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Recent Suicidality in the General Population: Multivariate Association With Childhood Maltreatment and Adult Victimization
Abstract
Three hundred and eighty-seven participants from the general population completed the Suicidality scale of the Detailed Assessment of Posttraumatic Stress (DAPS) and the Traumatic Events Survey (TES). Within the prior month, 14% of adults reported some degree of suicidal ideation and 2% reported an active or passive suicide attempt. Multinomial logistic analysis indicated that, as compared with nonsuicidal participants, age, childhood physical abuse, childhood sexual abuse, and childhood emotional abuse were associated with recent suicide attempts, whereas recent suicidal ideation without attempts was predicted solely by emotional abuse. In contrast, adult sexual or physical assaults were not associated with recent suicidality in any form.
© The Author(s) 2015.
... collecting pills, buying a gun, tying a rope into a noose) (Matarazzo et al., 2013) and explicit, active suicidal behavior (e.g. walking into traffic, driving recklessly, or putting a noose around the neck) (Briere et al., 2016;Crosby et al., 2011). Silverman et al. (2007) and Silverman (2006) describe passive suicidal behavior as an episode in which an individual had suicidal intent and means but did not attempt suicide. ...
... Research findings suggest that interpersonal trauma (e.g. loss, bullying, trauma, abuse, violence) may also increase one's vulnerability to stress and predisposition for depression and subsequent onset of suicidal thoughts or behavior (Abdeen et al., 2018;Anestis et al., 2016;Briere et al., 2016;Carpenter et al., 2011;Cluver et al., 2015;Morrow & Krishna, 2019;Prinstein, 2008;Schonfelder et al., 2019;Taylor, 2020). ...
... Suicidal thinking and behavior vary among individuals with depression. Study findings indicate that depression alone predicts suicidal ideation but does not necessarily correlate with suicide plans or attempts (Briere et al., 2016;Cameron et al., 2017;Campos et al., 2016: King & Merchant, 2008Yazici et al., 2018). However, when compounded by additional psychiatric disorders or interpersonal trauma, depression is associated with suicide behavior and attempts (Bri ere et al., 2015;Camm-Crosbie et al., 2019;Cassidy et al., 2018;Chen et al., 2019;Dore et al., 2012;Lemaigre & Taylor, 2019;Yoo et al., 2018). ...
Suicide is a preventable health problem. Multiple definitions and inconsistent use of the term suicidality can result in failure to properly recognize suicide risk and behavior and confuses suicide research. Clarification of the suicidality concept is needed to facilitate the care for individuals at risk for suicide. Using Rodgers’ evolutionary concept analysis method, this analysis describes the breadth and scope of the suicidality concept. Findings indicate suicidality covers a spectrum of suicidal risk and levels of emotional suffering and intent. The analysis does not draw definite conclusions, but outlines a direction for further research.
... Although depression symptoms were not the primary focus of the present study, this variable was included to explicitly account for the strong association between symptoms of depression and suicidality (e.g., Sareen et al., 2005). Given that CSA has been found to be a robust predictor of suicidality (Briere, Madni, & Godbout, 2016;Devries et al., 2014;Dube et al., 2001), this study also included the conditional influence of CSA victimization by testing the hypothesized mediation model separately in youth with and without reported history of CSA. It was hypothesized that these indirect effects would be greater among survivors of CSA as compared to patients with no history of CSA. ...
... This may have led to misclassification of some individuals by not fully assessing all relevant domains of CSA victimization, or by conflating CSA with other forms of childhood abuse. Related to this limitation, the chart review data available for this study did not systematically assess for emotional abuse, and thus we were unable to evaluate the influence of this form of maltreatment that has been found to uniquely predict suicidal ideation relative to other forms of childhood maltreatment (Briere et al., 2016). ...
Adolescent psychiatric inpatients suffer high rates of childhood sexual abuse, trauma-related distress, and suicidality. This study evaluated the hypothesis that three domains of resiliency (i.e., Sense of Mastery, Sense of Relatedness, and Emotional Reactivity) would mediate the effect of trauma-related distress upon suicidal ideation, while accounting for symptoms of depression, and that the indirect effect of trauma-related distress upon suicidal ideation would be greater among survivors of childhood sexual abuse. Chart review patients included 550 adolescents admitted to a public psychiatric hospital in a Northwestern US State from 2010 to 2015. Adolescents completed self-report measures of trauma-related distress, depression, resiliency, and suicidal ideation. Half of the adolescents in this study reported past history of childhood sexual abuse, and more than half disclosed history of attempted suicide. There was a group noninvariant indirect effect of trauma-related distress upon suicidal ideation via emotional reactivity among survivors of childhood sexual abuse (β = 0.10, 95% ACI: 0.04 to .17), as well as a group invariant direct effect of depression symptoms (β = 0.88, p < .001). The other two domains of resiliency, sense of mastery and sense of relatedness did not mediate the association between trauma-related distress and suicidal ideation. These findings demonstrate the importance of emotional reactivity with regard to suicidal ideation, as well as the association between depression symptoms and suicidal ideation in this clinical population, and suggest the potential utility of skills-based interventions, and the need for trauma-informed policy and procedures in adolescent psychiatric inpatient settings.
... Moreover, with some notable exceptions (Assini-Meytin et al., 2021;Briere et al., 2016), much of the studies of early life traumas and adult suicidality have been limited to clinical samples (e.g. Berardelli et al., 2022;Brodsky et al., 2001;Charak et al., 2016, Ihme et al., 2022, Luk et al., 2021Read et al., 2001;Roy, 2005). ...
Exposure to traumas early in life has been found to have a range of negative health effects later in adulthood, including a higher risk for suicidal behavior. Using data from the Waves I (1994/95) and IV (2008) of the National Longitudinal Study of Adolescent to Adult Health (N = 14,385; 49.35% female; Mage in Wave IV = 29), this study examines the effects of exposure to three different types of early life traumas—emotional abuse, physical abuse, and sexual abuse before the age of 18—on adult suicidal ideation. Guided by the stress process model incorporated with a life-course perspective, potential mediating roles of psychological distress, subjective powerlessness, and perceived social rejection were also investigated. A series of regression and Karlson-Holm-Breen (KHB) mediation analyses were performed using Stata 14 to assess the total, direct, and indirect effects. All three early life trauma measures were found to be significantly and independently associated with a higher risk of suicidal ideation in adulthood. A substantive portion (between 30 and 50%) of the effects was mediated by psychological distress (i.e., depression and anxiety), subjective powerlessness, and perceived social rejection. The general policy implications of this study include evaluating suicidal individuals for prior childhood abuse experiences and assessing abuse survivors for suicidality.
... O trauma na infância pode ter um impacto marcante no desenvolvimento da criança (Dugal et al., 2016). De entre o vasto conjunto de consequências do trauma na infância no funcionamento psicológico e interpessoal (Reyome, 2010;Schury & Kolassa, 2012) estão os pensamentos e comportamentos suicidários (Briere et al., 2016). Diversas evidências sugerem que a probabilidade de ter pensamentos e/ou comportamentos suicidários é de 2 a 5 vezes mais elevada em vítimas de trauma na infância, quando comparadas com indivíduos que não passaram por este tipo de experiências (e.g., Briere et al., 2015;Dube et al., 2001). ...
Childhood trauma presents a negative impact on development, which can lead to dysfunctionality and to suicidal behaviors, namely self-harming behaviors throughout life. The aim of this preliminary study is to test the mediation and moderation effects of different facets of psychological pain, cognitive dimension, affective dimension and avoidance in the relationship between childhood trauma and self-harming behavior in young adults. A final sample of 323 young adults, college students, aged between 18 and 28 years participated. Path analysis techniques using Structural Equation Modeling and Multiple Hierarchical Regression Analysis were used to test mediation and moderation models, respectively. It was found that the dimension of psychological pain avoidance partially mediates the relationship between childhood trauma and self-injurious behaviors. There were no significant moderation effects. Results are discussed in their clinical implications.
... Emotional abuse in childhood also leads to greater exposure to emotional abuse in adulthood, which in turn leads to higher levels of depressive symptoms and suicidality (Lee, 2015). In fact, emotional, physical, and sexual abuse in childhood can all contribute to suicidal ideation and/or attempts in adulthood (Briere, Madni, & Godbout, 2016;Gomez et al., 2017) and to the emergence of psychotic symptoms through an affective pathway to psychopathology (Myin-Germeys & van Os, 2007). ...
Background
This retrospective chart review study investigates the relationship between the history of various forms of abuse and the presence of mood disorders and psychotic symptoms in predicting suicide attempts among psychiatrically hospitalized children and adolescents.
Method
A multi‐mediation analysis was conducted with an archival dataset of 101 children and adolescents hospitalized predominantly for mood disorders and bipolar disorders with and without history of psychotic symptoms.
Results
Results showed that history of suicide attempts was directly associated with physical abuse and indirectly associated with sexual abuse (mediated by bipolar disorders). Emotional abuse was also indirectly related to history of suicide attempts, mediated by mood disorders for boys, and by psychotic symptoms for girls.
Conclusions
This study is among the first to differentiate the unique effects of different types of early maltreatment on psychopathology, particularly mood disorders and psychotic symptoms, and histories of suicide attempts in psychiatrically hospitalized children and youth.
... Early meta-analytic reviews found significant associations between child sexual abuse and anxiety, anger, depression, re-victimization, self-mutilation, sexual problems, substance abuse, suicidality, impairment of self-concept, interpersonal problems, obsessions and compulsions, dissociation, posttraumatic stress responses and somatization in adult women (Neumann, Houskamp, Pollock, & Briere, 1996). Even when there are no direct long term psychological sequelae, more recent evaluations have concluded that child sexual abuse is an indirect risk factor for anxiety disorders (Maniglio, 2012), suicidal behaviour (Briere, Madni, & Godbout, 2016), sexual re-victimization (Waldron, Wilson, Patriquin, & Scarpa, 2015) and adult psychopathology in both males and females (Hillberg, Hamilton-Gachritsis, & Dixon, 2011) through complex, intermediary factors. ...
Background
Child sexual abuse (CSA) is a multi-dimensional problem. The search for best practice must consider the complexities surrounding CSA and its management in any particular society.
Objective
Data previously gathered from service providers on CSA service provision in Trinidad and Tobago identified key deficient issues in policy and practice. In this paper, researchers aimed to bridge the gaps identified, and effect changes to improve services for CSA using an action research methodology.
Participants and setting
Service providers from all sectors in governmental and non-governmental organizations in Trinidad and Tobago, who work with children at risk of CSA were involved in the process.
Methods
Researchers led the service providers into an awareness of their own practice through critical discussion of, and reflection on, the key deficient issues. The new knowledge generated, with guided input from evidenced-based best practice, led to the development of guidelines for management. Discussion of the practicability of the guidelines by service providers in multiple sectors generated more new knowledge that refined the management approach.
Results
The contextual knowledge obtained from service providers resulted in best practice guidelines for service providers that were culturally relevant and context-sensitive, adaptive and implementable, and allowed a seamless multidisciplinary response to CSA in Trinidad and Tobago within prevailing constraints.
Conclusions
Action research offers an effective approach to improve services for CSA through mobilization of service providers and changes in policy and practice. It is applicable in any setting and likely to be effective in any socio-cultural context.
Keywords
Child sexual abuse, Service provision, Legislative change, Action research, HIV, Trinidad and Tobago, Caribbean
... These include health problems, high health care utilization, a high risk of revictimization, low socio-economic well-being and criminal behavior in adulthood [1][2][3][4][5][6]. Childhood abuse is also related to many mental health problems such as depression, suicidality, dissociation, personality disorders, substance abuse and aggression [4,5,[7][8][9][10]. In many cases, childhood abuse leads to Posttraumatic Stress Disorder (PTSD): 22 to 49% of those who report childhood abuse fulfill criteria for lifetime PTSD [11]. ...
Background
Childhood abuse related posttraumatic stress disorder (CA-PTSD) is associated with a high burden of disease and with treatment response rates that leave room for improvement. One of the treatments for PTSD, prolonged exposure (PE), is effective but has high drop-out rates and remission rates are relatively low. An intensified form of PE (iPE) was associated with good response and low drop-out rates in PTSD and has not yet been tested in a controlled trial in CA-PTSD. Phase-based treatment (PBT), in which PE is preceded by skills training may improve overall outcomes in this population. We will assess the effectiveness and cost-effectiveness of standard PE, iPE and PBT in patients with CA-PTSD.
Methods/design
Multi-center randomized controlled trial. Treatment conditions are: prolonged exposure (PE; maximum of 16 sessions in 16 weeks); intensified PE (iPE; maximum of 12 sessions in four weeks and two booster sessions); phase-based treatment (PBT; maximum of eight sessions skills training followed by eight sessions PE in 16 weeks).
Primary outcome: Clinician-rated PTSD symptom severity. Secondary outcomes: loss of PTSD diagnosis, self-reported PTSD symptom severity, comorbid symptom severity and quality of life. Moreover, we will examine cost-effectiveness and moderators and mediators of treatment outcome. Target population: adults with CA-PTSD (N = 150). Assessments in weeks 0, 4, 8, 16, 26 and 52.
Discussion
Given that no consensus yet exists about the treatment guidelines for patients with CA-PTSD, the present study may have important implications for the treatment of CA-PTSD.
Trail registration
Registered at C.C.M.O. on Sept 7, 2016 (NL57984.058.16); retrospectively registered at June 21, 2017 at clinicaltrials.gov identifier: NCT03194113.
... A substantial evidence base demon- strates that those who have experienced trauma are at a higher risk of harming themselves or experiencing further harm from others ( Briere et al., 2016;Maniglio, 2009;Ouimette & Brown, 2003). A person's presentation can change rapidly in response to a wide range of overt and covert stressors. ...
Barriers and facilitators to CBTp implementation. Authors' reflections on using an implementation theory to formulate difficulties with CBTp implementation.
... Approximately three quarters of those who had attempted suicide had experienced childhood physical abuse compared with 30% of those who had never attempted suicide. Further, those who had attempted suicide reported twice as many experiences of childhood emotional abuse than nonattempters (Briere, Madni, & Godbout, 2016). In a large retrospective cohort study using data from adult participants in a health maintenance organization, those who reported having experienced emotional, physical, or sexual abuse were three to five times more likely to have attempted suicide at some point in their lives (Dube et al., 2001). ...
Background
Suicide is a leading cause of death among adolescents and young adults. The current study extends the research linking adverse childhood experiences (ACEs) to suicidal behaviors by testing these associations using a nationally representative sample, assessing for suicide ideation and attempts in adulthood, controlling for established risk factors for suicidality, and measuring a broad array of ACEs.
Methods
The sample included 9,421 participants from the National Longitudinal Study of Adolescent Health who participated in four waves of assessments spanning 13 years. We examined longitudinal associations between eight different ACEs (physical, sexual, and emotional abuse, neglect, parental death, incarceration, alcoholism, and family suicidality) with suicidal ideation and suicide attempts in adulthood, while controlling for depression, problem alcohol use, drug use, delinquency, impulsivity, gender, race, age, and urbanicity. We also tested for cumulative associations of ACEs with suicide ideation and attempts.
Results
Logistic regression analyses indicated that physical, sexual, and emotional abuse, parental incarceration, and family history of suicidality each increased the risk by 1.4 to 2.7 times for suicidal ideation and suicide attempts in adulthood. The accumulation of ACEs increased the odds of suicide ideation and attempts. Compared with those with no ACEs, the odds of seriously considering suicide or attempting suicide in adulthood increased more than threefold among those with three or more ACEs.
Conclusions
Intervention strategies need to prevent ACEs from occurring and, if they do occur, should take into account the impact of cumulative ACEs on suicide risk. Future research should focus on identifying mediating mechanisms for the ACEs‐suicidality association using longitudinal research designs and determine which ACEs are most important to include in a cumulative ACE measure.
... Autophagy is a lysosome-dependent degradation pathway that controls intracellular turnover of cytoplasmic components and organelles, which is essential for cell survival whose abnormality leads to activation of apoptosis [19]. Recent studies showed that disturbed autophagy played a key role in the pathophysiological process of multiple psychiatric disorders [20][21][22]. ...
... 103,104 For example, substance abuse is an individual-level behavior that is a risk factor for all forms of violence 8,13,15,42,72,76,105,106 and also a health outcome that is linked to risk factors at the community and relationship levels such as neighborhood poverty 107 and lack of social support. 108 Other risk factors at the individual level that are associated with increased risk for perpetration of almost all forms of violence include low educational achievement 5,42,76,79,109,110 lack of nonviolent coping skills, 5,18,27,75,76,79,80,111 poor behavioral control/impulsiveness, 5,18,29,52,75,76,79,111 history of violent victimization, 8,[10][11][12][13]18,42,112 witnessing violence, 18,29,52,76,94,113,114 and psychological or mental health problems. 8,12,13,18,42,76,115 Conversely, improvements in nonviolent problem-solving skills have been found to be protective against perpetration of some forms of violence including child abuse and neglect, 116 teen dating violence, 117 youth violence, 118 and suicide. ...
Violence takes many forms, including intimate partner violence, sexual violence, child abuse and neglect, bullying, suicidal behavior, and elder abuse and neglect. These forms of violence are interconnected and often share the same root causes. They can also co-occur together in families and communities and can happen at the same time or at different stages of life. Often, due to a variety of factors, separate, "siloed" approaches are used to address each form of violence. However, understanding and implementing approaches that prevent and address the overlapping root causes of violence (risk factors) and promote factors that increase the resilience of people and communities (protective factors) can help practitioners more effectively and efficiently use limited resources to prevent multiple forms of violence and save lives. This article presents approaches used by 2 state health departments, the Maryland Department of Health and Mental Hygiene and the Colorado Department of Public Health and Environment, to integrate a shared risk and protective factor approach into their violence prevention work and identifies key lessons learned that may serve to inform crosscutting violence prevention efforts in other states.
... A substantial evidence base demon- strates that those who have experienced trauma are at a higher risk of harming themselves or experiencing further harm from others ( Briere et al., 2016;Maniglio, 2009;Ouimette & Brown, 2003). A person's presentation can change rapidly in response to a wide range of overt and covert stressors. ...
Abstract
Background: In contrast to national guidelines, evidence suggest that only a minority of service users experiencing psychosis have access to Cognitive Behavioural Therapy for psychosis (CBTp). Although previous studies identified various barriers to implementation of CBTp, they did not use a theoretical framework to interpret them.
Aims: This study aims to utilize Normalisation Process Theory (NPT) to explore the experiences and perspectives of stakeholders regarding the implementation of CBTp in NHS A&A.
Method: The sample will consist of Community Mental Health Team (CMHT) managers and professionals working with people who experienced psychosis. This study will adopt a qualitative design using focus groups and semi-structured individual interviews with nursing staff, occupational therapist, clinical psychologists, psychiatrists. Transcribed interviews will be analysed using Framework Analysis (deductive) and Thematic Analysis (inductive methods).
Applications: To our knowledge the use of a theoretical framework to explore the barriers to implementation of CBTp, constitutes an innovative feature of this study in comparison with previous studies. Potential implication of this study would involve the generation of a plausible intervention plan to overcome implementation barriers in service and individual level.
... However, given that an emerging literature has linked high levels of perceived DT with greater acquired capability for suicide (Anestis et al., , 2013, it is important for future research efforts to evaluate at what point and for whom high DT becomes maladaptive. Several studies have found evidence for associations between child maltreatment and risk for suicide (Briere, Madni, & Godbout, 2016;Hadland et al., 2012;Hoertel et al., 2015). It may be the case that high levels of perceived DT partially mediate an association between child maltreatment and risk for suicide. ...
Individuals with a history of childhood trauma experience deficits in emotion regulation. However, few studies have investigated childhood trauma and both perceived (i.e., self-report) and behavioral measures of distress tolerance. The current study evaluated associations between childhood trauma (i.e., physical abuse, sexual abuse, and witnessing family violence) and measures of perceived (Distress Tolerance Scale) and behavioral distress tolerance (i.e., Paced Auditory Serial Addition Test, breath-holding). Participants were 320 undergraduate students with a history of interpersonal trauma (e.g., sexual/physical assault). Structural equation modeling was used to evaluate associations between frequency of childhood trauma type and distress tolerance. Greater childhood physical abuse was associated with higher perceived distress tolerance. Greater levels of witnessing family violence were associated with lower behavioral distress tolerance on the breath-holding task. No significant effects were found for Paced Auditory Serial Addition Test performance. Associations between childhood trauma and emotion regulation likely are complex and warrant further study.
... 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). ...
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.
... 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 only study to address this in African Americans focused only on sexual abuse (Lamis et al., 2016). ...
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.
... Among the wide range of repercussions observed in the aftermath of childhood interpersonal trauma, one of the most troubling is the development of suicidal thoughts and behaviors [116]. Several studies suggest that psychological, physical, and sexual abuse is related to later suicidal ideation, threats or attempts [117,118]. ...
Despite decades of prevention campaigns and research, childhood interpersonal trauma (i.e., psychological, physical and sexual abuse, psychological and physical neglect, witnessing interparental violence) remains an endemic problem with longstanding and deleterious negative effects on adult psycho-relational functioning. This chapter aims to present a comprehensive literature review of the repercussions associated with exposure to childhood interpersonal trauma. First, the nature and various forms of childhood interpersonal trauma are described. Subsequently, a review of the studies documenting disruptions in psychological and interpersonal functioning and the mechanisms explaining the development of each of these repercussions is unraveled. These repercussions include posttraumatic stress disorder, anxiety disorders, depression, personality disorders, affect dysregulation, substance use disorders, eating disorders, suicidal behaviors, alterations in attention and consciousness, disruptions in attributions, attachment, sexuality and violence in intimate relationships. Finally, suggestions for future research and intervention guidelines with childhood interpersonal trauma survivors are discussed.
Interestingly, early interpersonal trauma not only produces compelling and long-lasting psychological and relational maladjustment, but it is also related to a greater probability of sustaining additional interpersonal trauma during childhood and later in life. This vulnerability is referred to as revictimization [24, 25]. Substantial evidence suggests that individuals exposed to one category of interpersonal trauma during childhood are also likely to have experienced other types of victimization [26]. Research increasingly points to the experience of multiple types of interpersonal trauma, referred to as polyvictimization [3, 27, 28] and cumulative trauma [29]. Some researchers also refer to this phenomenon as complex childhood trauma since it encompasses exposure to multiple, often prolonged or extended developmentally adverse traumatic events that occur early in life [5, 24, 30]. Typically, these constructs refer to the experience of some combination of psychological, physical, and sexual abuse, psychological and physical neglect, and exposure to interparental violence and are operationalized as the total number of different types of interpersonal victimization experienced by a given individual [8, 17, 10, 31].
... In line with these findings, Ehnvall et al., reported that feeling rejected by parents was a significant predictor of lifetime suicide attempts for women, although not for men [76]. Being deprived of love and emotional security represent the core of emotional abuse, which has been noted in previous research to more strongly predict suicidal ideation than either sexual or physical abuse [59,77]. Results regarding the effects of anxiety were unexpected. ...
... In line with these findings, Ehnvall et al., reported that feeling rejected by parents was a significant predictor of lifetime suicide attempts for women, although not for men [76]. Being deprived of love and emotional security represent the core of emotional abuse, which has been noted in previous research to more strongly predict suicidal ideation than either sexual or physical abuse [59,77]. Results regarding the effects of anxiety were unexpected. ...
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.
... CEA has often been included within an overall childhood maltreatment variable, without examining its unique sequelae (DiLillo, Lewis, & Loreto-Colgan, 2007;Whisman, 2006). However, CEA appears to be one of the most pervasive and destructive types of childhood maltreatment (Barnett, Miller-Perrin, & Perrin, 2005;Briere, Madni, & Godbout, 2015;Kapeleris & Paivio, 2011;. Therefore specific attention to the long-term harmful effects of CEA is much needed. ...
The empirical literature indicates that childhood emotional abuse (CEA) produces long lasting impairments in interpersonal relatedness and identity, often referred to as self-capacities. CEA has also been shown to negatively impact couple functioning. This study examined the role of identity and interpersonal conflicts in mediating the relationship between CEA and women's report of couple adjustment among 184 French Canadian women from the general population. Path analysis revealed that CEA was related to poorer couple adjustment through its impact on dysfunctional self-capacities and the experience of greater conflicts in relationships. Findings highlight the importance of assessing CEA to better explain couple adjustment in women with relationship difficulties and provide potential intervention targets based on the self-capacities framework.
Copyright © 2015 Elsevier Ltd. All rights reserved.
Background: Suicidal ideation (SI) and suicide attempts (SAs) among
adolescents are a significant public health concern worldwide. The current study
extends previous research by exploring the association between adverse childhood
experiences (ACEs) and SI and SAs in a sample of adolescent inpatients as well as
identifying specific predictors for increased risk of SI and SAs.
Methods: Associations between ACE scores and self-reported SI and SAs were
explored in a sample of 154 adolescent inpatients via clinical interview and by
analyzing the association between cumulative ACE scores and scores on the Suicidal
Tendency scale of a larger personality measure. We also tested for independent
relationships between 19 ACEs and SI and SAs to determine unique predictors for
suicidality.
Results: One-way ANOVA analyses revealed that those who attempted suicide
reported significantly more ACEs compared to those who did not attempt suicide.
Witnessing violence in the home, school, or neighborhood and experiences of
discrimination increased one’s likelihood to attempt suicide by two to threefold,
while sexual abuse, neglect, and physical abuse increased this likelihood by three-tofourfold. Stepwise linear regression analyses demonstrated that emotional abuse,
living with someone who had mental health problems or attempted suicide were most
associated with elevated Suicidal Tendency scores on a personality measure.
Conclusion: Early identification, education and intervention are imperative to limit or
eliminate ACEs from occurring. The impact of cumulative as well as specific ACEs
on suicide risk should be closely considered as areas for such intervention. Areas for
future research include extending to include more diverse populations such as the
LGBTQ community as well as more ethnically and racially diverse populations
Background
: Adverse childhood experiences (ACEs) are associated with increased suicidal behaviors in adolescents and most research has been restricted to certain types of or cumulative exposure to ACEs. Few studies have examined the association between patterns of ACEs and suicidal behaviors.
Objective
: To identify the contributions of type and pattern of exposure to ACEs to suicidal behaviors and their gender differences among middle school students in China.
Methods
: A school-based health survey was conducted in four provinces in China between 2017 and 2018. 14 500 students aged 10–20 years completed standard questionnaires, to record details of ACEs, suicide ideation, suicide plan, and suicide attempt.
Results
: Latent class analysis indicated four distinct patterns of ACEs exposure: high ACEs (6.3%), high abuse and neglect (21.4%), high neglect (45.5%), and low ACEs (26.8%). Logistic analyses showed that, compared with low ACEs, the high ACEs were more likely to report suicidal behaviors. No gender differences were found in the independent effects of ACEs type or pattern on suicidal behaviors, except for the emotional neglect associated with suicidal behaviors in girls than boys.
Limitations
: The study was cross-sectional and used self-reported questionnaires. Thus, it is difficult to establish a causal relationship between patterns of ACEs and suicidal behaviors.
Conclusion
: Our findings addressed the need for a comprehensive consideration of ACEs in preventive healthcare work to identify children exposed to the most problematic ACE patterns. The study provided the evidence of targeted intervention to preempt the emergence of suicide behavior in at-risk students in adolescents.
Background
Associations between different types of victimization and symptomology among youth remain unclear due to methodological limitations preventing the identification of the independent contribution of each type of violence.
Objective
The purpose was to examine associations between different types of victimization and the odds of experiencing clinically significant levels of anxiety, depression, and anger/aggression. We also examined the unique contribution of each type of victimization to these outcomes.
Participants
Participants were a nationally representative sample of youth ages 10–17 (n = 1019) who were residing in the United States when data were collected in 2002–2003.
Methods
Youth reported on their experiences of different forms of victimization (e.g., physical abuse, emotional abuse, neglect, sibling abuse, bullying, sexual assault, and witnessing violence) within the past year. Logistic regression and relative weights analyses were used to examine associations between victimization and symptoms of depression, anxiety, and anger/aggression.
Results
The prevalence of reported victimization ranged from 1.3 % for neglect to 41.3% for sibling abuse. Physical and emotional child abuse, sibling abuse, bullying, and emotional bullying were associated with increased odds of clinically significant anxiety, depression, and anger/aggression. Witnessing parent intimate partner violence was associated with increased odds of clinically significant anger/aggression. Witnessing parental assault of a sibling was associated with increased odds of clinically significant anxiety and anger/aggression. Emotional bullying predicted the largest percentage of variance in anxiety and depression, followed by emotional abuse and sibling aggression.
Conclusions
These findings underscore the need for further assessment and treatment for sibling abuse and emotional bullying.
Suicide is a major public health concern. The aims of this study were to examine, in a selected clinical population, the effect of (a) early childhood trauma and (b) stressful life events on the occurrence of suicidal behavior during adulthood. Specifically, the present study focuses on whether, how and to what extent each of these under study parameters is related to self-destructive behavior.
Background:
As increasing research demonstrates that military sexual trauma (MST) is associated with suicidal ideation and attempts, discerning factors that place MST survivors at risk for these outcomes is critical. The present study aimed to: (1) characterize suicidal ideation and attempts among MST survivors; (2) identify factors associated with post-MST suicide attempts, post-MST suicidal ideation, and past-week suicidal ideation.
Methods:
A convenience sample of 108 veterans (66 women, 42 men) who reported a history of MST participated in this cross-sectional study. Pre-MST suicidal ideation and attempt, childhood physical and sexual abuse, military sexual assault, institutional betrayal, and posttraumatic cognitions about self, world, and self-blame were examined, with age and gender as covariates.
Results:
Seventy-five percent of participants reported experiencing post-MST suicidal ideation, and 40.7% reported attempting suicide following MST. Pre-MST suicide attempt and posttraumatic cognitions about self were associated with post-MST suicide attempt. Pre-MST suicidal ideation, military sexual assault, childhood physical abuse, and posttraumatic cognitions about self were associated with post-MST suicidal ideation. Lastly, pre-MST suicidal ideation and posttraumatic cognitions about self were associated with past-week suicidal ideation; results were unchanged when accounting for recent PTSD or depressive symptoms.
Limitations:
The cross-sectional design, retrospective self-report, and small sample are limitations.
Conclusions:
Addressing negative posttraumatic beliefs about self may be important for managing suicide risk among MST survivors. Assessing for pre-MST suicidal ideation and attempt is likely also warranted. Further understanding of the longitudinal impact of posttraumatic beliefs about self on subsequent risk for suicidal ideation and attempt is warranted.
Introduction:
The present study aims to investigate whether problem-focused and emotion-focused coping skills were associated with suicidal ideation. In addition, we examined whether childhood maltreatment (i.e. physical, psychological, sexual abuse, and neglect) is a risk factor for later-on suicidal ideation.
Methods:
Youths aged 16 or 18 (n = 307, 56% females) from San Diego and Seattle at Wave 6 and Wave 7 of the LONGSCAN were included in the study. We used hierarchical logistic regression.
Results & conclusions:
17.6% reported suicidal ideation. Those who reported better emotion-focused coping were .80 times less likely to report suicidal ideation. However, even after controlling for coping skills, adolescents with sexually abuse histories were 3.08 times more likely to report suicidal ideation. Our findings suggest implications for early intervention efforts. Building youth assets through promotion of positive youth development may serve as a driving force to reduce negative outcomes in youth who have experienced sexual abuse.
Suicide is an emerging, yet preventable global health issue associated with significant mortality. Identification of underlying risk factors and antecedents may inform preventive strategies and interventions. This study serves to provide an updated meta-analysis examining the extent of association of early life sexual abuse with suicide attempts. Using the keywords [early abuse OR childhood abuse OR sexual OR rape OR molest* OR violence OR trauma OR PTSD] AND [suicid* OR premature OR unnatural OR deceased OR died OR mortality], a preliminary search on the PubMed, Ovid, PsychINFO, Web of Science and Google Scholar databases yielded 12,874 papers published in English between 1-Jan-1988 and 1-June-2017. Of these, only 47 studies were included in the final meta-analysis. The 47 studies (25 cross-sectional, 14 cohort, 6 case-control and 2 twin studies) contained a total of 151,476 subjects. Random-effects meta-analysis found early life sexual abuse to be a significant risk factor for suicide attempts, compared to baseline population (pooled OR 1.89, 95% CI: 1.66 to 2.12, p < 0.001). Subgroup analyses of cross-sectional and longitudinal studies showed similar findings of increased risk as they yielded ORs of 1.98 (95% CI: 1.70 to 2.25, p < 0.001) and 1.65 (95% CI: 1.37 to 1.93, p < 0.001), respectively. In both cross-sectional and longitudinal studies, childhood sexual abuse was consistently associated with increased risk of suicide attempts. The findings of the present study provide strong grounds for funding public policy planning and interventions to prevent sexual abuse and support its victims. Areas for future research should include preventive and treatment strategies and factors promoting resilience following childhood sexual abuse. Future research on the subject should have more robust controls and explore the differential effects of gender and intra-versus extra-familial sexual abuse.
Childhood abuse is a major public health concern that has been consistently associated with many deleterious outcomes, including suicidal ideation (SI) and behavior. The processes through which early abuse experiences confer risk for suicidality are unclear. Drawing on Joiner’s (2005) interpersonal theory of suicide, we hypothesized that the relationship between SI and childhood abuse would be specific to childhood emotional abuse, and that this relationship would be mediated by thwarted belongingness and perceived burdensomeness. Participants (n = 189) with moderate to severe childhood abuse completed measures of childhood abuse, perceived burdensomeness, and lack of belongingness at the baseline assessment, and a measure of SI at a 7-week follow-up assessment. We found partial support for the study hypotheses. Childhood emotional abuse, but not childhood physical or sexual abuse, was found to be prospectively associated with SI. Perceived burdensomeness but not thwarted belongingness mediated this relationship. These findings suggest that the relationship between SI and childhood abuse may be specific to emotional abuse, and that this abuse subtype confers risk for ideation through increasing the individual’s sense of hindering or burdening to others within the social network. Implications of these findings are discussed.
The authors conducted a meta-analytic review of the relationship between a history of child sexual abuse (CSA) and psychological problems in adult women in 38 studies meeting rigorous research criteria. Across all symptoms, a significant association was found between history of CSA and adult symptomatology. Analysis of the role of moderating variables indicated the associations were stronger among subjects recruited from clinical populations. When individual symptom domains were examined, anxiety, anger, depression, revictimization, self-mutilation, sexual problems, substance abuse, suicidality, impairment of self-concept, interpersonal problems, obsessions and compulsions, dissociation, posttraumatic stress responses, and somatization all yielded significant associations with sexual abuse. These results are discussed in light of their relevance to research methodology and clinical intervention.
Data from 81 countries was used to estimate global prevalence of intimate partner violence against women.
Objective:
Men who were sexually abused during childhood are at risk for a variety of long-term mental health problems, including suicidality. However, little is known about which factors are related to recent suicide attempts for this vulnerable, under-researched population. The purpose of this study was to examine the relationship between abuse severity, mental health, masculine norms and recent suicide attempts among men with histories of child sexual abuse (CSA).
Methods:
We analyzed survey data gathered from a purposive sample of 487 men who were sexually abused during childhood. The age of the sample ranged from 19 to 84 years (μ = 50.4 years). Recent suicide attempts served as the dependent variable in the study. Self-reported measures of sexual abuse severity, child physical abuse, mental health, masculine norms, and demographic information (age, race) represented the independent variables.
Results:
The results from logistic regression modeling found that five variables - duration of the sexual abuse, use of force during the sexual abuse, high conformity to masculine norms, level of depressive symptoms, and suicidal ideation - increased the odds of a suicide attempt in the past 12 months.
Conclusion:
To improve mental health services for men with histories of CSA, mental health practitioners should incorporate sexual abuse severity, current mental health, and adherence to masculine norms into assessment and treatment planning.
Child sexual abuse is considered a modifiable risk factor for mental disorders across the life course. However the long-term consequences of other forms of child maltreatment have not yet been systematically examined. The aim of this study was to summarise the evidence relating to the possible relationship between child physical abuse, emotional abuse, and neglect, and subsequent mental and physical health outcomes.
A systematic review was conducted using the Medline, EMBASE, and PsycINFO electronic databases up to 26 June 2012. Published cohort, cross-sectional, and case-control studies that examined non-sexual child maltreatment as a risk factor for loss of health were included. All meta-analyses were based on quality-effects models. Out of 285 articles assessed for eligibility, 124 studies satisfied the pre-determined inclusion criteria for meta-analysis. Statistically significant associations were observed between physical abuse, emotional abuse, and neglect and depressive disorders (physical abuse [odds ratio (OR) = 1.54; 95% CI 1.16-2.04], emotional abuse [OR = 3.06; 95% CI 2.43-3.85], and neglect [OR = 2.11; 95% CI 1.61-2.77]); drug use (physical abuse [OR = 1.92; 95% CI 1.67-2.20], emotional abuse [OR = 1.41; 95% CI 1.11-1.79], and neglect [OR = 1.36; 95% CI 1.21-1.54]); suicide attempts (physical abuse [OR = 3.40; 95% CI 2.17-5.32], emotional abuse [OR = 3.37; 95% CI 2.44-4.67], and neglect [OR = 1.95; 95% CI 1.13-3.37]); and sexually transmitted infections and risky sexual behaviour (physical abuse [OR = 1.78; 95% CI 1.50-2.10], emotional abuse [OR = 1.75; 95% CI 1.49-2.04], and neglect [OR = 1.57; 95% CI 1.39-1.78]). Evidence for causality was assessed using Bradford Hill criteria. While suggestive evidence exists for a relationship between maltreatment and chronic diseases and lifestyle risk factors, more research is required to confirm these relationships.
This overview of the evidence suggests a causal relationship between non-sexual child maltreatment and a range of mental disorders, drug use, suicide attempts, sexually transmitted infections, and risky sexual behaviour. All forms of child maltreatment should be considered important risks to health with a sizeable impact on major contributors to the burden of disease in all parts of the world. The awareness of the serious long-term consequences of child maltreatment should encourage better identification of those at risk and the development of effective interventions to protect children from violence. Please see later in the article for the Editors' Summary.
Childhood physical abuse is associated with suicide-related behavior. We investigate how shared environment with perpetrator(s) identified as a family member or parent/parental figure or an adult at home contribute to this association. This systematic review of school- and population-based studies in children and youth reports on five relevant studies. The association was statistically significant in each study, and when examined the association was independent of childhood sexual abuse and other factors. Childhood physical abuse may translate into suicide-related behavior through mechanisms unique from childhood sexual abuse. Future research is needed to strengthen causal inferences to inform the prevention of suicide-related behavior.
Examined the relationship between childhood sexual abuse and subsequent suicidality in 195 women (mean age 27.4 yrs) presenting to the crisis intervention program of a community health center. As predicted, former sexual abuse victims were considerably more likely to have made at least 1 suicide attempt in the past (55% of the 133 Ss) than were nonabused clients (23% of the 62 Ss) and were more likely to report suicidal ideation upon intake. Sexual abuse was associated with suicide attempts that occurred in childhood or adolescence. Among former sexual abuse victims, greater suicidality was correlated with multiple perpetrators, concurrent physical abuse, and sexual intercourse. Childhood sexual abuse is hypothesized to result in lowered self-esteem, guilt and self-blame, perceived powerlessness, and interpersonal dysfunction—all of which may lead to increased self-destructiveness. (French abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Examines the quality of a range of different instruments available for the assessment of posttraumatic stress disorder (PTSD) in order to provide a heuristic structure that clinicians might employ when selecting a particular instrument for their clinical or research purposes. To qualify for a diagnosis of PTSD, an individual must be exposed to a traumatic event that involved life-endangering components and the individual's response had to include intense fear, helplessness, or horror. Symptoms of PTSD include arousal symptoms, avoidance and emotional numbing, and reexperiencing symptoms. People who are exposed to traumatic events do not always develop PTSD, but it has a high frequency in the general population. It is standard practice in clinical research to employ a structured diagnostic interview to ensure that all PTSD symptomatology is reviewed in detail, such as the Structured Clinical Interview for DSM. Self-report questionnaires are also used for diagnosis, such as the Impact of Event Scale—Revised. Also, psychophysiological indices are used to identify and classify cases of PTSD on the basis of reactivity to audio-, audiovisual-, and imagery-based cues. Recommendations of assessment standardization are given. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Previous research has shown that exposure to traumatic events, especially sexual trauma during childhood, is associated with an increased risk of attempted suicide. However, no information is available as to whether the increased risk of attempted suicide is related primarily to posttraumatic stress disorder (PTSD) following traumatic experiences or applies also to persons who experienced trauma but did not develop PTSD.
We examine the association between exposure to traumatic events with and without resulting PTSD and the risk of a subsequent suicide attempt in a community sample of urban young adults.
A cohort study followed young adults who had participated in a randomized trial of all first-grade students entering 19 public schools.
Baltimore, Maryland, an urban setting.
A total of 1698 young adults (mean age, 21; 47% male; 71% African American) who represented 75% of the original cohort of 2311 persons.
Relative risk of a subsequent suicide attempt associated with PTSD and with exposure to assaultive and non-assaultive traumas (no PTSD), as estimated using discrete time survival analysis.
Posttraumatic stress disorder was associated with increased risk of a subsequent suicide attempt. The PTSD-suicide attempt association was robust, even after adjustment for a prior major depressive episode, alcohol abuse or dependence, and drug abuse or dependence (adjusted relative risk, 2.7; 95% confidence interval, 1.3-5.5; P < .01). In contrast, exposure to traumatic events without PTSD was not associated with an increased risk of attempted suicide.
Posttraumatic stress disorder is an independent predictor of attempted suicide. Exposure to traumatic events without PTSD is not associated with a later suicide attempt.
A prospective study of 1,958 outpatients found that hopelessness, as measured by the Beck Hopelessness Scale, was significantly related to eventual suicide. A scale cutoff score of 9 or above identified 16 (94.2%) of the 17 patients who eventually committed suicide, thus replicating a previous study with hospitalized patients. The high-risk group identified by this cutoff score was 11 times more likely to commit suicide than the rest of the outpatients. The Beck Hopelessness Scale thus may be used as a sensitive indicator of suicide potential.
A random sample of 724 individuals across the United States were mailed a questionnaire containing demographic information, an abridged version of the Traumatic Events Survey (D. M. Elliott, 1992), and questions regarding memory for traumatic events. Of these, 505 (70%) completed the survey. Among respondents who reported some form of trauma (72%), delayed recall of the event was reported by 32%. This phenomenon was most common among individuals who observed the murder or suicide of a family member, sexual abuse survivors, and combat veterans. The severity of the trauma was predictive of memory status, but demographic variables were not. The most commonly reported trigger to recall of the trauma was some form of media presentation (i.e., television show, movie), whereas psychotherapy was the least commonly reported trigger.
Context Suicide is a leading cause of death in the United States, but identifying
persons at risk is difficult. Thus, the US surgeon general has made suicide
prevention a national priority. An expanding body of research suggests that
childhood trauma and adverse experiences can lead to a variety of negative
health outcomes, including attempted suicide among adolescents and adults.Objective To examine the relationship between the risk of suicide attempts and
adverse childhood experiences and the number of such experiences (adverse
childhood experiences [ACE] score).Design, Setting, and Participants A retrospective cohort study of 17 337 adult health maintenance
organization members (54% female; mean [SD] age, 57 [15.3] years) who attended
a primary care clinic in San Diego, Calif, within a 3-year period (1995-1997)
and completed a survey about childhood abuse and household dysfunction, suicide
attempts (including age at first attempt), and multiple other health-related
issues.Main Outcome Measure Self-reported suicide attempts, compared by number of adverse childhood
experiences, including emotional, physical, and sexual abuse; household substance
abuse, mental illness, and incarceration; and parental domestic violence,
separation, or divorce.Results The lifetime prevalence of having at least 1 suicide attempt was 3.8%.
Adverse childhood experiences in any category increased the risk of attempted
suicide 2- to 5-fold. The ACE score had a strong, graded relationship to attempted
suicide during childhood/adolescence and adulthood (P<.001).
Compared with persons with no such experiences (prevalence of attempted suicide,
1.1%), the adjusted odds ratio of ever attempting suicide among persons with
7 or more experiences (35.2%) was 31.1 (95% confidence interval, 20.6-47.1).
Adjustment for illicit drug use, depressed affect, and self-reported alcoholism
reduced the strength of the relationship between the ACE score and suicide
attempts, suggesting partial mediation of the adverse childhood experience–suicide
attempt relationship by these factors. The population-attributable risk fractions
for 1 or more experiences were 67%, 64%, and 80% for lifetime, adult, and
childhood/adolescent suicide attempts, respectively.Conclusions A powerful graded relationship exists between adverse childhood experiences
and risk of attempted suicide throughout the life span. Alcoholism, depressed
affect, and illicit drug use, which are strongly associated with such experiences,
appear to partially mediate this relationship. Because estimates of the attributable
risk fraction caused by these experiences were large, prevention of these
experiences and the treatment of persons affected by them may lead to progress
in suicide prevention.
Thoroughly updated with DSM-5 content throughout, Principles of Trauma Therapy, Second Edition: DSM-5 Update is both comprehensive in scope and highly practical in application. This popular text provides a creative synthesis of cognitive-behavioral, relational, affect regulation, mindfulness, and psychopharmacologic approaches to the "real world" treatment of acute and chronic posttraumatic states. Grounded in empirically-supported trauma treatment techniques and adapted to the complexities of actual clinical practice, this book is a hands-on resource for front-line clinicians, those in private practice, and graduate students of public mental health
Research into suicide is increasing so rapidly that a new textbook summarizing the field is needed every few years; simply updating the last such volume will not do. The current volume, edited by Robert Simon and Robert Hales and featur-ing a distinguished group of contributors, is a more than wor-thy successor to comparable past textbooks on suicide. In-tended for the practicing clinician, it provides important new insights and perspectives. Robert Simon's introductory chapter, "Suicide Risk: Assess-ing the Unpredictable," is a thorough explication of the possi-bilities and limitations of suicide risk assessment. The subse-q u e n t in d iv id u a l c h a p te rs p re se n t a n u p -to -d a t e, comprehensive treatment of almost every aspect of suicide risk assessment: age, gender, social and cultural factors, psy-chiatric diagnosis, prevention, treatment setting, and type of treatment. Simon and Hales also include special subjects ranging from murder-suicides to the aftermath of suicide not only for family survivors but also for psychiatrists who had been treating patients who killed themselves. Virtually every chapter offers information that is helpful in understanding and treating affected patients. Most of the chapters attempt to translate advances in our knowledge through research into practical information that the clinician can use. The chapters that achieve this best are outstanding, such as Jan Fawcett's chapter on assessing suicide risk in de-pressed patients.
Although early-onset, repeated trauma is relatively common in
socially marginalized populations and related to numerous negative
outcomes, most empirically validated interventions are not
especially well tailored to meet the complex and individualized
needs of child and adolescent trauma survivors in such contexts.
Integrative treatment of complex trauma (ITCT) was developed
as a specialized treatment that is empirically informed, culturally
sensitive, extendable beyond the short term, and customized
to the specific social and psychological issues of each child. This
article examines the potential effectiveness of ITCT in assisting
151 traumatized children living in an economically deprived
environment. Results indicate significant reductions in anxiety,
depression, posttraumatic stress, anger, dissociation, and sexual
concerns as a function of time in treatment.
Objectives: This study examines patterns of endorsements of active suicide ideation (SI), passive SI (synonymous with death ideation), and psychological distress (i.e., depressive and anxious symptomatology) in a sample of vulnerable older adults.Methods: Data were collected via in-home interviews with aging services care management clients aged 60 years and older (n = 377). The Paykel scale for suicide measured the most severe level of suicidality over the past year, and the ninth item of the Patient Health Questionnaire (PHQ-9) measured current passive/active SI. The remaining items from the PHQ (i.e., PHQ-8) and the Goldberg Anxiety scale measured distress.
Latent class analysis revealed a four-class model: a group with mild distress and no active SI, a group with high distress and no ideation, a group with mild distress and both passive and active SI, and a group with high distress and both passive and active SI.Discussion: Results indicate that passive SI rarely presents in vulnerable older adults in the absence of significant risk factors for suicide (i.e., psychological distress or active SI). Thus, the desire for death and the belief that life is not worth living do not appear to be normative in late life.
The purpose of the current study was to determine if college students' retrospective reports of family-of-origin physical abuse were related to their current reports of depressed symptomology, hopelessness, and suicidal and life-threatening behavior. Consistent with hypotheses, abuse by a parent (physical and psychological) and physical perpetration toward a parent were associated with increased rates of suicidal and life-threatening behavior. Gender of the parent was also shown to be important as symptoms of depression were related to mother but not father victimization and perpetration. Contrary to expectation, witnessing parental spouse abuse was not associated with young adults' current symptoms of depression, hopelessness, and suicidal and life-threatening behavior. These findings were interpreted with regard to the intergenerational transmission of violence theory.
This work provides realistic standards of care and a high-quality working model for the assessment, management and treatment of the suicidal patient in both inpatient and outpatient contexts. It also gives detailed suggestions for optimal clinical practice, along with risk management strategies.
This article reviews the research on the relationship between a reported history of sexual abuse and subsequent suicidal behavior. Based on this review, it is suggested that a conclusion that childhood sexual abuse (CSA) is a significant risk factor for subsequent suicidal ideation, attempts, and completed suicides is premature. Identified limitations of the existing research include the lack of consistency in definitions of CSA and suicidality, issues related to sample selection and causality interpretations, and the absence of theoretical grounding.
Although early-onset, repeated trauma is relatively common in socially marginalized populations and related to numerous negative outcomes, most empirically validated interventions are not especially well tailored to meet the complex and individualized needs of child and adolescent trauma survivors in such contexts. Integrative treatment of complex trauma (ITCT) was developed as a specialized treatment that is empirically informed, culturally sensitive, extendable beyond the short term, and customized to the specific social and psychological issues of each child. This article examines the potential effectiveness of ITCT in assisting 151 traumatized children living in an economically deprived environment. Results indicate significant reductions in anxiety, depression, posttraumatic stress, anger, dissociation, and sexual concerns as a function of time in treatment.
The present study examined the impact of the developmental timing of trauma exposure on posttraumatic stress disorder (PTSD) symptoms and psychosocial functioning in a large sample of community-dwelling older adults (N = 1,995). Specifically, we investigated whether the negative consequences of exposure to traumatic events were greater for traumas experienced during childhood, adolescence, young adulthood, midlife, or older adulthood. Each of these developmental periods is characterized by age-related changes in cognitive and social processes that may influence psychological adjustment following trauma exposure. Results revealed that older adults who experienced their currently most distressing traumatic event during childhood exhibited more severe symptoms of PTSD and lower subjective happiness compared with older adults who experienced their most distressing trauma after the transition to adulthood. Similar findings emerged for measures of social support and coping ability. The differential effects of childhood compared with later life traumas were not fully explained by differences in cumulative trauma exposure or by differences in the objective and subjective characteristics of the events. Our findings demonstrate the enduring nature of traumatic events encountered early in the life course and underscore the importance of examining the developmental context of trauma exposure in investigations of the long-term consequences of traumatic experiences. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
The associations of various forms of sexual and physical assault with a history of suicide attempts and recent suicide ideation were studied in two distinct samples: active duty military and undergraduate students. A total of 273 active duty Air Force personnel and 309 undergraduate students anonymously completed self-report surveys of assault victimization, emotional distress, belongingness, recent suicide ideation, and previous suicide attempts. Among military personnel, rape, robbery, or violent assault was associated with a nonsignificant trend toward increased risk for suicide attempts, whereas physical abuse or battering as an adult was significantly associated with recent suicide ideation. Among undergraduates, unwanted sexual experiences as an adult and physical or sexual abuse as a child were significantly associated with increased risk for suicide attempt, but only unwanted experiences as an adult was significantly associated with increased risk for suicide ideation. Experiencing multiple forms of assault increased risk for suicide attempts and ideation in both groups. Results suggest that different types of assault contribute differentially to suicide risk in military versus undergraduate populations, but experiencing multiple types of assault is associated with increased risk in both groups.
This study investigated the relationship among childhood sexual abuse and parental alcoholism, retroscpective reports of family functioning, and having had a history of either suicidal ideation or suicide attempts. Subjects were drawn from a sample of undergraduate college women. Results demonstrated that the experiences of childhood sexual abuse and parental alcoholism independetly predicted higher levels of suicidality. In addition, subjects' reports of past family conflict were associated with higher levels of suicidality, whereas reports that families were cohesive, fostered expressiveness and indpendence, engaged in intellectual-cultural recreational opportunities, and emphasized moral-religous values were associated with decreased risk. Regression models were found useful in describing the joint effects of childhood adversity and family environment.
It is now well accepted that the assessment, management, and treatment of suicidality in clinical practice is one of the most challenging and stressful tasks for any clinician (Jobes, 1995). The literature in suicidology routinely differentiates among treatment, treatment outcome, and risk assessment (e.g., Rudd, Joiner, & Rajab, 2000), with no clear theoretical link across the three areas. Additionally, there has been limited work addressing content versus process issues in each area specific to suicide risk assessment. The current theory being offered focuses specifically on the risk assessment process, not treatment outcome. Furthermore, its focus is not on the specific content of risk assessment (i.e., what questions to ask across what content domains). A considerable amount is known about the content of risk assessment (e.g., Rudd et al., 2000). This is a fairly significant departure from the routine in suicidology, but it is one I believe to be important for a number of reasons that are emphasized in this chapter. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The assessment of risk for suicide in patients with major depression is a difficult task for professional psychologists. Not only is prediction itself a nearly impossible feat, but the literature is full of risk factors to which one should attend. Which of these factors are specific to the patient sitting before you? By combining clinical and empirical literature of major depression-specific risk factors with the reported behaviors of practicing psychologists, the authors present critical factors for assessing suicidal risk. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
"The APSAC Handbook on Child Maltreatment" provides . . . information for those who dedicate their working lives to alleviating the causes and consequences of child abuse and neglect. This . . . handbook covers physical and sexual abuse, all forms of neglect, and psychological maltreatment. Experts in a variety of specialized areas have designed each chapter to inform professionals in mental health, law, medicine, law enforcement, and child protective services of the most current empirical research and literature available as well as strategies for [assessment, treatment,] intervention and prevention. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study assessed whether some of the correlates of learned helplessness—depression, low self-esteem, and a maladaptive attributional style—are long-term consequences of child abused. In this study, 260 subjects were identified as physically abused, psychologically abused, both physically and psychologically abused, or nonabused, based on responses to the Child Abuse Questionnaire (CAQ).Subjects were tested for levels of nonclinical depression via the Beck Depression Inventory (BDI), for levels of self-esteem via the Rosenberg Self-Esteem Scale (RSE), and for the adaptiveness of attributional style via the Attributional Style Questionnaire (ASQ). It was hypothesized that each of the three abuse groups would differ from the control group on the three dependent measures; differences among the three abuse groups were also explored.Three one-way analyses of variance indicated that (1) BDI scores reflected a greater tendency toward depression in subjects reporting both types of abuse than in nonabused subjects or in subjects reporting either psychological or physical abuse, (2) subjects reporting psychological abuse only or both psychological and physical abuse showed lower self-esteem than did nonabused subjects, and (3) abused subjects did not seem to exhibit a more maladaptive attributional style than that of nonabused subjects. In addition, multiple linear regression analyses pointed to psychological abuse as a critical variable in predicting levels of depression, self-esteem, and attributional style, when physical abuse effects were controlled. Controlling for the effects of psychological abuse, however, indicated that physical abuse did not significantly contribute to the variance in these variables. Implications for the learned helplessness model and for future research are discussed. © 1992 Wiley-Liss, Inc.
Epidemiological and neurobiological perspectives about suicidality in borderline patients are described, highlighting how self-destructive and seemingly suicidal acts are their “behavioral specialty.” Principles for management, including the need for a primary clinician to oversee safety, and the pros and cons of both “contracting for safety” and hospitalization are presented. Clinical material is used to illustrate an approach that involves minimal initiative to rescue by therapists, a readiness to comply with patients' wishes for protection (the principle of false submission), and very active interpretation. This approach is contrasted with those advocated by Linehan and Kernberg.
Can knowing whether an adult client was abused as a child assist psychologists when assessing
suicidality? Reviewing the files of 200 outpatients revealed, in keeping with previous studies, that child
abuse was related not only to previous psychiatric admissions and younger age at first treatment and first
admission, but also to past and present suicidality. Current suicidality was predicted better by child sexual
abuse (experienced on average 20 years previously) than by a current diagnosis of depression. Evidence
that abuse histories are not routinely taken, and recommendations for why, and how, taking abuse
histories should be integrated into suicide assessment and treatment, are presented.
The multivariate relationship between interpersonal trauma, posttraumatic stress, affect dysregulation, and various avoidance behaviors was examined in a sample of 418 trauma-exposed participants from the general population. Structural equation modeling indicated that (a) suicidality, substance abuse, dissociation, and problematic activities such as self-injury and dysfunctional sexual behaviors were all indicators of a robust latent variable, named dysfunctional avoidance, (b) accumulated exposure to various types of interpersonal trauma was associated with this avoidance factor, and (c) the relationship between trauma and dysfunctional avoidance was independently mediated by both posttraumatic stress and diminished affect regulation capacity.
Many reports of treatments for suicidal patients claim effectiveness in reducing suicidal behavior but fail to demonstrate which treatment interventions, or combinations thereof, diminish suicidality. In this study, treatment manuals for empirically supported psychological treatments for suicidal patients were examined to identify which interventions they had in common and which interventions were treatment-specific.
Empirically supported treatments for suicidality were identified through a literature search of PsychLit and MEDLINE for the years 1970-2007, employing the following search strategy: [suicide OR parasuicide] AND [therapy OR psychotherapy OR treatment] AND [random OR randomized]. After identifying the reports on randomized controlled studies that tested effectiveness of different treatments, the reference list of each report was searched for further studies. Only reports published in English were included. To ensure that rated manuals actually correspond to the delivered and tested treatments, we included only treatment interventions with explicit adherence rating and scoring and with adequate adherence ratings in the published studies. Five manualized treatments demonstrating efficacy in reducing suicide risk were identified and were independently evaluated by raters using a list of treatment interventions.
The common interventions included a clear treatment framework; a defined strategy for managing suicide crises; close attention to affect; an active, participatory therapist style; and use of exploratory and change-oriented interventions. Some treatments encouraged a multimodal approach and identification of suicidality as an explicit target behavior, and some concentrated on the patient-therapist relationship. Emphasis on interpretation and supportive interventions varied. Not all methods encouraged systematic support for therapists.
This study identified candidate interventions for possible effectiveness in reducing suicidality. These interventions seem to address central characteristics of suicidal patients. Further studies are needed to confirm which interventions and which combinations thereof are most effective.
Suicidal behavior is a major problem worldwide and, at the same time, has received relatively little empirical attention. This relative lack of empirical attention may be due in part to a relative absence of theory development regarding suicidal behavior. The current article presents the interpersonal theory of suicidal behavior. We propose that the most dangerous form of suicidal desire is caused by the simultaneous presence of two interpersonal constructs-thwarted belongingness and perceived burdensomeness (and hopelessness about these states)-and further that the capability to engage in suicidal behavior is separate from the desire to engage in suicidal behavior. According to the theory, the capability for suicidal behavior emerges, via habituation and opponent processes, in response to repeated exposure to physically painful and/or fear-inducing experiences. In the current article, the theory's hypotheses are more precisely delineated than in previous presentations (Joiner, 2005), with the aim of inviting scientific inquiry and potential falsification of the theory's hypotheses.
The interpersonal-psychological theory of suicidal behavior (Joiner, 2005) holds that an individual will die by suicide if he or she has both the desire for suicide and capability to act on that desire. According to the theory, suicidal desire results from the convergence of two interpersonal states: perceived burdensomeness and thwarted belongingness. However, desire alone is not sufficient to result in death by suicide--a third component must be present: the acquired capability for suicide, which develops from repeated exposure and habituation to painful and provocative events. The purpose of this article is to discuss four viable and timely directions for future research, given the current status of the theory.
To determine how the experiences of child abuse and parental divorce are related to long-term mental health outcomes using a nationally representative adult sample after adjusting for sociodemographic variables and parental psychopathology.
Data were drawn from the National Comorbidity Survey (NCS, n=5,877; age 15-54 years; response rate 82.4%). Logistic regression models were used to determine the odds of experiencing lifetime psychiatric disorders and suicidal ideation and attempts.
Parental divorce alone was associated with some psychiatric disorders after adjusting for sociodemographic variables (AOR ranging from 1.30 to 2.37), while child abuse alone was associated with psychiatric disorders (AOR ranging from 1.39 to 6.07) and suicidal ideation (AOR=2.08; 95% CI=1.57-2.77) and attempts (AOR=1.54; 95% CI=1.02-2.31) after adjusting for sociodemographic variables. However, having experienced both parental divorce and child abuse together resulted in significantly increased odds for lifetime PTSD (AOR=9.87; 95% CI=6.69-14.55), conduct disorder (AOR=4.01; 95% CI=2.92-5.51) and suicide attempts (AOR=2.74; 95% CI=1.84-4.08) compared to having experienced either parental divorce or child abuse alone. These results were attenuated when further adjusting for parental psychopathology.
When the experience of parental divorce is accompanied with child abuse, the associations with some poor mental health outcomes are significantly greater compared to the impact of either parental divorce or child abuse on its own. Therefore, parental divorce is an additional childhood adversity that significantly contributes to poor mental health outcomes especially when in combination with child abuse. Parental psychopathology attenuated these relationships suggesting that it may be one possible mechanism to explain the relationships between child abuse, parental divorce, and psychiatric disorders and suicide attempts.
The relationships among adult attachment styles, interpersonal problems, and categories of suicide-related behaviors (i.e., self-harm, suicide attempts, and their co-occurrence) were examined in a predominantly psychiatric sample (N = 406). Both anxious and avoidant attachment styles were associated with interpersonal problems. In turn, specific interpersonal problems differentially mediated the relations between attachment style and type of suicide-related behaviors. These findings suggest the importance of distinguishing between these groups of behaviors in terms of etiological pathways, maintenance processes, and treatment interventions.
The existing literature on the long-term sequelae of child sexual abuse is reviewed. The evidence suggests that sexual abuse is an important problem with serious long-term sequelae; but the specific effects of sexual abuse, independent of force, threat of force, or such family variables as parental psychopathology, are still to be clarified. Adult women with a history of childhood sexual abuse show greater evidence of sexual disturbance or dysfunction, homosexual experiences in adolescence or adulthood, depression, and are more likely than nonabused women to be revictimized. Anxiety, fear, and suicidal ideas and behavior have also been associated with a history of childhood sexual abuse but force and threat of force may be a necessary concomitant. As yet, there is insufficient evidence to confirm a relation between a history of childhood sexual abuse and a postsexual abuse syndrome and multiple or borderline personality disorder. Male victims of child sexual abuse show disturbed adult sexual functioning. The relation between age of onset of abuse and outcome is still equivocal. Greater long-term harm is associated with abuse involving a father or stepfather and abuse involving penetration. Longer duration is associated with greater impact, and the use of force or threat of force is associated with greater harm.
Suicide is analyzed in terms of motivations to escape from aversive self-awareness. The causal chain begins with events that fall severely short of standards and expectations. These failures are attributed internally, which makes self-awareness painful. Awareness of the self's inadequacies generates negative affect, and the individual therefore desires to escape from self-awareness and the associated affect. The person tries to achieve a state of cognitive deconstruction (constricted temporal focus, concrete thinking, immediate or proximal goals, cognitive rigidity, and rejection of meaning), which helps prevent meaningful self-awareness and emotion. The deconstructed state brings irrationality and disinhibition, making drastic measures seem acceptable. Suicide can be seen as an ultimate step in the effort to escape from self and world.