association of sexual abuse to suicidal behavior in ten European countries, whereas Anderson, Tiro Price, Bender and Kaslow [65] validated the impact of sexual and physical abuse on suicidal behavior of African American women. Further evidence regarding the role of sexual and physical abuse in Turkish, Moroccan and South-Asian Surinamese immigrant women in The Netherlands was found by van Bergen, van Balkom, Smit and Saharso [33]. ...
... This finding has also been validated cross culturally. African American women who suffered multiple forms of abuse had 2-4 times more vulnerability to suicide attempts compared to those women who reported a single form of abuse [65]. ...
Ethnicity plays a major role in the rates and risk factors of suicidal behavior. While ethnocultural factors increasingly receive attention of suicidologists, the relevance of the intersections of ethnicity and gender are yet to be recognized. In this chapter, we review findings on the role that gender has for suicidal behavior of immigrants. We focus in particular on suicidal behavior of immigrant women and discuss gender specific risk factors. In addition, we summarize the indicators that exist cross culturally for the relevance of Durkheim's fatalistic suicide to understanding women's suicidal behavior.
... The vulnerability to suicidal behavior after abuse has been validated cross culturally and validated for immigrant populations [33,59,65]. Salander Renberg, Lindgren and Osterberg [59] established the association of sexual abuse to suicidal behavior in ten European countries, whereas Anderson, Tiro Price, Bender and Kaslow [65] validated the impact of sexual and physical abuse on suicidal behavior of African American women. ...
... The vulnerability to suicidal behavior after abuse has been validated cross culturally and validated for immigrant populations [33,59,65]. Salander Renberg, Lindgren and Osterberg [59] established the association of sexual abuse to suicidal behavior in ten European countries, whereas Anderson, Tiro Price, Bender and Kaslow [65] validated the impact of sexual and physical abuse on suicidal behavior of African American women. Further evidence regarding the role of sexual and physical abuse in Turkish, Moroccan and South-Asian Surinamese immigrant women in The Netherlands was found by van Bergen, van Balkom, Smit and Saharso [33]. ...
... This finding has also been validated cross culturally. African American women who suffered multiple forms of abuse had 2-4 times more vulnerability to suicide attempts compared to those women who reported a single form of abuse [65]. ...
Ethnicity plays a major role in the rates and risk factors of suicidal behavior. While ethnocultural factors increasingly receive attention of suicidologists, the relevance of the intersections of ethnicity and gender are yet to be recognized. In this chapter, we review findings on the role that gender has for suicidal behavior of immigrants. We focus in particular on suicidal behavior of immigrant women and discuss gender specific risk factors. In addition, we summarize the indicators that exist cross culturally for the relevance of Durkheim's fatalistic suicide to understanding women's suicidal behavior.
... Besides the commonly researched outcomes of depression and posttraumatic stress disorder, research has consistently found that a history of childhood maltreatment is a risk factor associated with suicide (Anderson, Tiro, Price, Bender, & Kaslow, 2002;Kaslow, Jacobs, Young, & Cook, 2006;Kaslow et al., 2002;Moeller, Bachmann, & Moeller, 1993). Historically, suicide rates among African Americans have been reported to be lower than for European Americans (National Center for Health Statistics, 1996), but some researchers report that the highest rates of misclassification of cause of death are for women and African Americans because a significant number of deaths were not classified as suicides, despite evidence to the contrary (J. ...
... Finally, information was only collected about the presence of suicidal ideation along with the frequency of abuse and not on the age the abuse occurred, the perpetrator's relation- ship to the abused person, ethnicity of the perpetrator, the number of perpetrators, the severity of the abuse, or the time of the suicidal ideation. These contextual factors of abuse have been found to affect psychological outcomes ( Anderson et al., 2002), so they would be important to investigate in the future, especially with variables such as spiritual- ity and ethnic identity, which could have different impacts depending on the characteris- tics of the perpetrator (e.g., family member, clergy person, ethnicity of the perpetrator). ...
Running away from home is a known risk factor for commercial sexual exploitation among youth; however, research has not fully investigated the process by which multiple factors at individual, familial, and extra-familial levels increase youths’ risk for runaway behavior. This study applies an ecological risk factor framework to assess risk for runaway behavior among individuals exposed to commercial sexual exploitation and examines mediating relationships between salient risk factors (i.e. substance abuse, insufficient basic needs, having a much older boyfriend/girlfriend) and runaway behavior. A cross-sectional, retrospective survey was administered to individuals involved in the commercial sex industry using Respondent Driven Sampling methods (N = 273). Bivariate results suggested associations between runaway behavior and childhood emotional and physical abuse, having friends who sold sex, having a much older boyfriend/girlfriend, dropping out of school, being worried about where to eat/sleep, homelessness, and frequent alcohol and drug use prior to entering the commercial sex industry. Hierarchical logistic regression revealed that individuals with runaway behavior histories were more likely to have frequently used alcohol and/or drugs and to have insufficient basic needs compared to those did not run away; however, these factors were no longer significant after accounting for having a much older boyfriend/girlfriend. Having an older boyfriend/girlfriend fully mediated the relationship between frequent alcohol and/or drug use and runaway behavior. Findings support the need for community and school-based prevention programs that target these risk factors with a specific focus on healthy dating relationships, which may reduce risk for runaway behavior and subsequent commercial sexual exploitation.
... Childhood abuse is a risk factor for suicidal behavior in diverse groups (Anda et al. 2006;Briere et al. 2016;Devries et al. 2014;Dube et al. 2001;Fuller-Thomson et al. 2012;Harford et al. 2014), including low-income African American women (Anderson et al. 2002). Suicidal behavior, a major cause of disease burden and death, emerges in response to biological, psychological, and social factors (Curtin et al. 2016a). ...
... Second, as noted earlier, childhood abuse is a risk factor for suicidal behavior in adults (Devries et al. 2014;Harford et al. 2014;Norman et al. 2012), including among African American women . There is a significant and graded association between adverse childhood experiences, such as childhood abuse, and risk of attempted suicide for multiple populations, including African American women (Anderson et al. 2002). Moreover, the type of childhood abuse impacts one's risk for future suicide attempts (Power et al. 2016). ...
There is a significant association between childhood abuse and suicidal behavior in low-income African American women with a recent suicide attempt. Increasingly, empirical focus is shifting toward including suicide resilience, which mitigates against suicidal behavior. This cross-sectional study examines childhood abuse, intrapersonal strengths, and suicide resilience in 121 African American women, average age of 36.07 years (SD = 11.03) with recent exposure to intimate partner violence and a suicide attempt. To address the hypothesis that childhood abuse will be negatively related to suicide resilience and that this effect will be mediated by intrapersonal strengths that serve as protective factors, structural equation modeling examined the relations among three latent variables: childhood abuse (measured via physical, sexual, and emotional abuse), intrapersonal strengths (assessed by self-efficacy and spiritual well-being), and suicide resilience (operationalized via the three components of suicide resilience—internal protective, external protective, and emotional stability). The initial measurement model and the structural model both indicated excellent fit. Results indicated that childhood abuse was negatively associated with intrapersonal strengths and suicide resilience, intrapersonal strengths were positively associated with suicide resilience, and intrapersonal strengths fully mediated the association between childhood abuse and suicide resilience. Thus, the results suggest a positive and protective influence of intrapersonal strengths on suicide resilience in the face of childhood abuse in suicidal African American women. The clinical implications and directions for future research that emerge from these findings are discussed.
... The measure has good test-retest reliability; internal consistency reliability; and concurrent criterion validity and convergent validity (Bernstein & Fink, 1998;Scher, Stein, Asmundson, McCreary, & Forde, 2001;Spinhoven et al., 2014). It has shown measurement invariance across racial groups (Thombs, Lewis, Bernstein, Medrano, & Hatch, 2007) and high internal consistency reliability in African American women (Anderson, Tiro, Price, Bender, & Kaslow, 2002;α's = .89, .93, ...
... Historically, researchers have focused primarily on the link between childhood maltreatment defined broadly and suicidal behavior in adulthood, a connection that has been found in African American women (Anderson et al., 2002). More recently, investigators studying specific types of maltreatment, have found associations between self-reported childhood physical (Norman et al., 2012), sexual (Devries et al., 2014), and emotional (Briere et al., 2016;De Araujo & Lara, 2016;Norman et al., 2012) abuse and later suicidal ideation and attempts. ...
The interpersonal-psychological theory of suicidal behavior (IPTS) is an exemplary model for understanding the desire for suicidal behavior. As such, it is important to explore its applicability in ethnoracial minority groups at increasing risk for suicidal behavior, such as low-income, African American women. Guided by the IPTS, the current study used 5 parallel mediation models to examine if there are links between individual types of childhood abuse (physical, sexual, emotional) and suicide resilience, and between cumulative abuse (higher levels of abuse inclusive of all three types, more types of severe levels of abuse) and suicide resilience, and whether the three components of the model (thwarted belongingness, perceived burdensomeness, acquired capability for suicide) mediate these associations. In a sample of low-income, African American women (n = 179), higher levels of each of the 3 types of childhood abuse and cumulative abuse correlated with lower levels of suicide resilience. Parallel mediation analyses using bootstrapping techniques revealed that increased acquired capability for suicide mediated all 5 associations and perceived burdensomeness mediated 3 of the links (emotional abuse, cumulative abuse, and cumulative abuse–severe with suicide resilience). Attention is paid to the clinical implications of the findings in terms of attending to the acquired capability for suicide and suicide resilience in the assessment and treatment of low-income, suicidal, African American women.
... Emotional abuse and neglect, disrupted parental attachment, and the cumulative effect of multiple forms of maltreatment also increase the risk. These associations have been documented across adolescent, adult, inpatient, and outpatient populations, as well as in epidemiological studies of community and more general populations [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. ...
... In addition, longitudinal and prospective studies have been providing more robust support for previous findings regarding both the specific role of early sexual abuse and suicidal This article is part of the Topical Collection on Mood Disorders behavior, as well as the cumulative effects of multiple adverse experiences [2,13]. And, recent research is expanding what we know about the relationship between childhood abuse and other adverse early life experiences and suicidal behavior within specialized high-risk international populations, as well as in the military [16,[21][22][23][24]. ...
Adverse childhood experiences are associated with higher risk for suicide and suicidal behavior later in life. There are known associations between childhood trauma, particularly sexual abuse, and higher rates of suicide, non-lethal suicide attempts, and non-suicidal self-injurious behaviors in adolescence and adulthood. Emotional abuse/neglect, disrupted parental attachment, and cumulative effect of multiple forms of maltreatment, also increase risk. Yet, the causal relationship remains unclear. The diathesis-stress model provides a framework for understanding how early life adverse experiences contribute to suicide vulnerability. Current findings from the fields of biology, neurology, and genetics shed new light on mediating variables and possible causal links between early childhood trauma and suicide. In this paper, we review recent advances, particularly regarding the interaction of early life environmental adverse events with genetics factors, that increase the diathesis for psychological traits are associated with subsequent deliberate self-harm behaviors.
... or phone (859-257-6890). associated with suicide (Anderson, Tiro, Price, Bender, & Kaslow, 2002;Kaslow et al., 2002;Kaslow, Jacobs, Young, & Cook, 2006;Moeller, Bachmann, & Moeller, 1993). Historically, suicide rates among African Americans have been reported to be lower than for European Americans (National Center for Health Statistics, 1996), but some researchers report that the highest rates of misclassification of cause of death are for women and African Americans because a significant number of deaths were not classified as suicides, despite evidence to the contrary (Gibbs, 1997;Maris, Berman, & Silverman, 2000;Nisbet, 1996;Phillips & Ruth, 1993;Warshauer & Monk, 1978). ...
... Finally, information was only collected about the presence of suicidal ideation along with the frequency of abuse and not on the age the abuse occurred, the perpetrator's relationship to the abused person, ethnicity of the perpetrator, the number of perpetrators, the severity of the abuse, or the time of the suicidal ideation. These contextual factors of abuse have been found to impact psychological outcomes (Anderson et al., 2002), so they would be important to investigate in the future especially with variables such as spirituality and ethnic identity which could have different impacts depending on the characteristics of the perpetrator (family member, clergy person, ethnicity of the perpetrator, etc.). ...
Compared with other ethnic groups, African Americans have the highest rate of childhood victimization. The literature is sparse with regard to suicidal ideation among African American women with a history of sexual violence as a minor. Using survey data, this study utilized logistic regression to investigate the roles of a risk factor, criminal justice involvement, and protective factors, ethnic identity, and spiritual well-being, in experiencing suicidal ideation. Findings suggest that criminal justice involvement and the interaction of ethnic identity and spiritual well-being are important factors in understanding which African American women may be at a greater risk of experiencing suicidal ideation.
... Therefore, our findings are also in line with the rich literature showing an association between child maltreatment and borderline personality disorder (Porter et al., 2020). The positive association of the CTQ sum score with selfharm further mirrors previous findings of cumulative effects of adverse childhood experiences (Afifi et al., 2008;Anderson et al., 2002;Miller et al., 2013). These findings underscore the need to disseminate knowledge of the long-term effects of child maltreatment and to advance child protection efforts (e.g., Fegert & Stötzel, 2016). ...
Background
Child maltreatment is a risk factor for a range of mental disorders later in life, including dangerous self-harm and suicide attempts. A better understanding of the mechanisms underlying this association can inform prevention and intervention.
Objective
To investigate personality functioning as a potential mediator of the association of childhood abuse and neglect and self-harm and suicide attempts in the general population.
Participants and setting
Data were drawn from a representative German population sample (N = 2510).
Methods
Participants filled out the Childhood Trauma Questionnaire (CTQ), OPD Structure Questionnaire (OPD-SQS), and items of the Self-Injurious Thoughts and Behaviors Interview (SITBI). In structural equation models, we operationalized impaired personality functioning as the mediator between childhood abuse and neglect and self-harm.
Results
Individuals with a history of self-harm (combining suicide attempts, N = 47, and non-suicidal self-injury, N = 83) reported more childhood abuse and neglect (d = 1.39, p < .001) and greater impairments in personality functioning (d = 1.64, p < .001) than the rest of the population. The indirect effect via personality functioning accounted for 48.8 % of the total effect of childhood abuse and neglect on self-harm. In more differentiated analyses, emotional abuse showed the strongest association with self-harm. Only physical and sexual abuse had direct effects.
Conclusions
The results specify the relationship between child maltreatment and self-harm by demonstrating that it is partly mediated by basic functions of personality assessed using a dimensional measure. These abilities constitute modifiable risk factors that can be addressed by psychotherapy.
... For example, in a study comprised of low-income African Americans, childhood emotional abuse was correlated with depressive symptoms (Crow et al., 2014). In a sample of low-income African American women, five forms of childhood maltreatment (physical, sexual, and emotional abuse; emotional and physical neglect) were independently related to risk for suicide attempts (Thompson et al., 2000), and the more forms of childhood abuse endorsed, the greater the likelihood of a suicide attempt (Anderson et al., 2002). ...
Adverse childhood experiences (ACEs) disproportionately impact African Americans because of profound subjection to historical-systemic oppression in addition to personal and intergenerational trauma exposure. This article utilizes a biopsychosocial-cultural framework to understand the correlates of ACE exposure in African Americans and attends to the cultural factors that contribute to resilience. We review the evidence base for culturally informed, preventive-interventions, as well as strategies for bolstering this work by capitalizing on cultural strengths that are salient in the African American community. We also highlight pertinent policy initiatives guided by recent strategic outlines by the Centers for Disease Control and Prevention. These policies provide the backdrop for the recommendations offered to facilitate the healthy biopsychosocial development of individuals and families. These recommendations can contribute to the expansion and creation of new policies that aim to strengthen individual coping in the face of adversity, enhance family bonds and resilience, and promote community capacity to reduce ACE exposure in African Americans. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... Research has demonstrated that self-esteem, emotional regulation, attachment, peer relationships, and school preparedness are some of the domains negatively impacted by ACEs (Arata et al., 2005;Cicchetti & Rogosch, 2002;Cicchetti & Valentino, 2006;Kim & Cicchetti, 2004). Furthermore, individuals exposed to ACEs have an increased risk of mental health concerns across the lifespan, including depression, anxiety, aggression, social withdrawal, suicidality, and posttraumatic stress disorder (PTSD; Anderson et al., 2002;De Bellis, 2001;Felitti et al., 1998;Lansford et al., 2002;Moore et al., 2013;Nurius et al., 2015). Among the mental health concerns linked to ACEs, PTSD and posttraumatic stress (PTS) symptoms are most relevant to the current investigation. ...
Adverse childhood experiences (ACEs) and posttraumatic stress disorder (PTSD) are both associated with lower performances on executive function tasks. However, few researchers have evaluated ACEs, posttraumatic stress (PTS) symptoms, and executive function difficulties in conjunction. Using an online micropayment service, the current study assessed whether PTS symptoms mediated the relationship between ACEs and executive functions. In total, 83 participants (54.2% female, age: M = 28.86, SD = 7.71) were administered the ACE questionnaire, PTSD Checklist for DSM-5 (PCL-5), and the Executive Function Index (EFI). A higher number of reported ACEs was related to greater PTS symptom severity (β = .40, p < .001) and worse self-rated executive functions (β = -.32, p = .002). Controlling for the number of reported ACEs, current PTS symptom severity was related to worse executive functions (β = -.45, p < .001). A bootstrapped 95% confidence interval (CI) indicated a significant indirect effect, β = -.18 (95% CI: -.30, -.08), by which current PTS symptoms mediated the relationship between the number of reported ACEs and executive functions. These results suggest that psychological interventions targeting PTS symptoms, in the context of a history of childhood trauma, may concurrently improve executive functions in adult populations.
... Socio-emotional well-being are often related to social skills, such as the "ability to competently meet the demands of one's social environment, and psychological well-being, which includes feelings of self-worth, mastery, and purpose" (Hurd et al. 2013, p. 583). Studies have found that the additive component of adverse experiences impacts suicide attempt, depression, and psychological well-being among children and adolescents (Anda et al. 2006;Anderson et al. 2002;Chapman et al. 2004;Nurius et al. 2015;Turner et al. 2006;Youssef et al. 2017). However, other research has found mixed support for this link (Lamers-Winkelman et al. 2012). ...
It is well established that adverse childhood experiences (ACEs) are linked to health and emotional outcomes. However, less is known about the relationship between ACEs and educational attainment—a potentially important feature of educational stratification in America. Using the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative study following 7–12th grade students in the 1994–95 school year, I investigate the link between ACEs and these students’ timely post-secondary attainment. I also explore the role of health and socio-emotional factors as mediators. Results confirm that there is a graded relationship between ACEs and timely bachelor’s degree attainment—an additional ACE decreases the odds of timely bachelor’s degree attainment by about 17%, even after accounting for other related factors. In addition, the findings suggest that general health partially mediates this link.[1]
... In addition to affecting physical health, childhood adversity is linked to developing psychological disorders as people age [6,7,16]. Studies have provided evidence that experiencing ACEs puts an individual at increased risk for depression, anxiety, behavior disorders, personality disorders, substance abuse, high-risk behaviors, and suicide [17][18][19][20][21][22]. ACEs are associated with increased anxiety or worry related to physical health, poorer self-rated health and life satisfaction, and higher self-reported disability in adulthood [21,[23][24][25]. ...
Background
More than half of the U.S. population has experienced adverse childhood experiences (ACE), which are linked to physical and mental health issues. This study examines the relationship between ACEs and life satisfaction, psychological well-being, and social well-being.
Methods
Data of 6323 participants from three waves of the Midlife Development in the United States (1995–1996, 2004–2006, and 2011–2014) were used. Repeated measures models were used to test the associations between ACEs and all three psychosocial scales. Generalized estimating equations (GEE) were used to account for multiple survey measures. Adjusting for demographics and survey wave, GEE models were run for each ACE construct.
Results
After controlling for demographic covariables, those reporting an ACE had significantly lower levels of life satisfaction (β = − 0.20, 95% CI − 0.26 to − 0.15) compared to those without an ACE. Those reporting higher ACE counts were associated with lower life satisfaction compared to those with no ACE (β = − 0.38, 95% CI − 0.56 to − 0.20; β = − 0.36, 95% CI − 0.46 to − 0.27; and β = − 0.13, 95% CI − 0.19 to − 0.08 for ACE counts of 3, 2, and 1, respectively). Abuse (β = − 0.41, 95% CI − 0.48 to − 0.33) and household dysfunction (β = − 0.18, 95% CI − 0.25 to − 0.10) were associated with significantly lower life satisfaction. Overall, those exposed to ACEs had significantly lower sense of social well-being.
Conclusion
In this sample of adults, ACEs were significantly associated with lower life satisfaction, lower psychological well-being, and lower social well-being, especially for those who report abuse and household dysfunction during childhood.
... The majority of studies find a greater correlation of suicidal behavior with a history of sexual, rather than physical abuse, (Molnar et al., 2001;Ogata et al., 1990;McHolm et al., 2003). Some find a greater risk for suicide attempts in those reporting more than one type of abuse (Anderson et al., 2002). Sexual abuse perpetrated by a parental figure (incest) as opposed to a non-parent, is related to the likelihood of multiple suicide attempts among women outpatients (Cankaya et al., 2012). ...
... From this point of view, while several studies explored the mediating role of mental disorders, such as depression, anxiety, and borderline personality disorder (Anderson et al., 2002;Hahm et al., 2010;Gershon et al., 2013;Infurna et al., 2016a), relatively fewer studies have focused on the role of personality dimensions (e.g., low self-esteem and perfectionism) and how these can contribute to risk for suicidal behavior from adolescence to adulthood (Glassman et al., 2007;Campos and Holden, 2014). ...
Several studies have demonstrated that child maltreatment (psychological, physical, and sexual abuse, and neglect) may be a significant factor in the development of pathological personality traits that increase the risk for suicidal ideation and behavior from adolescence to adulthood. Currently, the challenge is to understand how different forms of early negative experiences render an individual prone to develop specific personality traits and, in turn, be more vulnerable to suicide risk. To understand the relationship between childhood maltreatment and personality dimensions in suicide risk, our study aims to explore the role of self-criticism and dependency, two different pathological personality traits, as potential mediators of the link between different types of childhood maltreatment and suicide risk in young adults.
For this purpose, 306 students from three Italian public universities were recruited. We used the Italian version of the Childhood Experience of Care and Abuse Questionnaire (CECA.Q) to assess experiences of lack of care by parents (i.e., antipathy and neglect) as well as psychological and physical abuse before the age of 17 years. The Depressive Experiences Questionnaire was used to assess the personality dimensions of self-criticism and dependency, and the Suicide History Self-Rating Screening Scale was administered to assess suicide risk.
Results revealed that lack of care and psychological abuse were significantly associated with suicide risk and this association was partially mediated by the maladaptive personality dimension of self-criticism.
These findings suggest that the combined effect of specific forms of dysfunctional parental behavior during childhood and the development of rigid and dysfunctional negative personality traits may increase the risk for suicidal ideation and behavior during adulthood.
... Childhood adversity puts individuals at risk for the development of psychological disorders not only in childhood and adolescence but into adulthood (Green et al., 2010;Nurius, Green, Logan-Greene, & Borja, 2015). More specifically, individuals who have experienced ACEs are at increased risk of depression, anxiety, aggression, suicide risk (Anderson, Tiro, Price, Bender, & Kaslow, 2002;Chapman et al., 2004;Turner, Finkelhor, & Ormrod, 2006), behavioral disorders (McLaughlin et al., 2012), and substance abuse (Mersky, Topitzes, & Reynolds, 2013). ...
Although the association between adverse childhood experiences (ACEs) and adult mental health is becoming well established, less is known about the complex and multiple pathways through which ACEs exert their influence. Growing evidence suggests that adversity early in life conveys not only early impacts, but also augments risk of stress-related life course cascades that continue to undermine health. The present study aims to test pathways of stress proliferation and stress embodiment processes linking ACEs to mental health impairment in adulthood. Data are from the 2011 Behavioral Risk Factor Surveillance Survey, a representative sample of Washington State adults ages 18 and over (N = 14,001). Structural equation modeling allowed for testing of direct and indirect effects from ACEs though low income status, experiences of adversity in adulthood, and social support. The model demonstrated that adult low income, social support and adult adversity are in fact conduits through which ACEs exert their influence on mental health impairment in adulthood. Significant indirect pathways through these variables supported hypotheses that the effect of ACEs is carried through these variables. This is among the first models that demonstrates multiple stress-related life course pathways through which early life adversity compromises adult mental health. Discussion elaborates multiple service system opportunities for intervention in early and later life to interrupt direct and indirect pathways of ACE effects.
... Although some researchers have not found a causal connection between childhood physical abuse and adolescent suicidal ideation (Anderson, Tiro, Price, Bender, & Kaslow, 2002), some international studies have indicated that childhood physical abuse is related to adult suicidal behavior (Glowinski et al., 2001;McHolm, MacMillan, & Jamieson, 2003;Roy, 2003). Childhood physical abuse has been defined as "… the intentional use of physical force against a child that results inor has a high likelihood of resulting inharm for the child's health, survival, development, or dignity. ...
This study examined the relationship between childhood physical abuse and adolescent suicidal ideation in Hong Kong, China. Emotional competence and resilience were investigated as possible moderators of the relationship between physical abuse and suicidal ideation. A cross-sectional survey using convenience sampling was conducted and a total of 268 valid self-administered questionnaires were completed by the participating university students. The results indicate that physical abuse in childhood is significantly associated with greater suicidal ideation among young people at university. Higher levels of emotional competence and resilience are shown to moderate the relationship between physical abuse and suicidal ideation. To decrease Chinese adolescent suicidal ideation arising out of childhood physical abuse, preventative measures are suggested; these involve enhancing adolescents' emotional competence and resilience by providing training for children and young people who are at risk. The results also suggest that there should be programs that encourage adolescents with a history of childhood physical abuse to join training groups to enhance their emotional competence and resilience in the context of Chinese communities.
... For almost two decades, studies have examined the intersection of IPVand suicide across the lifespan. Research shows that individuals who are abused or neglected as children have an increased rate of suicide (Anderson et al. 2002;Dube et al. 2001), and this risk remains true for abuse during adolescence, young adulthood (Chan et al. 2007), and adulthood (Gielen et al. 2005;Golding 1999; Kaslow et al. 2000;Pico-Alfonso et al. 2006). A recent study examined the prevalence and correlates of suicidal threats and attempts among 662 adult female victims of IPV and found that one in five had threatened or attempted suicide during her lifetime (Cavanaugh et al. 2011). ...
Despite evidence of an intersection between suicide risk and intimate partner violence (IPV), crisis hotlines tend to focus on callers at-risk for suicide or callers involved in IPV, but not both. In an effort to begin to address this gap, we developed and conducted an initial pilot test of a suicide prevention curriculum for hotline workers at the National Domestic Violence Hotline (NDVH), highlighting the intersection of these two public health issues. A mixed methods approach was used as a first step to assess the impact of the 3-h suicide prevention training for 42 domestic violence hotline workers. Results showed significant increase in knowledge regarding suicide risk from pre to post-training and a high degree of satisfaction among attendees. Focus groups conducted with hotline workers 3 months after training indicated a greater willingness to engage callers in suicide screening and prevention efforts. A 6-month follow-up focus group with NDVH managers revealed that suicide prevention had become more integrated in the agency culture, a finding that was consistent with an environmental scan of the workplace that showed an increase in displays of suicide prevention information. In sum, suicide prevention training can be feasibly incorporated into domestic violence hotline workers’ roles. Limitations and suggestions for future studies are discussed.
... A review has suggested that sexual abuse may have a larger impact on DSH behavior than other types of maltreatment (Miller, Esposito-Smythers, Weismoore, & Renshaw, 2013). Previous research has also shown an increased risk of DSH associated with experiencing multiple types, versus a single type, of maltreatment (Anderson, Tiro, Price, Bender, & Kaslow, 2002;Brezo et al., 2008;Sansone, Gaither, & Songer, 2002). ...
Adolescents exposed to maltreatment have an elevated risk of deliberate self-harm (DSH). The aim of this study was to investigate longitudinally the effects of the number, timing, and type of maltreatment allegations on adolescent risk of having a DSH-related hospital admission, using linked data in Western Australia. A total of 351,372 children born between 1986 and 2000 were followed from birth up to the year 2010. Cox regression models were utilized, while controlling for a range of psychosocial covariates. Compared to children without allegations of maltreatment, children with unsubstantiated allegations only (aHR = 1.04, 95%CI: 1.00–1.08, p < .01) and children with a substantiated allegation (aHR = 1.10, 95%CI: 1.06–1.15, p < .001) all had significantly increased risk of DSH in adolescence. Among children with a substantiated allegation of maltreatment, the greater the number of allegations, the longer the exposure to maltreatment, and the more types of maltreatment experienced by a child, the higher the child's risk of DSH. However, this dose–response pattern was not found among children with unsubstantiated allegations only. This study calls for the early identification of children who are vulnerable to maltreatment, the better identification of the duration and severity of maltreatment experiences, and the provision of continued care and support, to reduce the child's DSH risk in adolescence.
... In spite of the important role that childhood experience appears to play in later suicide risk, research on gender differences regarding the effects of different adversities is limited and inconclusive. One large study reported an increased rate of suicide attempts in abused women compared to men, although investigators questioned whether the findings reflected higher abuse prevalence in women rather than differential susceptibility to the abuse [66]. However, Isohookane et al. also found that early sexual abuse predicted suicidal behavior among adolescent girls but not boys [67]. ...
... In spite of the important role that childhood experience appears to play in later suicide risk, research on gender differences regarding the effects of different adversities is limited and inconclusive. One large study reported an increased rate of suicide attempts in abused women compared to men, although investigators questioned whether the findings reflected higher abuse prevalence in women rather than differential susceptibility to the abuse [66]. However, Isohookane et al. also found that early sexual abuse predicted suicidal behavior among adolescent girls but not boys [67]. ...
1.1 Objective: Suicide is a leading cause of death, especially for individuals who have a diagnosed mood disorder. There is conflicting evidence regarding factors that may heighten risk for suicide and whether they differ for men and women. The aims of this study were to identify the degree to which gender influences suicide risk among patients with mood disorders, or moderates the effects of other demographic and clinical suicide risk factors. 1.2 Methods: The sample included 268 women and 154 men who were part of a geographically diverse, multi-center registry of the National Network of Depression Centers. Measures of depression, anxiety, childhood adversity, psychiatric diagnosis, living arrangement and employment status were analyzed, along with gender, to determine their association with suicidal risk. 1.3 Results: Multiple regression analysis indicated that men had greater suicide risk than women. In addition, factors that predicted suicide risk differed by gender. Childhood adversity was more strongly associated with suicide risk for women (beta = .22, p < .000) than for men (beta = .04, NS) while anxiety predicted suicide risk for men (beta = .25, p < .000) but not for women (beta = .05, NS). Severity of depression was the primary predictor for both sexes (beta = .79, p < .000). Specific mood diagnosis, living arrangement and employment status did not predict suicide risk. 1.4 Conclusions: Findings indicate the importance of regularly assessing severity of depressive and anxiety symptoms, with attention to anxiety as a key factor that may heighten suicide risk for men. Results suggest a profound role for early cumulative trauma in exacerbating later suicide risk for women, indicating a need to also screen for childhood adversity. Further research is warranted to identify the gender-specific effect of different adversities and types of anxiety in development of suicidal ideation and suicide completion.
... Individuals who feel trapped within an inescapable and abusive relationship (e.g., situations involving domestic violence, marital rape, or child abuse) or who anticipate continued, imminent exposure to traumatic experiences or stimuli may be more likely to act on suicidal ideas. An association has also been observed between the number of previous traumatic events and the likelihood that an individual will attempt suicide (67,68). Thus, a complete assessment of suicide risk should be individualized to the particular circumstances of the patient and should also include an evaluation of the patient's strengths, social support, and motivation to seek help (69)(70)(71). ...
... Dados da literatura confirmam que maior envolvimento religioso se associa a menor taxa de comportamento suicida 37,38 . Entretanto, esses achados não foram confirmados em nossa pesquisa, uma vez que se pesquisou apenas se o paciente tinha uma religião. ...
Objetivo
Considerando o envenenamento como o método mais utilizado para a tentativa de suicídio e a escassez de evidências nacionais sobre o tema, investigamos alguns possíveis indicadores de risco nesse tipo de tentativa.
Métodos
Estudo do tipo caso-controle em uma emergência geral de um hospital público, na cidade do Recife com 220 indivíduos, distribuídos em dois grupos de 110 pacientes cada, que estavam em tratamento, sendo o grupo casos os sobreviventes de tentativa de suicídio por envenenamento e os controles, sem história de intoxicação/envenenamento nem tentativa de suicídio, pareados por gênero e idade.
Resultados
O gênero feminino predominou na amostra (70,9%), com idade média de 29 anos; 73% declararam etnia branca ou morena; menos da metade vivia em convívio marital; a maioria tinha religião; ambos tinham poucos anos de estudo. Houve diferença significativa (p = 0,003) para dependência financeira entre os grupos, com chance 2,25 vezes maior para tentar suicídio entre os casos. Ter sofrido fatos traumáticos e abuso sexual na infância revelou diferença significativa.
Conclusões
Foram considerados indicadores de risco no grupo caso: estar em dependência financeira de terceiros, ter sofrido abuso sexual na infância, ideação suicida, histórico de transtorno mental na família, possuir algum transtorno mental e, principalmente, comorbidade(s) psiquiátrica(s). No modelo de regressão, foi possível estimar uma chance de tentativa de suicídio por envenenamento de até 94,0% na presença conjunta de quatro fatores. A pesquisa representa uma das primeiras iniciativas para ampliação das discussões sobre os fatores de risco para tentativa de suicídio em âmbito nacional.
... Consistent with previous reports (O'Neill et al., 2014 ) conflict exposures independently predicted a broad range of psychiatric diagnoses and suicidality , even while controlling for exposures to childhood maltreatment and parental maladjustment. Additionally, and consistent with previous research (Anderson et al., 2002 ), the cumulative effects of co-occurring maltreatment and parental maladjustment categories predicted very high risks for psychiatric diagnoses and suicidality. ...
There has been a rise in suicide rates among men who grew up during the 1970's in Northern Ireland (NI). Conflict exposures (CEs) have been linked with suicide ideation but not attempts. Civil conflict has also been linked with aggressive parenting which is associated with the development of aggressive drives, psychopathology and suicidality. This study investigated (1) cohort specific associations between latent classes (LCs) of maltreatment and (2) associations between LCs, CEs, psychopathology and suicidality. Data were from NI Study of Health and Stress (N = 1986). Maltreatment and suicidality were queried using validated measures. Psychiatric assessments were based on DSM-IV criteria. Logistic regression, latent class analysis, chi square tests and mediation analyses were conducted. Two at risk LCs were identified, entitled "family violence exposure" (FVE, 10.4%; Male, 55.4%) and "family violence and sexual abuse exposure" (FVSAE, 1.2%; Female, 90.5%). Both were more likely to have experienced CEs (FVE = 71%; FVSAE = 77.5%) than the low risk class. The FVE were more likely to be male; aged 35-49 and to suffer from a mental disorder. The FVSAE class all endorsed rape, were more likely to be separated and to suffer from a mental disorder. CEs uniquely predicted ideation but not enactment. Psychopathology partially mediated the relationship between LCs and suicidality. FVE and FVSAE directly increased the odds of enactment. These findings are original and highly pertinent and they should be used to inform any strategy for addressing the cohort specific and trauma related rise in suicide rates in NI.
... Answers were categorized separately for each item as yes if the adolescent answered having experienced the event during or before age 12 (coded 1 if the life event occurred and 0 if not, and then summed). Considering that the effect of childhood adversity on mental health may not be linear, we dichotomized childhood adversity as yes if the participant had more than one type of event, and no if the participant had none or just one type of event [45,46]. ...
Childhood adversity contributes to depressive symptoms in adolescence, but far less research has focused on an Asian context. This study aims to identify the long-term impact of childhood adversity on adolescents' depressive symptoms and whether this association is moderated by gender and early pubertal timing in Taiwan. Data in this study are from the Taiwan Education Panel Survey, a longitudinal study that surveyed and followed 4261 junior high school students in year 2001 (at age 13) and three more waves (at ages 15, 17, and 18). Conditional latent growth model results show that having adversity is positively associated with the intercept, but negatively associated with the linear trend of changes of depressive symptoms in adolescence (p < .01). Early pubertal timing is only positively associated with baseline levels for boys (p < .01). Both adversity and early pubertal timing contributes to depressive symptoms when adolescents start junior high school.
... Child abuse specifically is a strong risk factor for suicidality among all age groups with 9% to 20% of adult suicide attempts being linked to childhood sexual abuse (Goldsmith et al., 2002). Anderson, Tiro, Price, Bender and Kaslow (2002) found that pre ted t ses of vious abuse was positively correlated with suicide attempts, whether it was emotional (U rU = .34, U pU < .0001), ...
... Findings from population-based studies indicate that childhood adversity is common and associated with development of psychological disorders not only in childhood but in adolescence and adulthood (Green et al., 2010;Kessler, Davis, & Kendler, 1997;McLaughlin et al., 2012). More specifically, adverse childhood experiences (ACEs) have demonstrated increased risk of depression, anxiety, aggression, suicide risk (Anderson, Tiro, Price, Bender, & Kaslow, 2002;Chapman et al., 2004;Turner, Finkelhor, & Ormrod, 2006), personality disorders (Afifi et al., 2010), behavior disorders (McLaughlin et al., 2012), and substance abuse (Mersky, Topitzes, & Reynolds, 2013;Turner & Butler, 2003). Children exposed to adverse psychosocial experiences demonstrate elevated risk for depression in addition to high inflammation levels and clustering of metabolic risk markers reflecting multiple biological system dysregulations, with the effects of these adversities being nonredundant, cumulative, and independent of developmental contributors (Danese et al., 2009). ...
Growing evidence suggests that toxic stressors early in life not only convey developmental impacts but also augment risk of proliferating chains of additional stressors that can overwhelm individual coping and undermine recovery and health. Examining trauma within a life course stress process perspective, we posit that early childhood adversity carries a unique capacity to impair adult psychological well-being both independent of and cumulative with other contributors, including social disadvantage and stressful adult experiences. This study uses data from a representative population-based health survey (N=13,593) to provide one of the first multivariate assessments of unique, cumulative, and moderated effects of adverse childhood experiences (ACEs) toward explaining 3 related yet distinct measures of adult mental health: perceived well-being, psychological distress, and impaired daily activities. Results demonstrate support for each set of hypothesized associations, including exacerbation and amelioration of ACEs effects by adult stress and resilience resources, respectively. Implications for services and future research are discussed.
Copyright © 2015 Elsevier Ltd. All rights reserved.
... Mental health disorders are frequently reported risk factors for suicide in both civilian and military populations. 2,7,[10][11][12][13][14] Other risk factors identified in the suicide literature include marital status and partner relationship problems, [15][16][17][18] history of childhood trauma and sexual abuse, 19,20 and access to firearms. [21][22][23] Military-specific risk factors, such as deployment history, have found less support in the literature. ...
Identification of risk and protective factors for suicide is a priority for the United States military, especially in light of the recent steady increase in military suicide rates. The Department of Defense Suicide Event Report contains comprehensive data on suicides for active duty military personnel, but no analogous control data is available to permit identification of factors that differentially determine suicide risk. This proof-of-concept study was conducted to determine the feasibility of collecting such control data. The study employed a prospective case-control design in which control cases were randomly selected from a large Army installation at a rate of four control participants for every qualifying Army suicide. Although 111 Army suicides were confirmed during the study period, just 27 control soldiers completed the study. Despite the small control sample, preliminary analyses comparing suicide cases to controls identified several factors more frequently reported for suicide cases, including recent failed intimate relationships, outpatient mental health history, mood disorder diagnosis, substance abuse history, and prior self-injury. No deployment-related risk factors were found. These data are consistent with existing literature and form a foundation for larger control studies. Methodological lessons learned regarding study design and recruitment are discussed to inform future studies.
... There are reasons to study the childhood emotional abuse-hopelessness link in African American women who have experienced IPV and suicidal behavior in the past year. Women exposed to interpersonal violence during childhood are at high risk for both re-victimization (e.g., IPV, rape) (Whitfield, Anda, Dube, & Felitti, 2003) and a range of mental disorders in adulthood (Norman et al., 2012), findings also true in African Americans (Anderson, Tiro, Price, Bender, & Kaslow, 2002;Patel, Bhaju, Thompson, & Kaslow, 2012). Further, hopelessness mediates the childhood maltreatment-suicide attempt link in low-income African American women with histories of IPV (Meadows & Kaslow, 2002). ...
Although there is an association between experiencing childhood emotional abuse and feeling hopeless as an adult, it is critical to understand the factors that may be protective in this relationship. The goal of this study was to determine if two protective factors, namely spiritual well-being, including both religious and existential well-being, and positive self-esteem, served to mediate the association between childhood emotional abuse and adult hopelessness. The sample for this investigation was low-income African American women suicide attempters who were abused by a partner in the prior year (N=121). A path analysis revealed that in this sample, the childhood emotional abuse-hopelessness link was mediated by existential well-being and positive self-esteem, as well as by the two-mediator path of emotional abuse on existential well-being on self-esteem on hopelessness. Results suggested that existential well-being may be a more salient protective factor for hopelessness than religious well-being among abused, suicidal African American women who experienced childhood emotional abuse. Findings highlight the value of culturally relevant strategies for enhancing existential well-being and self-esteem in this at-risk population to reduce their vulnerability to feelings of hopelessness.
... Moderate to severe maltreatment cut off scores are as follows: emotional abuse = 13, Physical abuse = 10, Sexual abuse = 8, Emotional neglect = 15, and Physical neglect = 10. The dichotomous scores were summed to create a cumulative maltreatment variable, with 0 = no to mild maltreatment, 1 = one type of moderate to severe maltreatment, and 2 = two or more types of moderate to severe maltreatment (see Anderson, Tiro, Webb Price, Bender, & Kaslow, 2002;Goldstein et al., 2010). ...
It is well established that childhood maltreatment is an important predictor of marijuana use, but few studies have examined the mechanisms underlying this relationship. The current study examines marijuana motives as mediators of the relationship between childhood maltreatment and marijuana use in a sample of young adults. In addition, pathways from childhood maltreatment to emotion dysregulation, coping motives, and marijuana use were explored. Participants were 125 young adults (ages 19-25, 66.9% female) recruited through online community advertising. All participants completed questionnaires assessing childhood maltreatment, emotion dysregulation, marijuana motives, past year and past three-month marijuana use, and marijuana problems. Correlational analyses revealed bivariate relationships between childhood maltreatment, emotion dysregulation, marijuana motives and marijuana problems (rs=.24-.50). Mediation analyses revealed that coping motives mediated the relationship between childhood maltreatment and marijuana problems, and emotion dysregulation was associated with marijuana problems both directly and indirectly via coping motives. The present findings highlight emotion dysregulation and coping motives as important underlying mechanisms in the relationship between childhood maltreatment and marijuana problems.
Abuse and neglect can lead to suicide in adolescents; however, the internal mechanisms between abuse and neglect and suicidality remain unclear. We hypothesized that abuse and neglect could affect adolescent suicidality, and that mediating and moderating mechanisms exist between these two variables. We tested the mediating effects of stressful life events (misunderstanding and discrimination by others, poor academic performance, failed exams, interpersonal problems, and school punishment) on suicidal tendencies and moderating effects of resilience among 5,852 adolescents from 37 middle schools in five provinces of North, south, East, west, and central China. We used a questionnaire to collect data and adopted structural equation modeling to verify the correlation, mediating, and moderating effects among the variables. The results showed that stressful life events mediated the relationship between abuse, neglect, and suicide. Furthermore, resilience moderated the direct effect and second half of the mediating effect.
The present study investigated the effects of childhood physical neglect (CPN), childhood physical abuse (CPA), and the moderator role of perceived resilience on adult life satisfaction (LS). The National Longitudinal Study of Adolescent Health public-use Wave 3 dataset were used, which included a nationally representative sample (N = 4,397) whose ages ranged from 21 to 28 (M = 21.83, SD = 1.81). The factor structure of the perceived resilience scale was examined using exploratory and confirmatory factor analysis. Ordinal logistic regression (OLR) analysis was used for data analysis, and McFadden's Pseudo R-squares were reported to compare the OLR models. Age, gender, and education were controlled in the study. The results showed that CPA and CPN had a negative direct effect on adult LS. Although the effect of resilience on adult LS was found highly significant in this study, the moderator role of resilience was not found significant. Gender differences were found in adult LS when perceived resilience was taken into account. These findings suggest that childhood adversity is a critical factor in adult LS. Future studies should focus on protective factors, strategies for establishing, building, reinforcing resilience, and gender dynamics in childhood adversities and well-being.
A consequence of a growing incarceration rate is that an increasing number of children face having an incarcerated household member, a known contributor to diverse lifelong behavioral health risks such as substance use and mental health impairment. Few studies have
explored how household incarceration uniquely contributes to these
subsequent behavioral health concerns, nor mediational contributors to these associations, within a theoretical framework. Using state Behavioral Risk Factor Surveillance System survey data (n=14,001), this study tests pathways of household incarceration and Adverse Childhood Experiences (ACEs) to mental health impairment and substance use in adulthood. Within a life course stress process perspective, this study uses structural equation modeling to examine mediational pathways through adulthood incarceration and indicators of adulthood adversity, low income, and supportive resources. In line with stress process theorizing, results indicate significant
direct and indirect paths of ACEs through nearly all theorized mediators, and indirect pathways of household incarceration, through incarceration and low income, to adulthood mental health impairment and substance use. Implications of these findings address preventive and interventive leverage points to mitigate long-term consequences of household incarceration and other childhood adversities.
Research indicates that African American women experience especially high rates of intimate partner violence (IPV). Unique contributing factors, such as experiences of racism, compound the experience of IPV for African American women. This complex web of victimization is associated with a host of significant mental and physical health consequences, social and economic consequences, and increased engagement in high-risk behaviors for these women. African American women’s help-seeking efforts are hindered by a diverse set of circumstances. In addition, the picture of the African American community has changed significantly in recent decades. The growing diversity of the “African American” community in the U.S. implores us to enhance our understanding of the unique sub-populations of Black women in America (African Americans, African immigrants and refugees, African Caribbean immigrants, African American lesbian, bisexual, and transgender women) to better meet their needs, and ultimately reduce IPV within the African American community. Despite over two decades of growth in the research and literature on IPV in the African American community, many sub-populations remain neglected. This paper aims to present a brief overview of the current state of the literature regarding the experience of IPV for African American female survivors and identify areas for further research.
This comprehensive systematic review and meta-analysis aimed to quantify the association between different types of childhood maltreatment and suicidality. We searched five bibliographic databases, including Medline, PsychINFO, Embase, Web of Science and CINAHL, until January 2018. Random-effects meta-analysis was employed followed by univariable and multivariable meta-regressions. Heterogeneity was quantified using the I2 statistic and formal publication bias tests were undertaken. The methodological quality of the studies was critically appraised and accounted in the meta-regression analyses. Data from sixty-eight studies based on n = 261.660 adults were pooled. All different types of childhood maltreatment including sexual abuse (OR = 3.17, 95% CI = 2.76 to 3.64), physical abuse (OR = 2.52, 95% CI = 2.09 to 3.04) and emotional abuse (OR = 2.49, 95% CI = 1.64 to 3.77) were associated with 2 to 3-fold increased risk for suicide attempts. Similar results were found for the association between childhood maltreatment and suicidal ideation. Complex childhood abuse was associated with a particularly high risk for suicide attempts in adults (OR= 5.18, 95% CI = 2.52 to 10.63). Variations across the studies in terms of demographic and clinical characteristics of the participants and other core methodological factors did not affect the findings of the main analyses. We conclude that there is solid evidence that childhood maltreatment is associated with increased odds for suicidality in adults. The main outstanding challenge is to better understand the mechanisms which underpin the development of suicidality in people exposed to childhood maltreatment because current evidence is scarce.
Conversing about suicide with an at-risk individual can be enough to save a life. Given the rise of suicidal behavior among African American subgroups (i.e., youth and male), advocates are urging blacks to have candid conversations about the issue. The current study highlights black women’s experiences discussing suicide. Findings suggest that widespread beliefs that suicide is an insignificant issue among blacks make conversing about suicide especially challenging. These findings reveal problematic implications for African Americans contemplating suicide in their communities. Suicide may be a phenomenon for which communal support is less prevalent.
There is evidence that individuals emotionally abused as children endorse more hopelessness, a precursor of suicidal behavior in adulthood. However, there has been little focus on this association among African-Americans or on factors that may mediate the childhood emotional abuse (CEA) - adult hopelessness link. The present study examined whether CEA is linked to hopelessness in adulthood in African-American women suicide attempters and if adult self and other attachment models mediate this association. Participants included 116 African-American women recruited from a large, urban hospital. Results revealed that CEA had no direct effect on hopelessness in adulthood, but did have an indirect effect on hopelessness through attachment models. Bootstrapping analyses showed that higher levels of CEA were related to more negative self and other attachment models, which were then linked to higher levels of hopelessness. Implications for targeting attachment in suicide intervention programs are discussed.
Suicide is a leading cause of morbidity and mortality among women. Childhood sexual abuse (CSA) and intimate partner violence are significant risk factors for suicidal ideation among women. The purpose of this study was to examine the interrelationships among these three constructs and test if intimate partner sexual coercion may explain the CSA–suicidal ideation link. African American women (N = 141) completed an assessment of childhood trauma, intimate partner sexual coercion, and suicide ideation. A significant positive correlation was found between CSA and sexual coercion, between CSA and suicidal ideation, and between sexual coercion and suicidal ideation. Also, intimate partner sexual coercion was found to mediate the relationship between CSA and suicidal ideation when controlling for covariates such as spiritual well-being, self-esteem, and barriers to services. The association between CSA and suicidal ideation may be explained by sexual revictimization in the context of an intimate relationship among African American women. Clinically, practitioners should engage in regular screening for suicide ideation among African American women who have experienced CSA and intimate partner sexual coercion.
The aim of the current study was to investigate the contributions of sad childhood experiences, depression, anxiety, and stress, existence of a sense of meaning, and pursuit of meaning in explaining life satisfaction of young adults in Turkey. The sample comprised 400 undergraduate students (M age = 20.2 yr.) selected via random cluster sampling. There were no statistically significant differences between men and women in terms of their scores on depression, existence of meaning, pursuit of meaning, and life satisfaction scores. However, there were statistically significant differences between men and women on the sad childhood experiences, anxiety and stress. In heirarchical regression analysis, the model as a whole was significant. Depression and existence of meaning in life made unique significant contributions to the variance in satisfaction in life. Students with lower depression and with a sense of meaning in life tended to be more satisfied with life.
The Oxford Texbook of Suicidology is the most comprehensive work on suicidology and suicide prevention that has ever been published.
This chapter examines suicide and suicidal behaviors among African American adolescent and young adult males. It shows that the odds for suicide were highest for African American males, even after controlling for the numerous clinical, geographic, and sociodemographic vulnerability factors associated with suicide. This finding supports previous risk factor studies and epidemiological research that illustrated a rise in suicide among African Americans, particularly the younger age groups. Consistent with prior analysis of suicidal behavior, the analyses reveal that African Americans are more likely to die at younger ages of suicide. The study also confirmed prior research showing that having a gun in the home substantially increases the risk for suicide. This is particularly true for males, as illustrated by the almost fourfold increase in the risk of suicide when a gun is known to be in the home.
This study examined if attachment patterns mediated the link between childhood maltreatment and total daily and interpersonally oriented life hassles in 135 low-income, inner-city, suicidal African American women. Participants completed self-report measures of childhood maltreatment, attachment styles, and daily life hassles dimensions. Bootstrapping analyses revealed that (a) negative views of self mediated the relationship between childhood maltreatment and social and cultural difficulties and social acceptability; and (b) negative views of other mediated the relationship between childhood maltreatment and total daily life hassles, social victimization, and social and cultural difficulties. These findings can inform interventions for suicidal African American women with a history of childhood maltreatment and subsequent maladaptive attachment styles.
This study examined differences in suicidal behavior between lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) and non-LGBTQ university students as well as investigated the importance of risk and protective factors in the prediction of suicidality between these two groups. A total of 1,205 university students participated in the survey. Findings show, compared to non-LGBTQ respondents, sexual minority youth are at a greater risk for serious suicidal ideation (8.9% versus 23%, respectively) and suicide attempt (3.5% versus 26.2%). Among LGBTQ respondents, significant risk covariates for suicidality were depressive symptoms, socioeconomic status, being bullied, age, and childhood trauma. The only significant protective factor was self-esteem.
Divorce is considered to be a significant life stressor, and yet little is known about how early life experiences predict adjustment to marital dissolution in adulthood. Using a sample of 99 recently-separated adults, we examine whether adults' selfreported history of traumatic experiences is associated with increased psychological distress and self-blame following divorce as well as linguistic indices of self-focus while discussing the divorce experience (more first person pronouns). We also evaluate whether among individuals with greater trauma histories, selffocused processing of the divorce experience prospectively predicts increase in psychological distress over 7.5 months. Participants reported on their trauma history and provided four minute speech samples regarding the divorce. At intake and 7.5 months later they reported on the psychological impact of the divorce. Results indicated that adults with greater trauma histories report more psychological distress at Time 1, more self-blame regarding the divorce, and more distress in response to discussing the divorce experience. Further, self-blame mediates the association between trauma history and the psychological impact of the divorce. Among adults with greater trauma histories, greater use of first person singular pronouns when discussing the divorce prospectively predicted increases in psychological distress. Findings are discussed in terms of their contribution to the literature on divorce and trauma.
Introduction: Suicide is one of the important social and mental health problems in many countries and
considerable resources are devoted to health care. The purpose of this study was to investigate the
demographic features of more than thousand cases of attempted suicide in Semnan province
Materials and Methods: In this cross sectional study in 2008-2009, we collected data from cases referred
to public hospitals and forensic medicine offices of Semnan province, using researcher made checklists,
included demographic data and factors associated with suicide.
Results: Among 1217 cases of suicide attempts occurred in Semnan province, 768 cases (63.1%) were
female and the rest were male. The mean age±SD of participants was 24.6±8.4. 599 cases (49.2%) were
single. There was a significant relationship between gender and marital status (p<0.001) in a way that most
of the male cases were single (60.8%) and most females were married (56.1%). The most common methods
of suicide was drug toxicity (83.98%) and poison or opium overdose (7.1%). Totally, 1.6% of suicide
attempts led to death which was significantly higher in men than in women (p<0.001).
Conclusion: Since drug poisoning is the most common method of suicide, officials should ensure that
drugs are offered only on prescriptions and physicians should avoid prescribing excessive drugs. Trying to
identify high risk groups, providing education requirements, planning for employment and reducing the
economic problems in young age group, is suggested.
This paper reviews the literature on African-American women’s suicide rates. This topic is often neglected due to African-American women’s low rates of suicide occurrence. This review seeks to answer the call for increased scientific inquiry on matters related to African-American women and suicide. The author begins by identifying complex dynamics surrounding African-American women’s unique social position in order to establish a better understanding of how socio-cultural influences are addressed in the literature in relation to the suicide paradox. Both theoretical and empirical studies are thoroughly assessed in order to identify the risk and protective factors exclusive to African-American women. The literature concludes that a history of mental disorders, particularly depression, a history of physical and emotional abuse, and a history of alcohol and substance abuse have all proven significant in increasing the risk of suicidal behavior among African-American women. Untreated depression continues to be the leading cause of suicide among African-American women. Contrarily, the literature identifies religious/spiritual beliefs, strong social ties, low rates of suicide acceptability, and unique coping strategies developed as a result of longstanding oppressive conditions as primary reasons for African-American women’s exceptionally low suicide rates.
Male violence is an enduring feature of women's lives from childhood through old age. The review covers child sexual abuse, rape, and partner violence with emphasis on the prevalence of violence, its mental health consequences, the course of recovery, and mediators and moderators of traumatic impact. The primary focus is depression and posttraumatic stress disorder, the two major diagnostic entities through which postassault emotions and behaviors have been conceptualized and measured. The effects of psychiatric conceptualizations of victimization and patterns of individual recovery are critically reviewed. The PTSD paradigm as the sole foundation for most victimization research is also debated. Following the review, mental health services for victimized women are examined. The article concludes with public policy recommendations to improve the availability and accessibility of mental health services with emphasis on reaching those survivors who are less likely to consult the formal system.
The independent and combined roles of childhood maltreatment (physical abuse, sexual abuse, emotional abuse, emotional neglect, and physical neglect) and current post-traumatic stress disorder (PTSD) were examined in predicting nonfatal suicide attempts among 335 African American women. It was hypothesized that suicide attempters (n = 157) would evidence higher rates of all forms of childhood maltreatment and higher rates of current PTSD than controls (n = 178). The authors predicted that women with both current PTSD and a lifetime history of child maltreatment would be at greatest risk for making a nonfatal suicide attempt. Results revealed that current PTSD and all five forms of childhood maltreatment were independently related to risk for suicide attempts. PTSD in combination with any of the five forms of childhood maltreatment increased a woman's risk for making a nonfatal suicide attempt. This suggests interventions designed to reduce suicidal behavior should focus on women with PTSD and a history of child maltreatment.
To determine the prevalence of childhood physical or sexual abuse in women seen in primary care practices; to identify physical and psychologic problems associated with that abuse; and to compare the effects of childhood physical vs sexual abuse and childhood vs adult abuse.
Cross-sectional, self-administered, anonymous survey.
Four community-based, primary care internal medicine practices.
A total of 1931 women of varied age and marital, educational, and economic status examined from February through July 1993.
Prevalence of physical and sexual abuse, physical symptoms, psychological symptoms (Symptom Checklist-22), alcohol abuse (CAGE questions), and street drug use.
Of the 1931 respondents, 424 (22.0%) reported childhood or adolescent physical or sexual abuse. Compared with women who reported never having experienced abuse (n=1257), women who reported abuse as children but not adults (n=204) had more physical symptoms (mean+/-SE, 6.2+/-0.2 vs 4.0+/-0.9; P<.001) and had higher scores for depression, anxiety, somatization, and interpersonal sensitivity (low self-esteem) (P<.001); were more likely to be abusing drugs (prevalence ratio [PR], 4.7; 95% confidence interval [CI], 2.9-7.6) or to have a history of alcohol abuse (PR, 2.2; 95% CI, 1.5-3.2); were more likely to have attempted suicide (PR, 3.7; 95% CI, 2.6-5.1); and were more likely to have had a psychiatric admission (PR, 3.2; 95% CI, 2.2-4.7). Women abused only as children did not differ from women who reported current, but not childhood, abuse in number of physical symptoms, emotional distress, substance abuse, or suicide attempts. Patients who reported both childhood and adult abuse had higher levels of psychological problems and physical symptoms than those who reported childhood or adult abuse alone.
Childhood physical or sexual abuse is associated with adult health problems including physical symptoms, psychological problems, and substance abuse; for many variables, this association is as strong as for patients experiencing current abuse.
Objective.
—To determine the ability of patients to complete successfully basic reading and numeracy tasks required to function adequately in the health care setting.Design.
—Cross-sectional survey.Setting.
—Two urban, public hospitals.Patients.
—A total of 2659 predominantly indigent and minority patients, 1892 English-speaking and 767 Spanish-speaking, presenting for acute care.Main Outcome Measure.
—Functional health literacy as measured by the Test of Functional Health Literacy in Adults (TOFHLA), an instrument that measures ability to read and understand medical instructions and health care information presented in prose passages and passages containing numerical information (eg, prescription bottle labels and appointment slips).Results.
—A high proportion of patients were unable to read and understand written basic medical instructions. Of 2659 patients, 1106 (41.6%) were unable to comprehend directions for taking medication on an empty stomach, 691 (26%) were unable to understand information regarding when a next appointment is scheduled, and 1582 (59.5%) could not understand a standard informed consent document. A total of 665 (35.1%) of 1892 English-speaking patients and 473 (61.7%) of 767 Spanish-speaking patients had inadequate or marginal functional health literacy. The prevalence of inadequate or marginal functional health literacy among the elderly (age ≥60 years) was 81.3% (187/230) for English-speaking patients and 82.6% (57/69) for Spanish-speaking patients, and was significantly higher (P<.001) than in younger patients.Conclusions.
—Many patients at our institutions cannot perform the basic reading tasks required to function in the health care environment. Inadequate health literacy may be an important barrier to patients' understanding of their diagnoses and treatments, and to receiving high-quality care.(JAMA. 1995;274:1677-1682)
Objectives.
—To determine the prevalence of childhood physical or sexual abuse in women seen in primary care practices; to identify physical and psychologic problems associated with that abuse; and to compare the effects of childhood physical vs sexual abuse and childhood vs adult abuse.
Findings from a study comparing partner abuse in African American women suicide attempters (
n = 148) and nonattempters (
n = 137) revealed higher rates of physical and nonphysical partner abuse among attempters than their demographically similar nonsuicidal counterparts. The partner abuse–suicidal behavior link was mediated by psychological distress, hopelessness, and drug use and moderated by social support. Results also revealed that nonphysical partner abuse accounted for unique variance in the prediction of suicide attempt status beyond that attributable to childhood maltreatment. Implications of the findings for assessing both suicidal and abused women are discussed, and recommendations for preventive interventions for women at risk for suicidal behavior are provided. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Topics include: the legacy of chronic traumatization; silent cries: parasuicidal behavior (meanings of self-harming behavior, therapeutic responses to self-harming behavior); suicide intervention with severely traumatized patients (assessing ambivalence concerning suicide, using safety contracts, coping with suicidal impulses, managing crises with suicidal patients); countertransference responses to suicidal trauma patients (overidentification, anger); trauma-related comorbidity and suicide risk; psychopharmacology for trauma-related disorders; and implications for the clinician. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Since Browne and Finkelhor's (1986) seminal review of the impact of child sexual abuse, there has been a dramatic increase in the child sexual abuse literature. Because of this tremendous growth in the literature, a more current review is warranted. The focus of this paper is a review of the long-term correlates of child sexual abuse published since 1987. Sexually abused subjects report higher levels of general psychological distress and higher rates of both major psychological disorders and personality disorders than nonabused subjects. In addition, child sexual abuse survivors report higher rates of substance abuse, binge eating, somatization, and suicidal behaviors than nonabused subjects. Adult survivors of child sexual abuse report poorer social and interpersonal relationship functioning, greater sexual dissatisfaction, dysfunction and maladjustment including high-risk sexual behavior, and a greater tendency toward revictimization through adult sexual assault and physical partner violence. The long-term correlates of child sexual abuse are conceptualized within a theoretical framework based on a theory of emotional avoidance. Although more recent empirical findings have demonstrated improved designs and methodology, these studies continue to be limited in their generalizability. Recommendations for future research are discussed.
The accuracy of suicide statistics was assessed by comparing published Health Department suicide rates for an area of New York City with Medical Examiner records. For the period 1968--1979, records from the Medical Examiner's Office were searched to determine all deaths classified as definite suicides. Another group of deaths was considered suicide by the Medical Examiner but never classified as such. These deaths we labeled "assigned suicides." When definite suicides were compared with all deaths considered suicide by the Medical Examiner (definite and assigned suicides), black suicide was underestimated by 80 per cent and white suicide by 42 per cent. Underestimation was the same for males and females but varied by age group. In 1968, when the seventh revision of the International Classification of Deaths (ICD) was used, Health Department suicide rates for blacks were almost identical to Medical Examiner rates, while white rates were underestimated by 25 per cent. In 1969--1970, when the eighth revision was used, Health Department statistics underestimated black suicides by 82 per cent and white suicides by 66 per cent. Reasons for the underestimations were related to the methods used in committing suicide by the two ethnic groups and to the ways that suicide classification has changed from the seventh to eighth revision. Implications for research using official death certificate reports are discussed.
Methods of coping with childhood sexual abuse were retrospectively studied in a community sample of 54 adult women who had been sexually abused in childhood. From the time the abuse ended until the present, "denial" and "emotional suppression" were the coping methods most commonly employed of the nine methods measured. One purpose of this study was to determine if the methods used to cope with the aftermath of being sexually abused during childhood were associated with current psychological adjustment beyond what could be predicted by the characteristics of the abusive experience per se. A partial correlation analysis and a multiple regression analysis suggested that avoidant/emotion suppressing coping strategies although frequently used and rated by subjects as helpful, were in fact associated with poorer adult psychological adjustment.
The authors intensively studied 207 patients hospitalized because of suicidal ideation, but not for recent suicide attempts, at the time of admission. During a follow-up period of 5-10 years, 14 patients committed suicide. Of all the data collected at the time of hospitalization, only the Hopelessness Scale and the pessimism item of the Beck Depression Inventory predicted the eventual suicides. A score of 10 or more on the Hopelessness Scale correctly identified 91% of the eventual suicides. Taken in conjunction with previous studies showing the relationship between hopelessness and suicidal intent, these findings indicate the importance of degree of hopelessness as an indicator of long-term suicidal risk in hospitalized depressed patients.
The authors investigated the association between sexual abuse in childhood and subsequent incidents of deliberate self-harm in women.
A random community sample of women (N = 252) that reported having been sexually abused as children was interviewed and compared to a similarly sized group (N = 225) that did not report abuse. The subgroup of women sexually abused as children who reported subsequent incidents of deliberate self-harm was then contrasted with abused women who did not report self-harm.
There was a clear statistical association between sexual abuse in childhood and self-harm that was most marked in those subjected to more intrusive and more frequent abuse. Self-harm was also associated with major interpersonal problems in the subject's family of origin and with becoming involved in further abusive relationships as an adult.
Sexual abuse in childhood is associated with later incidents of deliberate self-harm and may well be an etiologic factor in its development.
This report presents initial findings on the reliability and validity of a new retrospective measure of child abuse and neglect, the Childhood Trauma Questionnaire.
Two hundred eighty-six drug- or alcohol-dependent patients were given the Childhood Trauma Questionnaire as part of a larger test battery, and 40 of these patients were given the questionnaire again after an interval of 2 to 6 months. Sixty-eight of the patients were also given a structured interview for child abuse and neglect, the Childhood Trauma Interview, that was developed by the authors.
Principal-components analysis of responses on the Childhood Trauma Questionnaire yielded four rotated orthogonal factors: physical and emotional abuse, emotional neglect, sexual abuse, and physical neglect. Cronbach's alpha for the factors ranged from 0.79 to 0.94, indicating high internal consistency. The Childhood Trauma Questionnaire also demonstrated good test-retest reliability over a 2- to 6-month interval (intraclass correlation = 0.88), as well as convergence with the Childhood Trauma Interview, indicating that patients' reports of child abuse and neglect based on the Childhood Trauma Questionnaire were highly stable, both over time and across type of instruments.
These findings provide strong initial support for the reliability and validity of the Childhood Trauma Questionnaire.
To describe the prevalence of childhood physical, sexual, and emotional abuse and suicide attempts in a sample of adult patients from a primary care setting and to examine the relationship between suicide attempts and a self-reported history of childhood abuse.
Cross-sectional sampling via a self-administered survey that included an abuse questionnaire, the Inventory to Diagnose Depression, and questions regarding suicide.
University medical center family medicine practice.
A convenience sample of patients aged 18 years and older presenting for care. Of the 778 patients approached, 448 patients (58%) consented and returned their surveys. We report only on the 292 surveys (38%) returned with complete information. Subjects were predominantly middle class and white, with a mean age of 37 years.
Forty-four percent of the patients reported experience of childhood abuse, and 22% reported multiple forms of abuse. Eighteen percent of abused vs 3% of nonabused patients (P = .00001) reported a history of suicide attempts. Being female, younger, and less educated were associated with any abuse. Females reported more sexual abuse; less educated patients, more physical abuse; and younger patients, more physical and sexual abuse and suicide attempts. Odds ratios for suicide attempts, when adjusted by abuse status, were 6.4 for any abuse (95% confidence intervals [CI], 2.4 to 17.6), 4.1 for sexual abuse (95% CI, 1.7 to 9.9), 3.7 for emotional abuse (95% CI, 1.4 to 10.0), and 1.2 for physical abuse (95% CI, 0.5 to 3.1).
A history of childhood abuse was a common experience in this sample. Patients with a history of abuse, particularly sexual and emotional abuse, are at increased risk of suicidal behavior. To facilitate more appropriate care and treatment, primary care practitioners should question patients regarding a history of abuse.
The long-term health effects of physical, sexual, and emotional abuse during childhood were studied in a sample of 668 middle class females in a gynecologic practice who responded to a self-administered, anonymous questionnaire covering demographic information, family history, physical and psychological health, as well as stressful events and abusive experiences as a child. Half (53%) of the sample reported childhood abuse, with 28.9% recounting exposure to one type of abuse, 18.7% to two types of abuse, and 5.4% to all three types of abuse. In comparison to women not abused during childhood, the abused reported significantly more hospitalizations for illnesses, a greater number of physical and psychological problems, and lower ratings of their overall health. The greater the number of childhood abuses, the poorer one's adult health and the more likely one was to have experienced abuse as an adult. Thus, in addition to the deleterious psychological consequences of abuse described in the literature, physical health also appears to be adversely affected in women abused as children.
Many researchers have claimed that the study of suicide and the formation of public policy are not undermined by the misclassification of suicide as other causes of death. We evaluated this claim using a new technique and causes of death not previously considered. We examined computerized California death certificates, 1966-1990. Mortality peaks at symbolic ages are a characteristic feature of suicide. We sought such peaks in (1) causes of death commonly suspected of containing misclassified suicides (e.g., accidental barbiturate poisoning), (2) causes of death not hitherto suspected (e.g., pedestrian deaths), and (3) control groups. The first two categories displayed peaks at symbolic ages, but control groups did not. The size of the peak, indicative of misclassified suicides, varied markedly by race (p < .0001) and sex (p < .0001). Misclassification is evident for all time periods examined, large and small counties, and each race and sex. The maximum misclassification occurs for Blacks (14.92% of officially recorded suicides). We conclude that suicides are misallocated to at least five other causes of death (two of which have not been previously considered in the literature) and are most likely to be underreported for groups with low official suicide rates, that is, Blacks and females. Consequently, Blacks and females are not as protected from suicide as was previously supposed. It may be inadvisable to use official suicide data to test scientific hypotheses about suicide, unless the effects of underreporting are estimated and, if necessary, corrected for.
The primary purpose of this review is to highlight the progress made in the area of child sexual abuse during the recent decade and to identify the gaps in our current knowledge about this syndrome.
More than 100 articles on child sexual abuse were reviewed, the majority written from 1980 to the present concerning the demographics of child sexual abuse, the psychological effects of child sexual victimization, the psychopathology encountered in adult survivors of child sexual abuse, hypotheses regarding the nature of the trauma, a critique of the research, and approaches to intervention.
Although a wide variety of psychological sequelae have been documented in sexually abused children referred for evaluation or treatment, there appears to be considerable variability in the severity of the symptoms, and we remain ignorant of sequelae in abused children who never enter the mental health system. However, some of these children may become symptomatic in adult life. Validation of sexual abuse is hampered by the lack of specific behavioral markers. Methodological difficulties in child sexual abuse research include problems with definition, failure to measure severity of the abuse, sampling problems, failure to use standardized or appropriate instruments, problems with validation, and failure to use control groups.
Despite an increased focus on child sexual abuse in the recent decade, many gaps remain in our knowledge. Prospective longitudinal follow-up studies of sexually abused children and treatment outcome studies are urgently needed.
Efforts to accurately measure rates of reabuse have been elusive because of problems in definition and methodology. The present study examines reabuse rates across a 5-year follow-up period in a sample of children assessed for child abuse (October 1986-October 1987). Participants consisted of 304 children (7 months-15 years of age), systematically selected from a population of 1,100 children consecutively admitted to a hospital-based, interdisciplinary, child abuse assessment unit. Reabuse was determined by matching sample names against information in a centralized reporting system. Reabuse was studied across demographic and socioeconomic variables, vulnerability days, initial and subsequent type(s) of abuse, and other considerations. At the end of the 61-72 month follow-up period, the sample had a 16.8% incidence of reabuse. The greatest risk of reabuse occurred during the first 2 years following an initial discharge diagnosis of maltreatment. Although no particular initial maltreatment diagnosis was a statistically significant predictor of the likelihood or type of reabuse, neglect was shown to be the most frequent type of reabuse. Children experiencing reabuse were more likely to reside in public housing/apartments, have unmarried and/or unemployed parent(s), and be Medicaid recipients. Opportunities for secondary prevention initiatives and future research are discussed.
To present initial findings on the validity of a recently developed maltreatment inventory, the Childhood Trauma Questionnaire (CTQ), in a sample of adolescent psychiatric patients.
Three hundred ninety-eight male and female adolescents (aged 12 to 17 years) admitted to the inpatient service of a private psychiatric hospital were given the CTQ as part of a larger test battery. Structured interviews were also conducted with the primary therapists of 190 of the patients to obtain ratings of abuse and neglect based on all available data, including clinical interviews with patients and their relatives and information from referring clinicians and agencies.
Principal-components analysis of the CTQ items yielded five rotated factors-emotional abuse, emotional neglect, sexual abuse, physical abuse, and physical neglect-closely replicating the factor structure in an earlier study of adult patients. The internal consistency of the CTQ factors was extremely high both in the entire sample and in every subgroup examined. When CTQ factor scores were compared with therapists' ratings in a series of logistic regression analyses, relationships between the two sets of variables were highly specific, supporting the convergent and discriminant validity of the CTQ. Finally, when therapists' ratings were used as the validity criterion, the CTQ exhibited good sensitivity for all forms of maltreatment, and satisfactory or better levels of specificity.
These initial findings suggest that the CTQ is a sensitive and valid screening questionnaire for childhood trauma in an adolescent psychiatric inpatient setting.
Prior research has suggested that women who experience childhood sexual abuse are at increased risk for sexual victimization and Posttraumatic Stress Disorder (PTSD) in adulthood. However, previous studies have paid insufficient attention to the overlap of childhood sexual and physical abuse. In the present study we disentangled the separate and combined effects of childhood sexual and physical abuse by comparing groups of participants who reported contact childhood sexual abuse only (SA), sequelae of childhood physical abuse only (PA), combined childhood sexual and physical abuse (CA), or no child abuse (NA).
A sample of 475 female college students completed measures of sexual and physical abuse in childhood (before age 15) and adulthood (after age 15), PTSD and trauma symptoms, and demographic variables. Of these participants, 27 were assigned to the SA group, 53 to the PA group, 31 to the CA group, and 211 to the NA group.
The highest rate of adult sexual and/or physical victimization was reported by the CA group, followed by the PA group, with lower rates reported by the SA and NA groups. Using adult victimization as a covariate, the analyses revealed that the CA group reported significantly higher rates of PTSD and trauma symptoms compared to the NA group.
The results suggest that prior reports of differences in rates of adult victimization and PTSD between women who experienced childhood sexual abuse and women who did not may be attributable to the inclusion of participants with a history of combined childhood sexual and physical abuse in childhood sexual abuse groups. The importance of separating physical and combined forms of victimization from sexual abuse is discussed.
A retrospective study of long Validity term methods of coping with having been sexually of the Childhood Trauma Questionnaire in an ad-abused during childhood. Child Abuse and Neglect, olescent psychiatric population
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