Article

The independent effects of child sexual abuse and impulsivity on lifetime suicide attempts among female patients

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  • Instituto de Farmacología. Facultad de Medicina. UBA
  • VISN 20 Clinical Resource Hub
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Abstract

Child sexual abuse (CSA) is a causal agent in many negative adulthood outcomes, including the risk for life-threatening behaviors such as suicide ideation and suicide attempts. Traumatic events such as CSA may pose risk in the healthy development of cognitive and emotional functioning during childhood. In fact, high impulsivity, a risk factor for suicidal behavior, is characteristic of CSA victims. The current study aims to understand the relations among CSA, impulsivity, and frequency of lifetime suicide attempts among a female patient sample admitted for suicidal behavior. Participants included 177 female patients between the ages of 18 and 63 years admitted at two hospitals in Buenos Aires, Argentina. Number of previous suicide attempts and CSA were assessed via structured interviews, while impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11). A model of structural equations was employed to evaluate the role of impulsivity in the relation between CSA and suicide attempts. CSA (β=.18, p<.05) and impulsivity (β=.24, p<.05) were associated with the number of previous suicide attempts. However, impulsivity was not significantly associated with CSA (β=.09, p>.05). CSA and impulsivity are independently associated with lifetime suicide attempts among female patients with recent suicidal behavior.

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... Intraclass correlation coefficient (ICC) among reviewers was 0.87 (95% CI 0.71-0.96). Table 1 summarizes the characteristics of the reviewed studies (Arens et al., 2012(Arens et al., , 2014Bornovalova et al., 2011;Brodsky et al., 2008;Dal Santo et al., 2020;Daray et al., 2016;Dervic et al., 2006;Fanning et al., 2014;Lopez-Castroman et al., 2014;Marwaha et al., 2020;Oquendo et al., 2020;Perez et al., 2016;Rytilä-Manninen et al., 2018;Soloff et al., 2002). The total number of participants considering all A. Pérez-Balaguer et al. studies was 69.609. ...
... One article was of moderate quality; the other thirteen articles were of high quality. Table 2 summarizes the outcomes and assessment methods of the reviewed studies (Arens et al., 2012(Arens et al., , 2014Bornovalova et al., 2011;Brodsky et al., 2008;Dal Santo et al., 2020;Daray et al., 2016;Dervic et al., 2006;Fanning et al., 2014;Lopez-Castroman et al., 2014;Marwaha et al., 2020;Oquendo et al., 2020;Perez et al., 2016;Rytilä-Manninen et al., 2018;Soloff et al., 2002). ...
... Two studies were carried out in a sample of suicide attempters (Daray et al., 2016;Lopez-Castroman et al., 2014). One of them found that impulsive traits could be one of the links between childhood abuse and the severity of the suicidal behaviors. ...
Article
Childhood maltreatment is a known risk factor for the development of suicidal behavior. Possible mediators of the association between childhood maltreatment and suicide have been analyzed. Some studies have considered impulsivity as one of these mediators, but there are no previous reviews on this topic. We, therefore, present a systematic review and mediation meta-analysis of the literature summarizing the evidence on impulsivity as a mediator of the relationship between childhood maltreatment and lifetime suicidal behavior. This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The review was registered in the PROSPERO database. We searched PubMed, PsycINFO, WebOfScience, and EMBASE databases up to February 2021 to identify studies exploring the association between childhood maltreatment and suicide through impulsivity. Fourteen articles met the selection criteria and were included in the review. Seven articles could be included in the mediation meta-analysis. Impulsivity was a significant mediator of the relationship between childhood maltreatment and suicidal behavior in ten of the fourteen included studies. This result was confirmed using mediation meta-analysis (β = .06, 95% CI 0.03–0.10). Studies suggest that exposure to traumatic situations in childhood affects the proper neurobiological, cognitive, and affective development of individuals. This may increase impulsivity, which in turn would be related to an increased risk of suicide. The effects of childhood maltreatment and impulsivity may be both therapeutic targets of interest to reduce suicide rates.
... 7 In 2016, Daray et al found a significant and positive correlation between child sexual abuse and suicide attempts in young women. 8 In 2016, Martin et al studied the relationship between child abuse and suicide attempts in adulthood in Canada. Their results indicated that child abuse increases the risk of future suicide attempt to 1.77 times more, regardless of other factors. ...
... The results of this study are consistent with those of Fanning, Marin, and Daray. 8,9,13 The present results are congruent with those of Fanning et al, who studied child abuse and suicidal behavior in 2014 in the United States. In this study, people who had a history of child abuse had a higher number of suicide attempts than others. ...
... Their results showed a significant and positive correlation between sexual abuse and suicide attempts in young women. 8 This result is in agreement with the current result that showed that the correlation between sexual abuse and suicide is greater in women. Suicidal thoughts and attempts are more common in women who have been sexually abused, because these women have usually suffered sexual violence in addition to the abuse. ...
Article
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Background: Child abuse is defined as any act or omission which causes physical or psychological harassment and lasting effects on children. Injuries resulting from child abuse are widespread, and this trauma can lead to psychological problems in adulthood. Objective: The aim of this study was to investigate the correlation between a history of child abuse and suicide attempts. Methods: In this case-control and retrospective study, patients admitted in 2016 to the toxicity emergency center in Yazd city, Iran, with symptoms of attempted suicide and patients of other conditions were recruited. Participants in the control and case groups were matched for age, gender, marital status, and place of residence. Each patient was given a questionnaire to collect information on demographics, history of suicide attempt or suicide in other members of the family, and history of child abuse (self-report scale) which investigated five aspects of childhood abuse (sexual, physical, neglect, lack of nutrition, and emotional neglect). Results: The chi-square test and t test were used in the analysis. Mean severity rates of physical, sexual, neglect, nutrition, and emotional child abuse were 8.49, 6.42, 10.4, 6.43, and 9.62, respectively, for the case group and 7.89, 5.52, 7.88, 5.92, and 8.52, respectively, for the control group. Conclusion: Statistical analysis revealed that except for nutritional abuse cases, the incidence rates of all other aspects of child abuse were significantly higher among cases than in the control group. The results of this study showed that a history of child abuse, especially sexual and emotional types, are correlated with the incidence of attempted suicide.
... However, this is not always valid for suicide prediction or may lead to biased results. For example, previous studies showed that child sexual abuse and impulsivity were associated with the number of previous suicide attempts among female patients, so the inclusion of these variables in a regression model that requires independence would not be correct (Daray et al., 2016). ...
... Interestingly, the genetic market and young age were the most important predictor across both models, confirming this variable as supplying the highest predictive power for a subsequent SA (Christiansen and Jensen, 2007;Daray et al., 2018;Grendas et al., 2019). Surprisingly, childhood sexual abuse has often been found to be associated with SA (Afifi et al., 2016;Daray et al., 2016;Turecki and Brent, 2016), which is confirmed by the RSF, but they were not detected by Cox regression. The ML model seems to be more sensitive to detect SA predictors than the Cox regression model. ...
Article
Background Despite considerable research efforts during the last five decades, the prediction of suicidal behaviour (SB) using traditional model-based statistical has been weak. This marks the need to explore new statistical methods. Objective To compare the performance of Cox regression models versus Random Survival Forest (RSF) to predict SB. Methods Using a data set of more than 300 high-risk suicidal patients from a multicenter prospective cohort study, we compare Cox regression models with RSF to address predictors of time to suicide reattempt. Cross-validation was used to assess model prediction performance, including the area under the receiver operator curve (AUC), precision, Integrated Brier Score (IBS), sensitivity, and specificity. Results A variant of the RSF denominated the RSFElimin, in which irrelevant predictor variables were eliminated from the model, presented the best accuracy, sensitivity, AUC and IBS. At the same time, the sensitivity of this method was slightly lower than that obtained with the Cox regression model with all predictor variables (CoxComp). Conclusion The RSF, a machine learning model, seems more sensitive and precise than the traditional Cox regression model in predicting suicidal behaviour.
... Unfortunately, child sexual abuse has psychological and emotional implications on the well-being of child victims. This supports Borg et al. (2014), Daray et al. (2016) and Widom and Massey (2015) who postulate that child sexual abuse has life-long devastating impact on the well-being of the child victim. Widom and Massey further state that this social ill has serious physical, psychological, social and health consequences. ...
... However, sexual abuse incidents leave children under serious consequences due to the secrecy of sexual abuse amongst family members. This has been confirmed in several studies that child sexual abuse has serious implications on children (Borg et al., 2014;Daray et al., 2016;Rapholo, 2014 ...
Article
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Child sexual abuse is a global public health issue calling the attention of practitioners, scholars and policy makers to address it. This study argues that children are being sexually abused both by family and non-family members, and such incidents are not always reported and/or disclosed due to various influential factors. This study was aimed at exploring and describing possible influential factors for the non-disclosure of child sexual abuse amongst Bapedi tribe. A qualitative approach with a descriptive phenomenological design was followed. Fifteen caregivers of children were purposively selected in order to pursue the aim of this study. Data was collected through semi-structured interviews and analysed thematically through the help of Nvivo Software. The findings indicate that due to factors such as fear of the perpetrator, the practice of the spirit of ubuntu, socio-economic status of the family and relationship with the perpetrator, protecting the dignity of the family, fear of victimisation, fear of witchcraft, and cultural beliefs, child sexual abuse in the Bapedi tribe is an issue to be dealt with by families affected and if need be, traditional courts intervene in case the families disagree. It can therefore be concluded that there is a lack of information on the nastiness of child sexual offences against children amongst Bapedi tribe. Therefore, the Bapedi tribe must be empowered to disclose and/or report child sexual abuse and the implications of not doing so.
... Mental health factors such as anxiety, depression, and alcohol and illicit substance use have been found to be associated with suicidal behaviors among adolescents (Capron, Allan, Ialongo, Leen-Feldner, & Schmidt, 2015;Gart & Kelly, 2015;Horwitz, Berona, Czyz, Yeguez, & King, 2017). Also, adverse childhood experiences such as emotional, physical, and sexual abuse, and neglect have been identified as major predictors of suicidal ideation (Doorley, Williams, Mallard, Esposito-Smythers, & McGeary, 2017;Mossige, Huang, Straiton, & Roen, 2016) and suicide attempt (Daray et al., 2016). Feelings of loneliness (Lamis, Ballard, & Patel, 2014) and isolation (Endo et al., 2017;Miranda, Jaegere, Restifo, & Shaffer, 2014) have similarly been found to be significant predictors of suicidal ideation and suicide attempt among adolescents. ...
... Although the prevalence of suicide attempt is often lower than suicidal ideation among adolescents (e.g., (Thullen, Taliaferro, & Muehlenkamp, 2016), it is interesting to note that in this study, the proportion of adolescents who attempted suicide in the past year was greater than the proportion of adolescents who experienced suicidal ideation. Some scholars have suggested that high levels of impulsivity may explain why some adolescents may attempt suicide without first experiencing suicidal ideation (Auerbach, Stewart, & Johnson, 2017;Daray et al., 2016). The concept of impulsivity as it relates to sensation seeking, frequent engagement in acting out behaviors, lack of perseverance, and engagement in violent and risk taking behaviors, such as dangerous driving (Pedersen & McCarthy, 2008), substance use (Charles et al., 2016), risky sexual behaviors (Dir, Coskunpinar, & Cyders, 2014), and suicidal behaviors (Glenn & Klonsky, 2010;You & Leung, 2012) has been studied extensively. ...
Article
Full-text available
This paper examined the effect of bullying victimization on suicidal ideation and suicide attempt among adolescents in Ghana. Data on 1,633 students ages 14–18 years (50.6% males) were analyzed using logistic regression. We found that 17% of the 1,633 adolescents examined reported experiencing suicidal thoughts and about 21% of the 1,633 adolescents attempted suicide at some point during the past year. Prevalence of bullying was reported among 40% of the adolescents. Importantly, we found that the experience of bullying victimization was a significant predictor of both suicidal ideation and suicide attempt. While factors such as loneliness, anxiety, and use of illicit substances were positively associated with suicidal behaviors, participating in physical activity, having friends, and parental support reduced the likelihood of experiencing suicidal ideation. We make several policy recommendations, including educational programs on suicidal behaviors, antibullying interventions, and social support programs within schools and other social settings.
... Higher familial impulsivity may lead to a more chaotic family environment that allows these other adversities to unfold. History of maltreatment, in turn, influence cognitive and emotional development, which intensify the risks of impulsivity and poor constraint over harmful behaviors (Braquehais et al., 2010;Daray et al., 2016). Inhibitory control shared by patients and relatives as an impulsivity dimension fosters dysfunctional behaviors such as maltreatment and suicide behavior. ...
... The reasons for relatives and patients to present dysfunctional may be diverse, possibly involving learnt behavior, developmental interferences of one behavior over another as well as shared genetic aspects that this study could not assess. That is, above and beyond the genetic influences, maltreatment has been shown to predict impulsivity over time (Braquehais et al., 2010;Daray et al., 2016). Current findings indicated that inhibitory control and emotional abuse set the stage for recurrent suicide attempts rather than single attempts. ...
Article
Full-text available
Introduction: Impulsivity is a core characteristic of bipolar disorder and it was observed as elevated in individuals with the disorder and in their relatives. Both impulsivity and history of maltreatment are risk factors for suicide attempts, however, these two key variables may not be independent, given the fact that parental impulsivity and associated social context could increase the risk of child maltreatment. In this study it was examined the association between the impulsivity of relatives and child maltreatment taking into consideration the conjoint and unique effects of these two variables on the risk of suicide attempts among the patients. Materials and Methods: Participants of the study consisted of 117 patients diagnosed with bipolar disorder and 25 first-degree relatives. Linear regression model was conducted to describe associations between facets of impulsivity of relatives and levels of child maltreatment reported by patients. The independent associations of suicide attempt history with the dimensions of impulsivity of the patient and maltreatment were tested by multinomial logistic regression. Results: Impulsivity of relatives and, more specifically, inhibitory control can predict the maltreatment of the patient. Inhibitory control and emotional abuse were related, conjointly, to a greater likelihood of having a history of more than one suicide attempt. Discussion: Considering that the impulsivity of relatives predicts child maltreatment, it is possible that a genetically shared impulsivity is an underlying feature associated with the history of multiple suicide attempts. These findings highlight the importance of considering child maltreatment, impulsivity and suicide attempt history in integrative models.
... Jakubczyk et al. (2014) revealed that history of SA was an independent risk factor for suicide attempts in alcoholic individuals. Daray et al. (2016) indicated that SA independently was associated with lifetime suicide attempts among female patients with suicidal behaviors. Also, additional studies found that SA had more correlation with suicide ideation and lifetime suicide attempt than other CT dimensions (O'Leary and Gould, 2009;Bedi et al., 2011;Maniglio, 2011;Stewart et al., 2015;Rabinovitch et al., 2015). ...
... The results of this study revealed that among CT dimensions, only SA was linked to suicide ideation. This finding was in line with previous studies (O'Leary and Gould, 2009;Bedi et al., 2011;Maniglio, 2011;Jakubczyk et al., 2014;Rabinovitch et al., 2015;Stewart et al., 2015;Daray et al., 2016). On the other hand, it was not consistent with Norman et al. (2012) which revealed that both PA and EA increased the probability of making a suicide attempt by more than three times. ...
Article
The aim of this study was to evaluate the relations of childhood trauma (CT) and obsessive-compulsive (OC) symptom dimensions to suicide ideation in patients with obsessive-compulsive disorder (OCD). Seventy OCD outpatients with lifetime suicide attempts and 60 controls were included. Participants completed the Scale for Suicide Ideation (SSI), the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Dimensional Obsessive-Compulsive Scale (DOCS) and the Depression Anxiety Stress Scales (DASS-21). Among OCD patients, 97.1% had current suicide ideation. OCD patients revealed higher scores on CT, suicide ideation, depression and anxiety than controls. The CT history of sexual abuse (SA) and OC symptom dimension of unacceptable thoughts explained suicide ideation. It was concluded that SA and unacceptable thoughts may contribute to high suicidality and have important implications for the assessment and treatment of suicide risk in OCD patients with lifetime suicide attempts.
... Jakubczyk et al. (2014) revealed that history of SA was an independent risk factor for suicide attempts in alcoholic individuals. Daray et al. (2016) indicated that SA independently was associated with lifetime suicide attempts among female patients with suicidal behaviors. Also, additional studies found that SA had more correlation with suicide ideation and lifetime suicide attempt than other CT dimensions (O'Leary and Gould, 2009;Bedi et al., 2011;Maniglio, 2011;Stewart et al., 2015;Rabinovitch et al., 2015). ...
... The results of this study revealed that among CT dimensions, only SA was linked to suicide ideation. This finding was in line with previous studies (O'Leary and Gould, 2009;Bedi et al., 2011;Maniglio, 2011;Jakubczyk et al., 2014;Rabinovitch et al., 2015;Stewart et al., 2015;Daray et al., 2016). On the other hand, it was not consistent with Norman et al. (2012) which revealed that both PA and EA increased the probability of making a suicide attempt by more than three times. ...
... Jakubczyk et al. (2014) revealed that history of SA was an independent risk factor for suicide attempts in alcoholic individuals. Daray et al. (2016) indicated that SA independently was associated with lifetime suicide attempts among female patients with suicidal behaviors. Also, additional studies found that SA had more correlation with suicide ideation and lifetime suicide attempt than other CT dimensions (O'Leary and Gould, 2009;Bedi et al., 2011;Maniglio, 2011;Stewart et al., 2015;Rabinovitch et al., 2015). ...
... The results of this study revealed that among CT dimensions, only SA was linked to suicide ideation. This finding was in line with previous studies (O'Leary and Gould, 2009;Bedi et al., 2011;Maniglio, 2011;Jakubczyk et al., 2014;Rabinovitch et al., 2015;Stewart et al., 2015;Daray et al., 2016). On the other hand, it was not consistent with Norman et al. (2012) which revealed that both PA and EA increased the probability of making a suicide attempt by more than three times. ...
... As risk factors and protective factors vary across cultures, it is essential to discuss the long-term consequences of CSA in the South Asian region (Sanjeevi et al., 2018). CSA is related to a higher threat of suicidal attempts and self-injurious behaviour (Daray et al., 2016). ...
Article
Background Sexual abuse is a global issue and happens in every culture and country. It is a risk factor for developing several mental disorders and suicide. While there are many studies on the relationship between childhood sexual abuse (CSA) and suicide, there are no reviews on this association from South Asia. Aims A scoping review to explore the association between CSA and suicidal behaviour in South Asian countries. Method A literature search was conducted with Databases PubMed/Medline, Google Scholar, and Scopus from 1st January 2001 to 31st December 2020 for articles related to child sexual abuse and suicidal behaviour. Studies from Afghanistan, Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka were included in the search. Results Among 356 articles found, 45 publications were further evaluated based on exclusion and inclusion criteria, and 12 papers that reported quantitative outcomes of the association between CSA and suicidal experiences were included in the review. There were no eligible studies from Afghanistan, Pakistan, Nepal, and the Maldives. Due to the limited number of publications and the heterogeneity of the studies, a meta-analysis was not conducted. Most studies indicated that CSA is a risk factor for suicidal behaviour or suicide later in life. Further, cultural barriers prevent the disclosure of CSA in Asian communities. Conclusions There is an association between CSA and suicidal behaviour in South Asian countries. Future studies should target socio-cultural aspects to develop preventive programs for CSA and later suicide.
... Every day around the world thousands of children are added to this list of being traumatized forever or losing their lives [8]. It is evident from the statistics that the laws alone can not keep children out of the perpetrator's grasp [9]. ...
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The objectives of this study are understanding the requirements of a CSA education app, identifying the limitations of existing apps, and providing a guideline for better app design. An electronic search across three major app stores(Google Play, Apple, and Microsoft) is conducted and the selected apps are rated by three independent raters. Total 191 apps are found and finally, 14 apps are selected for review based on defined inclusion and exclusion criteria. An app rating scale for CSA education apps is devised by modifying existing scales and used to evaluate the selected 14 apps. Our rating scale evaluates essential features, criteria, and software quality characteristics that are necessary for CSA education apps, and determined their effectiveness for potential use as CSA education programs for children. The internal consistency of the rating scale and the inter and intra-rater reliability among the raters are also calculated. User comments from the app stores are collected and analyzed to understand their expectations and views. After analyzing the feasibility of reviewed apps, CSA app design considerations are proposed that highlight game-based teaching approaches. Evaluation results showed that most of the reviewed apps are not suitable for being used as CSA education programs. While a few may be able to teach children and parents individually, only the apps "Child Abuse Prevention" (rate 3.89 out of 5) and "Orbit Rescue" (rate 3.92 out of 5) could be deemed suitable for a school-based CSA education program. However, all those apps need to be improved both their software qualities and CSA-specific features for being considered as potential CSA education programs. This study provides the necessary knowledge to developers and individuals regarding essential features and software quality characteristics for designing and developing CSA education apps.
... Violence in childhood, particularly sexual abuse, is devastating because of its long-term detrimental consequences that thwarts the child's impending growth as an adolescent and healthy adult (Voith et al., 2017 We found 12 models of potential interventions among adult victims of CSA, in which those who proposed to offer treatment demonstrated that they were able to reduce some of the symptoms presented by the survivors. The symptoms presented by the victims are very variable; however, the outcomes associated with this experience are consistent with that presented in the literature such as depressive symptoms (Chen et al., 2014;Fergusson et al., 2013;Li et al., 2020), anxiety (Fergusson et al., 2013;Maniglio, 2013), PTSD (Hartley et al., 2016;Robinaugh & McNally, 2011), interpersonal difficulties (Gamble et al., 2011;Krupnick et al., 2008), suicidal behaviours and self-harm (Daray et al., 2016;Obikane et al., 2018), mental health and physical problems and lower quality of life (Kamiya et al., 2016) and sexual behaviour problems (Hailes et al., 2019;Ports et al., 2016). ...
Article
Child sexual abuse (CSA) is a phenomenon that is ubiquitous to all cultures and social classes. It has short‐ and long‐term consequences, with specific treatment models that have been developed and adapted from psychological intervention models. A wide variety of studies have sought to evaluate the results of treatments with adult child sexual abuse survivors. This study presents an overview of research on the treatment of adult victims of CSA, by reviewing the existing literature on the types of treatment and the most studied psychotherapeutic avenues, and reports the findings related to the efficacy of these treatments. It is possible to conclude that psychological intervention exhibits benefits in the reduction of symptoms resulting from the experience of CSA, and demonstrated the need to conduct further research on the effectiveness of intervention.
... The results of this study revealed that childhood trauma, particularly emotional neglect, physical neglect, and sexual abuse, was higher in OCD patients with suicide attempts. This finding was consistent with previous studies (10,(30)(31)(32)(33). Khosravani et al. (10) compared 70 OCD patients with 60 healthy controls. ...
Article
Full-text available
Objective: The aim of this research is to determine the differences in childhood traumas and the probability of suicide in obsessive-compulsive disorder (OCD) patients with and without suicide attempts. Method: Sixty-five OCD patients without suicide attempt history and 39 OCD patients with a history of suicide attempts were included in the study. To measure the clinical variables The Childhood Trauma Questionnaire (CTQ), Suicide Probability Scale, Yale-Brown Obsessive-Compulsive Scale and Beck Depression Inventory were applied. Results: We found that the OCD group with suicide attempts was significantly higher than the OCD group without a suicide attempt due to emotional neglect, physical neglect, sexual abuse, and CTQ total scores. Aggression and sexual obsessions were higher in the OCD group who has attempted suicide. Obsessive-compulsive symptoms, depression and insight scores of OCD patients with suicide attempts were worse than OCD patients without suicide attempts. Also, correlations were observed between childhood traumas and suicidal probability scores. Conclusion: This study showed that childhood traumas may be a contributing factor to suicide probability and attempt in patients with OCD. Moreover, this study reveals that the current probability of suicide is a higher risk in OCD patients who had previously attempted suicide in the past. Keywords: Childhood trauma, lifetime suicide attempt, obsessive-compulsive disorder, suicide
... It is becoming very clear that projecting adult sexual attitudes onto children hinders the experience of childhood innocence and is traumatising [56,69]. Further, victims of childhood sexual assault are at risk of mental health conditions such as depression, anxiety, suicide idealisation, and borderline personality disorder, just to name a few [70]. Contemporary research indicates that child abuse is a widespread, intergenerational problem that is under-reported; further, it impairs healthy physical and emotional development [71]. ...
Article
Full-text available
The Oedipus complex is a child development construct developed by Sigmond Freud that asserts that all children experience sexual desire towards their opposite sex parent, and failure to accept this “truth” can lead to mental health issues. Freud also asserted that children are not harmed by acts of sexual violence. In contrast, the #MeToo movement is a global incentive aimed at creating an awareness of the harm that sexual violence can cause. In many regards, #MeToo is a reaction against a systemic failure to prevent sexual violence from occurring in the first place. By contrasting Freudian ideas with #MeToo, I argue that the enduring popularity of Freud and his psychoanalytic ideas is a negative influence on culture. In the light of contemporary research from cognitive psychology, psychosocial considerations, child development, and trauma-informed practices, Freudian ideas can be proven to be fallible. Moreover, dispelling misleading assumptions about sexual desires is a beneficial endeavour towards reducing the likelihood of future sexual violence. Additionally, I explore Freudian interpretations of mythology and propose that he misappropriated ancient belief systems.
... A growing body of research has linked these adverse childhood experiences with physical and mental health problems, which include heart problems, strokes, or cancer (Hughes et al., 2017); mood, anxiety, and obsessive-compulsive and related mental health problems (Afifi et al., 2008;Carr et al., 2013;Merrick et al., 2017;Khalifeh et al., 2015). Furthermore, traumatic childhood events have been associated with suicidal thoughts and behaviors (Brezo et al., 2008;Daray et al., 2016;Sunami et al., 2017). ...
Article
There is robust evidence for relationships between adverse events experienced in childhood and mental health problems experienced as an adult. However, the measurement of perceptions of different types of adverse relationships in childhood, especially those that are in social contexts, is lacking. Given the absence of an appropriate tool to measure perceptions of adverse social relationships in childhood within English-speaking populations, we endeavored to examine the construct validity of the English version of the History of Social Punishment (HoSP) scale. In total, 557 adults from the extant community participated by completing self-report scales that measured perceptions of adverse childhood relationships, symptoms of depression, obsessive-compulsive disorder (OCD), hoarding disorder (HD), body dysmorphic disorder (BDD), and suicidal experiences. Results demonstrated that the HoSP is a sound psychometric tool to evaluate perceptions of adverse social relationships within English-speaking populations. A strong association between perceptions of adverse social relationships in childhood, common mental health problems, and suicidal behaviors was established. These results provide robust evidence for the importance of screening for experiences of social adversities and for developing clinical interventions that directly target these experiences.
... The number of reported CSA may seem insignificant, but the total amount is much greater. Child sexual abuse can have very serious and negative social and psychological effects (Baker, Gleason, Naai, Mitchell, & Trecker, 2013;Daray et al., 2016;Sanjeevi et al., 2018) on children and their families as well as on academic performance (Wurtele, 2009). They also have other psychopathological effects (Beach et al., 2013) and may cause Post Traumatic Stress Disorders (PTSD) (Barrera, Calderón, & Bell, 2013;Mokma, Eshelman, & Messman-Moore, 2016;O'Driscoll & Flanagan, 2016). ...
Article
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The research aimed at assessing Muhammadiyah Elementary Schools' children's knowledge and skill in protecting themselves from CSA by analyzing them based on gender. It applied a quantitative method with descriptive statistical and inferential analysis designs. The samples amounted to 301 fifth-grade students from 10 Muhammadiyah Elementary Schools in Surakarta, Central Java, Indonesia. They were asked to complete the questionnaires of the "What If" Situation Test (WIST-III), adapted to an Indonesian context. When testing comprehension of touching situations, it was found that less than half of the respondents could identify appropriate touching situations (42%, M = 1.99, SD = ±1.04). There was a significant difference in the appropriate touching situation between males (M = 2.26, SD = ±1.9) and females (M = 1.76, SD = ±1.09). However, the ability to tell someone about the sexual abuse incident was very low, and a significant difference was found between females (p = .029, M = 1.7, SD = ± 2.3) and males (p = .029, M = 1.55, SD = ± 2.11). Only two per cent of the children achieved the maximum skills score. A CSA preventive program must be focused on building and developing children with regards to the skills to protect themselves from CSA by referring to cultural and Islamic values.
... CSA violates the UN Convention of the Rights of the Child aiming to protect the child from all forms of sexual exploitation and sexual abuse (UNICEF 2004, p. 10). CSA has serious social, psychological, and physical health consequences (Widom and Massey 2015), oftentimes with a life-long devastating impact (Borg et al. 2014;Daray et al. 2016). ...
Article
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Most of the foregoing research on child investigative interviewing has focused on interview practices in Western countries, thus potentially limiting the generalizability and application of the findings to improve interview practices in non-Western countries. The current studies are the first to examine police interviewing practices involving alleged child sexual abuse (CSA) victims in Indonesia which has marked cultural differences compared with Western countries. In Study 1, we presented Indonesian police child interviewers (N = 26) with a sexual abuse case vignette concerning a 7-year-old girl. Police interviewers were asked to write down the questions they would pose to the child. We categorized questions into four types: open-prompts, directives, option-posing, and suggestive. In Study 2, we examined Indonesian police files (N = 24) containing child sexual abuse interviews and also scored the type of questions used as per the first study. We compared our data with those obtained in Western countries. The consistent finding in both studies is that Indonesian police interviewers rarely used open-prompts, asked more directive and option-posing questions. Consistent with findings from Western countries, our studies provide indirect evidence that open-prompts may be infrequently used by forensic child interviewers in Indonesia.
... Although there is evidence that family history of suicidal behavior and childhood sexual abuse increase vulnerability for suicidal behavior ( Daray et al., 2016;Gould, Fisher, Parides, Flory, & Shaffer, 1996;Joiner et al., 2007;Rodante et al., 2016;Simon, 2011), family history of suicidal behavior and childhood sexual abuse have not been studied independently in patients at high risk for suicide. The current study aims to address this gap in the literature by comparing suicide-related factors as a function of two important components of the diathesis for suicide risk: 1) family history of suicidal behavior and 2) childhood sexual abuse among a diverse high-risk suicidal patient sample. ...
Article
The current study aimed to compare suicide-related variables as a function of 1) family history of suicidal behavior and 2) child sexual abuse among patients hospitalized for a suicide attempt or active suicidal ideation. Family history of suicidal behavior and child sexual abuse were examined independently and in combination as a diathesis for a high-risk suicidal phenotype. A multicenter cross-sectional study was designed to compare data obtained from 292 patients hospitalized for suicidal behavior. Demographic and clinical variables were compared among Group 1 (patients who reported both family history of suicidal behavior and child sexual abuse), Group 2 (patients who reported only family history of suicidal behavior), Group 3 (patients who reported only child sexual abuse), and Group 4 (patients who did not report family history of suicidal behavior or childhood sexual abuse). A multinomial logistic regression was used to examine suicide-related variables associated with each group and to compare differences between groups. Group 1 and 3 endorsed a higher number of previous suicide attempts and were more likely to be younger at the first suicide attempt compared to Group 4. Group differences remained after adjustment in a multinomial regression model. The current findings suggest that child sexual abuse may be more strongly related to suicide risk among high risk patients than a family history of suicidal behavior.
... Childhood sexual abuse independently increased the risk of a suicide reattempt, and the risk was significantly higher among patients who also endorsed low psychosocial functioning, as compared to those with CSA and high psychosocial functioning. Child sexual abuse is a severe form of childhood trauma that increases the risk for lifetime suicide attempts (Afifi et al., 2016;Daray et al., 2016;Hoertel et al., 2015;Turecki and Brent, 2016). Rates of suicide among victims of CSA (Bostwick and Pankratz, 2000;Koola et al., 2018) are particularly concerning. ...
Article
Background: To meet the goal of preventing suicide the most important thing is to know the risk factors of suicidal behavior and understand their interaction. Aims: The current study aims to evaluate prospective predictors and the interaction between factors for suicide and suicide re-attempts in high-risk, suicidal patients during a 24 month prospective follow-up period. Methods: A multicenter prospective cohort study was designed to compare data obtained from 324 patients admitted to the emergency department for current suicidal ideation or a recent suicide attempt. Participants were clinically evaluated at baseline and follow-up every 6 months to assess any unfavorable events (suicide or a suicide attempt). To estimate the rate of unfavorable events, the Kaplan-Meier method was used and Cox Proportional Hazards Regression Model was employed to examine predictors of suicide and suicide reattempt. Results: The incidence of a new suicide attempt was 26,000 events/100,000 persons-years. The incidence of death by suicide was 1110 events/100,000 person-year. The most reliable predictors of unfavorable events were being women, previous suicide attempts, younger age, and childhood sexual abuse. Findings revealed an interaction between childhood sexual abuse and low psychosocial functioning that increased the risk of an unfavorable event. Conclusion: The risk of suicide re-attempts and suicide in the current 2-year follow-up was high. There was an interaction between low psychosocial functioning and childhood sexual abuse. This evidence should be taken into account for the evaluation and planning of preventive strategies.
... As such, reasons for associations between childhood adversity and some specific items in the current study may be more or less obvious. In some cases, these associations are predicted by previous research, for example, the association to recent harm to self (Afifi et al., 2008), multiple diagnoses (Sansone, Songer, & Miller, 2005), internalizing traits (Heleniak, Jenness, Stoep, McCauley, & McLaughlin, 2016), impulsivity (Daray et al., 2016), adult trauma (Arata, 2000), and aspects of interpersonal isolation and insecure attachment (Murphy et al., 2014). In other cases, plausible paths are apparent. ...
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Childhood abuse, neglect, and loss are common in psychiatric patients, and the relationship between childhood adversity and adult mental illness is well known. However, beyond diagnoses that are specifically trauma-related, such as posttraumatic stress disorder, there has been little research on how childhood adversity contributes to complex presentations that require more intensive treatment. We examined the relationship between childhood adversity and other contributors to clinical complexity in adult outpatients seeking mental health assessment. In a cross-sectional study, patients completed standard measures of psychological distress and functional impairment. Psychiatrists completed an inventory of clinical complexity, which included childhood abuse, neglect, and loss. Of 4,903 patients seen over 15 months, 1,315 (27%) both consented to research and had the measure of complexity completed. Childhood abuse or neglect was identified in 474 (36.0%) and significant childhood loss in 236 (17.9%). Correcting for multiple comparisons and controlling for psychiatric diagnosis, age, and sex, patients with childhood abuse or neglect were significantly more likely to also have 11 of 31 other indices of clinical complexity, with odds ratios ranging from 1.7 to 5.0. Both childhood abuse or neglect and childhood loss were associated with greater overall complexity (i.e., more indices of complexity, χ ² = 136 and 38 respectively, each p < .001). Childhood abuse and neglect (but not childhood loss) were significantly associated with psychological distress (Kessler Psychological Distress Scale [K10] score, F = 6.2, p = .01) and disability (World Health Organization Disability Assessment Scale 2.0 [WHODAS 2.0] score, F = 5.0, p = .03). Childhood abuse and neglect were associated with many characteristics that contribute to clinical complexity, and thus to suboptimal outcomes to standard, guideline-based care. Screening may alert psychiatrists to the need for intensive, patient-centered, and trauma-informed treatments. Identifying childhood adversity as a common antecedent of complexity may facilitate developing transdiagnostic programs that specifically target sources of complexity.
... The severity of BDP psychopathology has also been linked to severity of CSA (59). History of CSA is a well-recognized risk factor for SB (60)(61)(62)(63). Wedig et al. found CSA as a risk factor for suicide, which increased risk for SA 2 times fold during a twoyear follow-up (OR: 2.27, 95% CI: 1.69-3.05). ...
Article
Objetive To evaluate the incidence of suicidal outcomes and risk factors for short and long term recurrence of suicidal behavior (SB) among high‐risk borderline personality disorder (BPD) patients during a 24 month prospective follow‐up period. Methods A multicenter prospective cohort study was designed to compare data obtained from 136 patients admitted to the emergency department for current suicidal ideation (SI) or a recent suicide attempt (SA). Subjects were clinically evaluated and monitored for a new SA or suicide. Results The incidence of a new SA was 25.63 events/100 persons‐year and one patient died by suicide. Child sexual abuse (CSA) was the only significant predictor throughout the complete follow‐up period. The absence of prior psychiatric treatment predicts the recurrence of SB in the first 6 months of follow‐up. Patient age, poor psychosocial functioning before hospitalization, age at first SA, and having multiple suicide attempts increased risk of SB recurrence at the long term period (24th month). In addition, there was an interaction between CSA and poor social functioning that increased risk of SB. Conclusion The risk of recurrence was higher during the first 6 months. Risk factors at 6 and 24 months vary. These findings are important for implementing suicide strategies. This article is protected by copyright. All rights reserved.
... For example, retrospective studies show 1 3 that various childhood adversities including neglect, physical, psychological and sexual abuse during childhood were associated with several negative physical health outcomes such as abnormal hemoglobin levels, poor peak flow, oral health problems, heart disease, cancer and chronic lung disease in later life [11,12]. In addition to poor physical health outcomes, researchers have demonstrated that individuals who experienced childhood adversities have higher rates of several psychosocial problems including anxiety and depression [13,14], sleep problems [15], suicidal behaviours [16,17], aggression and attention deficit disorder [18], and personality disorders [19]. Together, the above evidence makes an important case for the inclusion of childhood adversity as a critical factor for understanding immigrant health in Canada. ...
Article
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Childhood adversity is known to have an enduring effect on health outcomes of victims. The objective of the study was to examine the association between childhood adversity and psychosocial health outcomes among immigrants in Canada. Using descriptive and inferential statistics and fitting negative loglog regression models to the 2014 General Social Survey, the paper examined the relationship between experience of childhood adversity (i.e. physical and sexual abuse before age 15) and its association with psychosocial health outcomes (i.e. psychological-mental condition and self-rated mental health) among immigrants in Canada. After accounting for relevant socioeconomic and demographic factors, the results show that physical abuse during childhood resulted in 29% and 31% increased likelihood of having a psychological mental condition and poor self-rated mental health, respectively. Also, sexual abuse during childhood was associated with 28% increased likelihood of poor self-rated mental health. In conclusion, the findings show that experience of physical and sexual abuse during childhood is associated with negative mental health outcomes in later life.
... Other studies find that a history of suicide attempts is associated with all CT dimensions except for physical neglect (Hassan et al., 2016), while other studies find that aspects of neglect are indeed associated (Xie et al., 2018;Prokopez et al., 2018). Finally, some authors find that sexual abuse is most strongly associated with suicidality in schizophrenia patients (Ucok and Bikmaz, 2007;Conus et al., 2010;Bani-Fatemi et al., 2016), a finding that is often reported with other clinical and non-clinical populations (Fergusson et al., 2013;Jakubczyk et al., 2014;Velloso et al., 2016;Daray et al., 2016;Stewart et al., 2015;Khosravani et al., 2017). Although there is clearly an association between childhood maltreatment and both past suicide attempts and current suicidal ideation, this association may be confounded by the severity of other clinical symptoms in patients with schizophrenia. ...
Article
The aims of the present study were to investigate the dimensions of childhood trauma (CT) in patients with schizophrenia, and to predict suicidal risk (e.g., current suicidal ideation and lifetime suicide attempts) by CT dimensions and clinical factors (positive and negative symptoms and depression). Eighty-two inpatients with schizophrenia completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Beck Depression Inventory-II (BDI-II), and the Beck Scale for Suicide Ideation (BSSI); they were also administered the Positive and Negative Syndrome Scale (PANSS).The presence of lifetime suicide attempts was assessed by structured diagnostic clinical interview. Patients with lifetime suicide attempts scored higher on sexual abuse than those without attempts after controlling for depression severity. Patients with high suicidal risk had higher scores on physical neglect than those without high risk after controlling for depression severity. Patients with high CT had higher scores on negative and positive symptoms, current suicidal ideation, and depression than those with low CT. Logistic regression analyses indicated that sexual abuse was a unique predictor of lifetime suicide attempts, and that physical neglect and depression were unique predictors of current suicidal ideation. These findings indicate that patients with schizophrenia who have experienced CT may be at increased risk for suicide.
... The short-term and long-term sequelae of CSA are complex and a clear understanding of the effects is helpful in planning treatment and directing allocation of scarce resources. CSA is a causal agent in many negative adulthood outcomes, ranging from depression [17][18][19] and posttraumatic stress disorder [20][21][22], to life-threatening behaviors such as suicide ideation and suicide attempts [23][24][25][26][27]. Women with a history of CSA are also characterized by symptoms of sexual disturbance including fear of men, less sexual interest, and less sexual pleasure [28]. ...
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Background: The sensitiveness and stigma associated with sexual assault deter many victims from speaking about their experiences. This silence of victims worsens the problem, especially in patriarchal communities like Ethiopia where sex is taboo and girls are encouraged to remain behind curtains. Case presentation: This is the personal testimony of a 25-year-old Amhara woman, a student at an Ethiopian public university, and it is presented in her own words. The data were collected during an in-depth interview on 19 April 2015. The interview was conducted in a private environment and her name was concealed to protect her anonymity. A digital voice recorder was used to audio-tape the interview which was later transcribed and translated verbatim from the local language, Amharic, to English. Conclusions: The trouble and pain our participant experienced is beyond description. Four themes emerged from her narrative: Incest assault, repeated assault, feelings of guilt and shame, and orphanhood. Incest is both more common and more severe in stepparent families but reported cases are only the very tip of the iceberg and thus may greatly under-represent actual population rates. Therefore, more effort is required to hold the perpetrators accountable and restore the life of the victims.
... These include problems with partners, parents, children, and/ or friends, and problems related to finances, work, physical and mental health, housing, and justice (Milnes et al., 2002). A number of major life events or triggering factors associated with suicidal behaviour were added to this list, including such feelings of loneliness (Schinka et al., 2012), rejection of a love, school problems, sexual orientation (King et al., 2008), death of a significant other, suicide or attempted suicide of a significant other (Qin et al., 2002), or trauma (Brodsky et al., 2001;Daray et al., 2016). Patients needed to indicate whether they perceived a problem as being present or not. ...
Article
Background: A history of self-harm is a major risk factor for suicide. Some patients are more likely than others to repeat suicidal behaviour after an episode of self-harm. Insight in the relation between current thoughts of self-harm, motives for the self-harm episode and perceived problems may improve prevention strategies. Network analysis allows to investigate the co-occurence of these factors and their association with each other. Methods: Ising model based networks are estimated on data collected between 2007-2015 within the Multicentre Study of Self-harm in Flanders. Patients were interviewed within 24 hours after hospitalization by a trained professional on their motives for the episode of self-harm and their perceived problems. Additionally, they were asked whether they had current thoughts of self-harm. Network analyses are used to determine which motives and problems are uniquely related to current thoughts of self-harm, and which are most central in the network. Results: Data were used of 6068 patients (2279 males and 3789 females). Four internal motives (wish to die, lost control, escape from situation, situation was unbearable), one external motive (show somebody how hopeless I was) and four perceived problems (psychiatric, loneliness, trauma, rejection) are directly related to current thoughts of self-harm. Of all motives and problems, the motive a wish to die is most strongly related to current thoughts of self-harm. However, external motives are more central in the network when compared to internal motives and perceived problems. Limitations: Data most probably refer to a selected group of self-harm patients as many individuals who self-harm do not come to the attention of hospital services. Patients might be reluctant to tell professionals they had current thoughts of self-harm. Conclusions: Many internal motives and problems are directly related to current thoughts of self-harm, but external motives are more central in the network. The clinically most important motive (wish to die) does not play a central role in the network.
... O presente estudo constatou que a maioria das vítimas de tentativas de suicídio atendidas pelo serviço eram adultos jovens e adolescentes, corroborando com a literatura (4) . Os comportamentos suicidas entre jovens e adolescentes envolvem motivações complexas, incluindo humor depressivo, abuso de substâncias, problemas emocionais, familiares e sociais, história familiar de transtorno psiquiátrico, rejeição familiar, negligência, além de abuso físico e sexual na infância (12)(13)(14) . ...
Article
Objetivo: analisar as características epidemiológicas das tentativas de suicídio atendidas por um serviço de atendimento pré-hospitalar móvel de urgência. Metodologia: estudo retrospectivo e analítico desenvolvido no Serviço de Atendimento Móvel de Urgência do município de Teresina, Piauí, Brasil. A coleta de dados procedeu-se em fevereiro de 2015, mediante análise de 78 fichas referentes a vítimas de tentativa de suicídio atendidas pelo serviço em 2014. Os dados foram submetidos à análise estatística descritiva simples e bivariada. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Estadual do Piauí. Resultados: houve o predomínio de vítimas do sexo feminino (53,8%) e adultas jovens (37,1%). A intoxicação exógena destacou-se quanto ao método utilizado (47,4%) e as Unidades de Suporte Básico foram responsáveis pela maioria dos atendimentos (67,9%). Os métodos de escolha associaram-se estatisticamente ao sexo (p=0,011) e ao tipo de ambulância utilizada (p=0,027). Conclusão: o estudo possibilitou a detecção de características importantes das vítimas e dos atendimentos às tentativas de suicídio, proporcionando informações capazes de subsidiar a elaboração e o fortalecimento de estratégias preventivas e políticas públicas eficazes. Descritores: Tentativa de Suicídio. Assistência Pré-Hospitalar. Saúde Mental.
Article
Childhood sexual abuse (CSA) is a critical risk factor for suicidal ideation and attempts, especially among gay and bisexual men who experience living as a minority. However, whether internalized homophobia (IH) underlies suicide risk and the role of outness to one's family in this association warrants investigation to inform preventive interventions. Using a cross-sectional survey of 570 gay and bisexual men in China, we examined the relationship between CSA and suicidality in the Chinese context and tested a moderated mediation model in this relationship. Nearly 65.6% of the participants had experienced suicidal ideation and 36.8% had attempted suicide. Participants with a history of CSA had higher suicidal ideation (r = 0.33, p < .01) and attempts (r = 0.48, p < .01). Our bootstrapped mediation analysis showed that IH partially mediated the relationship between CSA and suicidal ideation and attempts. Moreover, outness to one's family (parents and other family members) strengthened the direct association of CSA and IH, and the indirect relationship between CSA and suicidal ideation and attempts. These findings highlight the significance of identifying risk factors and mechanisms for suicidality among Chinese gay and bisexual men, suggesting the importance of early intervention, especially for those who have experienced CSA, to eliminate their IH and to improve family support for coming out to prevent the onset of suicidal ideation and attempts.
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Background Research into the association between childhood sexual abuse (CSA) and self-harm repetition is limited. Aims We aimed to examine the association between self-harm repetition, mental health conditions, suicidal intent and CSA experiences among people who frequently self-harm. Method A mixed-methods study was conducted including consecutive patients aged ≥18 years, with five or more self-harm presentations, in three Irish hospitals. Information was extracted from psychiatric records and patients were invited to participate in a semi-structured interview. Data was collected and analysed with a mixed-methods, convergent parallel design. In tandem, the association between CSA and self-harm repetition, suicidal intent and mental health conditions was examined with logistic regression models and independent sample t -test, with psychiatric records data. Thematic analysis was conducted with interview data, to explore CSA experiences and self-harm repetition. Results Between March 2016 and July 2019, information was obtained on 188 consecutive participants, with 36 participants completing an interview. CSA was recorded in 42% of the total sample and 72.2% of those interviewed. CSA was positively associated with self-harm repetition (odds ratio 6.26, 95% CI 3.94−9.94, P = 0.00). Three themes emerged when exploring participants’ CSA experiences: CSA as a precipitating factor for self-harm, secrecy of CSA accentuating shame, and loss experiences linked to CSA and self-harm. Conclusions CSA was frequently reported among people who frequently self-harm, and associated with self-harm repetition. Identification of patients at risk of repetition is key for suicide prevention. This is an at-risk group with particular characteristics that must be considered; comprehensive patient histories can help inform and tailor treatment pathways.
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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.
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Both childhood maltreatment and impulsivity have been implicated in a broad array of negative public health outcomes and have been much studied in relation to each other. Characterizing this relationship, and the processes underlying it, are important for informing intervention efforts targeting this association and its psychopathological sequelae. The current review presented a systematic meta-analysis of the empirical literature on childhood maltreatment and impulsivity. In all, 55 eligible studies were identified and included in this review. General support was found for a positive association between childhood maltreatment, including its specific subtypes, and general trait impulsivity, with pooled effect sizes ranging from small in the case of childhood sexual abuse (OR = 1.59 [95% CI = 1.38–1.84]) to medium-to-large in the case of childhood emotional abuse (OR = 3.10 [95% CI = 2.27–4.23]). Support for a relationship between childhood maltreatment and laboratory-based measures of impulsive behavior was generally lacking. The current findings must be interpreted with a degree of caution, given several methodological limitations characterizing much of the empirical literature. Recommendations for addressing these limitations and directions for future research are provided.
Article
Child sexual abuse (CSA) continues to be a major public health issue with significant short- and long-term consequences. However, little contemporary research has examined the relationship between CSA and delinquent and violent behavior in adolescence. Children who have been sexually abused experience a unique form of victimization compared to children who have endured other forms of maltreatment, as CSA can result in feelings of shame, powerlessness and boundary violations. The purpose of this study was to examine the effect of CSA on delinquent and violent behavior in adolescence. We examined self-report data at the age 18 interview from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) on measures of sexual abuse experience, and engagement in delinquent and violent behavior in the past year. All participants reported either a history of maltreatment or were identified at-risk based on demographic risk factors. Participants included 368 males and 445 females who self-reported experiences of CSA and delinquent and violent behavior (N = 813). Findings indicated that, when controlling for gender and race, the odds of engagement in delinquent and violent behavior for those who have experienced CSA are 1.7 times higher than for those who have not. Additionally, female victims of CSA were .52 times less likely to engage in violent and delinquent behavior compared to their male counterparts. Further efforts are needed to examine the effects of CSA on violent and delinquent behavior to better guide treatment efforts that prevent juvenile justice involvement.
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Background: Despite emerging evidence for an association between communication disorders and maltreatment, little research has examined sexual abuse characteristics or disclosure experiences among individuals with language disorder (LD). Given that communication difficulties may constitute a barrier to disclosure, the disclosure experiences among individuals with and without communication difficulties may also differ. Methods: Five-year-old children identified with a language and/or speech disorder from a nonclinical community sample and a control group were followed to adulthood in a prospective longitudinal study. At age 31, participants completed a behaviorally specific questionnaire on experiences of sexual abuse and questionnaires on disclosure experiences and social reactions to disclosure. Due to low endorsement of sexual victimization among male participants and low sample size, results are reported for women only and exclude nine participants with speech disorder without LD. Participation rates were 28 of 40 in the LD cohort and 45 of 51 controls. Sexual victimization severity was defined using an index combining five indicators (duration, invasiveness, relationship to perpetrator, coercive tactics used, and number of perpetrators). Subthreshold sexual victimization was defined as a single, noncontact incident with a perpetrator unknown to the child; experiences with greater severity were classified as child sexual abuse. Results: Among women who reported sexual victimization by age 18, invasiveness and overall severity were greater in the LD cohort than in the control cohort. Women in the LD cohort (43%) were more likely than controls (16%) to report child sexual abuse, excluding subthreshold experiences. There were no differences between cohorts in probability of disclosure, latency to disclosure, or social reactions. Conclusions: Women with a history of child LD in a nonclinical sample reported substantial child sexual abuse experiences. Implications for understanding associations between LD and mental health and for prevention and early intervention are discussed.
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The purpose of the present study was to revise the Barratt Impulsiveness Scale Version 10 (BIS-10), identify the factor structure of the items among normals, and compare their scores on the revised form (BIS-11) with psychiatric inpatients and prison inmates. The scale was administered to 412 college undergraduates, 248 psychiatric inpatients, and 73 male prison inmates. Exploratory principal components analysis of the items identified six primary factors and three second-order factors. The three second-order factors were labeled Attentional Impulsiveness, Motor Impulsiveness, and Nonplanning Impulsiveness. Two of the three second-order factors identified in the BIS-11 were consistent with those proposed by Barratt (1985), but no cognitive impulsiveness component was identified per se. The results of the present study suggest that the total score of the BIS-11 is an internally consistent measure of impulsiveness and has potential clinical utility for measuring impulsiveness among selected patient and inmate populations.
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Importance Recent evidence indicates a high prevalence of child abuse exposure in modern US veterans, which may explain in part their higher likelihood of suicide relative to civilians. However, the relationship between child abuse exposure and suicide-related outcomes in military personnel relative to civilians is unknown. Furthermore, the associations among deployment-related trauma, child abuse exposure, and suicide-related outcomes in military personnel have not been examined.Objectives To determine whether child abuse exposure is more prevalent in Canadian Armed Forces (CAF) personnel compared with the Canadian general population (CGP); to compare the association between child abuse exposure and suicidal ideation, suicide plans, and suicide attempts among the CAF and CGP; and to determine whether child abuse exposure has an additive or interaction effect on the association of deployment-related trauma and past-year suicidal ideation and suicide plans among Regular Forces personnel.Data, Setting, and Participants Data were collected from the following 2 nationally representative data sets: the 2013 Canadian Forces Mental Health Survey (CFMHS) for the CAF (8161 respondents; response rate, 79.8%) and the 2012 Canadian Community Health Survey–Mental Health (CCHS-MH) for the CGP (23 395 respondents; response rate, 68.9% [of these, 15 981 age-matched participants were drawn]). Data were collected from April 15 to August 31, 2013, for the CFMHS and January 2 to December 31, 2012, for the CCHS-MH. Data were analyzed from October 2014 to October 22, 2015. Statistical weights were applied to both data sets.Main Outcomes and Measures Child abuse exposure, including physical abuse, sexual abuse, and exposure to intimate partner violence, and deployment-related trauma were assessed in relation to suicide-related outcomes.Results Data were analyzed from 24 142 respondents aged 18 to 60 years (Regular Forces, 86.1% male and 13.9% female; Reserve Forces, 90.6% male and 8.9% female; and CGP, 49.9% male and 50.1% female). Any child abuse exposure was higher in the Regular Forces (47.7%; 95% CI, 46.4%-49.1%) and Afghanistan mission–deployed Reserve Forces (49.4%; 95% CI, 46.3%-51.5%) compared with the CGP (33.1%; 95% CI, 31.8%-34.4%). All types of child abuse exposures were associated with increased odds of suicidal ideation, suicide plans, and suicide attempts in the CGP (range of adjusted odds ratios [AORs], 3.0 [95% CI, 2.3-3.9] to 7.7 [95% CI, 5.7-10.3]; P < .05) and CAF (range of AORs, 1.7 [95% CI, 1.0-2.9] to 6.3 [95% CI, 4.2-9.5]; P < .05), with many associations significantly weaker in military personnel relative to civilians. Additive effects for past-year suicide ideation (AOR, 2.7; 95% CI, 1.8-4.2) and past-year suicide plans (AOR, 4.6; 95% CI, 2.3-9.2) but not interactive effects for past-year suicide ideation (AOR, 1.2; 95% CI, 0.7-2.2) and past-year suicide plans (AOR, 0.8; 95% CI, 0.3-2.2) were noted between deployment-related trauma and child abuse exposure among Regular Forces personnel.Conclusions and Relevance Individuals with a child abuse history may be more likely to enter the military, and child abuse exposure may increase the likelihood of suicide-related outcomes. Prevention efforts targeting child abuse may reduce suicide-related outcomes.
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Objective: To measure the duration of the suicidal process among patients diagnosed with Borderline Personality Disorder (BPD). Method: The sample included 110 female patients who met DSM-IV-TR criteria for BPD and were consecutively admitted after suicide-related behavior. Results: Sixty-three patients (58%) reported that their suicidal process lasted 10 minutes or less. After being adjusted, the ? coefficient of impulsivity scales in women with a suicidal process ?10 min was lower compared to those observed in women with »10 min (?= -0.03, 95% CI=-0.06 - -0.01, p < 0.01). Conclusion: Suicidal patients with BPD can be divided into two groups; patients who report a suicidal process less than 10 minutes show a higher degree of impulsivity.
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Suicide is an issue of high public health impact. In Argentina there are few published studies on suicide and suicide attempt. To determine the percentage of hospitalizations caused by suicidal attempt or suicidal ideation in a Mental Health Hospital of the City of Buenos Aires, describe the clinical and demographic characteristics of these patients and to analyze the frequency of adverse events at a 6-month follow-up. In the present study, baseline and follow-up data of an analytical, observational, prospective cohort study are used. Baseline data show that of all patients who entered the Emergency Department, 27% did so for ideation or suicide attempt. The most frequent diagnoses were: borderline personality disorder (41%), major depressive disorder (38%), bipolar disorder (20%) and schizophrenia (16%). The method most commonly used during the suicide attempt was drug poisoning. In half of the patients, the suicidal process was developed in less than 10 minutes. Monitoring data show that 22% of patients had a new attempted suicide and 34% had a readmission in a 6-month period. Together, these results describe the characteristics of suicide patients admitted to a Mental Health Hospital and show the low efficacy of interventions and the need to devise new strategies for the management of suicidal patients.
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Childhood sexual abuse (CSA) histories are prevalent among adolescent girls in the juvenile justice system (JJS) and may contribute to their high rates of suicidal behavior. Among 166 JJS girls who participated in an intervention trial, baseline CSA and covariates were examined as predictors of suicide attempt and nonsuicidal self-injury (NSSI) reported at long-term follow-up (7–12 years later). Early forced CSA was related to lifetime suicide attempt and NSSI history and (marginally) to postbaseline attempt; effects were not mediated by anxiety or depressive symptoms. Findings suggest that earlier victimization and younger entry into JJS are linked with suicide attempt and NSSI.
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Borderline personality disorder (BPD) is determined by the presence of any five of nine diagnostic criteria, leading patients with heterogeneous clinical features to be diagnosed under the same label without an individualized clinical and therapeutic approach. In response to this problem, Oldham proposed five types of BPD: affective, impulsive, aggressive, dependent and empty. The present study categorized a sample of BPD patients hospitalized due to suicide-related behavior according to Oldham's BPD proposed subtypes, and evaluated their clinical and demographic characteristics. Data were obtained from a sample of 93 female patients admitted to the « Dr. Braulio A. Moyano » Neuropsychiatric Hospital following suicide-related behavior. A total of 87 patients were classified as affective (26 %), impulsive (37 %), aggressive (4 %), dependent (29 %), and empty (5 %). Patients classified as dependent were significantly older at the time of first suicide-related behavior (p = 0.0008) and reported significantly less events of previous suicide-related behaviors (p = 0.03), while patients classified as impulsive reported significantly higher rates of drug use (p = 0.02). Dependent, impulsive and affective BPD types were observed most frequently in our sample. Findings are discussed specific to demographic and clinical implications of BPD patients reporting concurrent suicidal behavior.
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It is widely accepted that suicidal behavior often occurs with little planning. We propose, however, that suicidal behavior is rarely if ever impulsive-that it is too frightening and physically distressing to engage in without forethought-and that suicidal behavior in impulsive individuals is accounted for by painful and fearsome behaviors capable of enhancing their capacity for suicide. We conducted a meta-analysis of the association between trait impulsivity and suicidal behavior and a critical review of research considering the impulsiveness of specific suicide attempts. Meta-analytic results suggest the relationship between trait impulsivity and suicidal behavior is small. Furthermore, studies examining a mediating role of painful and provocative behaviors have uniformly supported our model. Results from our review suggest that researchers have been unable to adequately measure impulsivity of attempts and that measures sensitive to episodic planning must be developed to further our understanding of this phenomenon.
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Objectives: Childhood sexual abuse (CSA) has been associated with many adverse medical, psychological, behavioral and socioeconomic outcomes in adulthood. This study aims to examine the linkages between CSA and a wide range of developmental outcomes over a protracted time period to age 30. Methods: Data from over 900 members of the New Zealand birth cohort the Christchurch Health and Development Study were examined. CSA prior to age 16 was assessed at ages 18 and 21 years, in addition to: mental health, psychological wellbeing, sexual risk-taking behaviors, physical health and socioeconomic outcomes to age 30. Results: After statistical adjustment for confounding by 10 covariates spanning socio-demographic, family functioning and child factors, extent of exposure to CSA was associated with increased rates of (B, SE, p): major depression (0.426, 0.094, <.001); anxiety disorder (0.364, 0.089, <.001); suicidal ideation (0.395, 0.089, <.001); suicide attempt (1.863, 0.403, <.001); alcohol dependence (0.374, 0.118, <.002); and illicit drug dependence (0.425, 0.113, <.001). In addition, at age 30 CSA was associated with higher rates of PTSD symptoms (0.120, 0.051, .017); decreased self-esteem (-0.371, 0.181, .041); and decreased life satisfaction (-0.510, 0.189, .007). Childhood sexual abuse was also associated with decreased age of onset of sexual activity (-0.381, 0.091, <.001), increased number of sexual partners (0.175, 0.035, <.001); increased medical contacts for physical health problems (0.105, 0.023, <.001); and welfare dependence (0.310, 0.099, .002). Effect sizes (Cohen's d) for the significant outcomes from all domains ranged from .14 to .53, while the attributable risks for the mental health outcomes ranged from 5.7% to 16.6%. Conclusions: CSA is a traumatic childhood life event in which the negative consequences increase with increasing severity of abuse. CSA adversely influences a number of adult developmental outcomes that span: mental disorders, psychological wellbeing, sexual risk-taking, physical health and socioeconomic wellbeing. While the individual effect sizes for CSA typically range from small to moderate, it is clear that accumulative adverse effects on adult developmental outcomes are substantial.
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This study evaluated the effect of childhood trauma exposure and the role of resilience on both depressive symptoms and suicidal ideation. The study evaluated 1,488 military personnel and veterans, who served after September 2001, for depressive, suicidal, and PTSD symptoms, combat exposure, childhood trauma exposure, and resiliency. Participants were enrolled as part of an ongoing multicenter study. Outcome measures were depressive symptoms and suicidal ideation. After controlling for the effects of combat exposure and PTSD, results revealed that childhood trauma exposures were significantly associated with depressive symptoms and suicidal ideation. In addition, resilience was negatively associated with depressive symptoms and suicidal ideation, suggesting a potential protective effect. These findings suggest that evaluation of childhood trauma is important in the clinical assessment and treatment of depressive symptoms and suicidal ideation among military personnel and veterans.
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Objectives: Systematic reviews on prevalence estimates of child sexual abuse (CSA) worldwide included studies with adult participants referring on a period of abuse of about 50 years. Therefore we aimed to describe the current prevalence of CSA, taking into account geographical region, type of abuse, level of country development and research methods. Methods: We included studies published between 2002 and 2009 that reported CSA in children below 18 years. We performed a random effects meta-analysis and analyzed moderator variables by meta-regression. Results: Fifty-five studies from 24 countries were included. According to four predefined types of sexual abuse, prevalence estimates ranged from 8 to 31 % for girls and 3 to 17 % for boys. Nine girls and 3 boys out of 100 are victims of forced intercourse. Heterogeneity between primary studies was high in all analyses. Conclusions: Our results based on most recent data confirm results from previous reviews with adults. Surveys in children offer most recent estimates of CSA. Reducing heterogeneity between studies might be possible by standardized measures to make data more meaningful in international comparisons.
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Context Despite empirical links between sexual revictimization (ie, experiencing 2 or more sexual assaults) and posttraumatic stress disorder (PTSD), to our knowledge, no epidemiological studies document the prevalence of sexual revictimization and PTSD. Establishing estimates is essential to determine the scope, public health impact, and psychiatric sequelae of sexual revictimization. Objective To estimate the prevalence of sexual revictimization and PTSD among 3 national female samples (adolescent, college, and adult household probability). Design Surveys were used to collect data from the National Women's Study–Replication (2006; college) as well as household probability samples from the National Survey of Adolescents–Replication (2005) and the National Women's Study–Replication (2006; household probability). Setting Households and college campuses across the United States. Participants One thousand seven hundred sixty-three adolescent girls, 2000 college women, and 3001 household-residing adult women. Main Outcome Measures Behaviorally specific questions assessed unwanted sexual acts occurring over the life span owing to the use of force, threat of force, or incapacitation via drug or alcohol use. Posttraumatic stress disorder was assessed with a module validated against the criterion standard Structured Clinical Interview for DSM-IV. Results About 53% of victimized adolescents, 50% of victimized college women, and 58.8% of victimized household-residing women reported sexual revictimization. Current PTSD was reported by 20% of revictimized adolescents, 40% of revictimized college women, and 27.2% of revictimized household-residing women. Compared with nonvictims, odds of meeting past 6-month PTSD were 4.3 to 8.2 times higher for revictimized respondents and 2.4 to 3.5 times higher for single victims. Conclusions Population prevalence estimates suggest that 769 000 adolescent girls, 625 000 college women, and 13.4 million women in US households reported sexual revictimization. Further, 154 000 sexually revictimized adolescents, 250 000 sexually revictimized college women, and 3.6 million sexually revictimized household women met criteria for past 6-month PTSD. Findings highlight the importance of screening for sexual revictimization and PTSD in pediatric, college, and primary care settings.
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Our comprehensive meta-analysis combined prevalence figures of childhood sexual abuse (CSA) reported in 217 publications published between 1980 and 2008, including 331 independent samples with a total of 9,911,748 participants. The overall estimated CSA prevalence was 127/1000 in self-report studies and 4/1000 in informant studies. Self-reported CSA was more common among female (180/1000) than among male participants (76/1000). Lowest rates for both girls (113/1000) and boys (41/1000) were found in Asia, and highest rates were found for girls in Australia (215/1000) and for boys in Africa (193/1000). The results of our meta-analysis confirm that CSA is a global problem of considerable extent, but also show that methodological issues drastically influence the self-reported prevalence of CSA.
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Background: This study was designed to determine lifetime prevalence of psychiatric disorders among twins who reported childhood sexual abuse (CSA), and to compare these rates with those among non-abused co-twins. The contribution of familial and individual-specific factors to reported sexual abuse was also examined. Method: Information about lifetime psychopathology and substance use was obtained by structured telephone interviews with 5995 Australian twins. Twins who reported a history of childhood sexual abuse (CSA) were contrasted on lifetime psychopathology with subjects without such a history; in addition, comparisons were made between same-sex twin pairs discordant for CSA. Results: A history of CSA was reported by 5.9% of the women and 2.5% of the men. In the sample as a whole, those reporting CSA were more likely to receive lifetime diagnoses of major depression, conduct disorder, panic disorder and alcoholism, and were more likely to report suicidal ideation and a history of suicide attempt. Abused women, but not men, were also more likely to report social phobia. When comparisons were restricted to non-abused co-twins, no differences in psychopathology were seen. However, rates of major depression, conduct disorder and suicidal ideation were higher if both co-twins were abused than if the respondent alone reported CSA. Model-fitting indicated that shared environmental factors influenced risk for reported CSA in women, but not in men. Conclusion: The association between CSA and psychopathology arises at least in part through the influence of shared familial factors on both risk of victimization and risk of psychopathology.
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Over the past several decades, research has focused increasingly on developmental precursors to psychological disorders that were previously assumed to emerge only in adulthood. This change in focus follows from the recognition that complex transactions between biological vulnerabilities and psychosocial risk factors shape emotional and behavioral development beginning at conception. To date, however, empirical research on the development of borderline personality is extremely limited. Indeed, in the decade since M. M. Linehan initially proposed a biosocial model of the development of borderline personality disorder, there have been few attempts to test the model among at-risk youth. In this review, diverse literatures are reviewed that can inform understanding of the ontogenesis of borderline pathology, and testable hypotheses are proposed to guide future research with at-risk children and adolescents. One probable pathway is identified that leads to borderline personality disorder; it begins with early vulnerability, expressed initially as impulsivity and followed by heightened emotional sensitivity. These vulnerabilities are potentiated across development by environmental risk factors that give rise to more extreme emotional, behavioral, and cognitive dysregulation. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
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To determine the risk factors for suicide, 6,891 psychiatric outpatients were evaluated in a prospective study. Subsequent deaths for the sample were identified through the National Death Index. Forty-nine (1%) suicides were determined from death certificates obtained from state vital statistics offices. Specific psychological variables that could be modified by clinical intervention were measured using standardized scales. Univariate survival analyses revealed that the severity of depression, hopelessness, and suicide ideation were significant risk factors for eventual suicide. A multivariate survival analysis indicated that several modifiable variables were significant and unique risk factors for suicide, including suicide ideation, major depressive disorder, bipolar disorder, and unemployment status.
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This study investigated whether a higher frequency of reported childhood trauma would be found in depressed adults with higher levels of trait impulsivity, aggression, and suicidal behavior. In 136 depressed adult inpatients, the authors assessed trait impulsivity, aggression history, and number of lifetime suicide attempts as well as the medical lethality and the intent to die associated with the most lethal attempt. These variables were then compared between those with and those without a reported history of childhood physical or sexual abuse. Subjects who reported an abuse history were more likely to have made a suicide attempt and had significantly higher impulsivity and aggression scores than those who did not report an abuse history. Impulsivity and aggression scores were significantly higher in subjects with a history of at least one suicide attempt. A logistic regression analysis revealed that abuse history remained significantly associated with suicide attempt status after adjustment for impulsivity, aggression history, and presence of borderline personality disorder. Among those who attempted suicide, there were no significant differences in severity of suicidal behavior between those with and without a childhood history of abuse. Abuse in childhood may constitute an environmental risk factor for the development of trait impulsivity and aggression as well as suicide attempts in depressed adults. Alternatively, impulsivity and aggression may be inherited traits underlying both childhood abuse and suicidal behavior in adulthood disorders. Additional research is needed to estimate the relative contributions of heredity and environmental experience to the development of impulsivity, aggression, and suicidal behavior.
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The authors discuss the relationship of impulsivity to psychiatric disorders and present selected hypotheses regarding the reasons for these relationships. Previous research has shown significantly higher levels of impulsivity among patients with conduct disorder, personality disorders, substance use disorders, and bipolar disorder, compared to other psychiatric patients or healthy comparison subjects. A literature review of the theoretical bases of the relationship between these disorders and impulsivity is presented. Measurements of impulsivity and treatment options are discussed in relation to the physiology of impulsivity and the disorders in which it is a prominent feature. Impulsivity, as defined on the basis of a biopsychosocial approach, is a key feature of several psychiatric disorders. Behavioral and pharmacological interventions that are effective for treating impulsivity should be incorporated into treatment plans for these disorders. The high comorbidity of impulsivity and selected psychiatric disorders, including personality disorders, substance use disorders, and bipolar disorder, is in a large part related to the association between impulsivity and the biological substrates of these disorders. Before treatment studies on impulsivity can move forward, measures of impulsivity that capture the core aspects of this behavior need to be refined and tested on the basis of an ideologically neutral model of impulsivity.
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The authors investigated the predictive potential of a stress-diathesis model for suicidal behavior based on correlates of past suicidal acts. In this model, suicidal acts are precipitated by stressors such as life events or a major depressive episode in the setting of a propensity for acting on suicidal urges. This diathesis is expressed as the tendency to develop more pessimism in response to a stressor and/or the presence of aggressive/impulsive traits. The predictive potential of the diathesis was tested by determining whether clinical correlates of past suicidal behavior predict suicidal acts during a 2-year follow-up of patients with a major depressive episode. Patients with DSM-III-R major depressive disorder or bipolar disorder (N=308) were assessed at presentation for treatment of a major depressive episode. Potential predictors of suicidal acts in the 2 years after study enrollment were identified on the basis of an association with previous suicidal behavior and were tested by using Cox proportional hazards regression analysis. In addition, pessimism and aggression/impulsivity factors were generated, and their predictive ability was tested by using Cox proportional hazards regression analysis. The three most powerful predictors of future suicidal acts were a history of suicide attempt, subjective rating of the severity of depression, and cigarette smoking, each of which had an additive effect on future risk. The pessimism and aggression/impulsivity factors both predicted suicidal acts, and each factor showed an additive effect. In addition to obtaining a history of suicidal behavior, clinicians may find it useful to assess patients' current level of pessimism, aggressive/impulsive traits, and comorbidity with substance use disorders, including nicotine-related disorders, to help identify patients at risk for suicidal behavior after major depression. Interventions such as aggressive pharmacotherapeutic prophylaxis to prevent relapse or recurrence of depressive symptoms may protect such at-risk individuals from future suicidal behavior.
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Data from depressed women with and without a history of childhood sexual abuse were used to characterize clinical features that distinguished the two groups and to examine relationships of childhood sexual abuse to lifetime deliberate self-harm and recent interpersonal violence. One hundred twenty-five women with depressive disorders were interviewed and completed self-report questionnaires. Path analysis was used to examine relationships of several childhood and personality variables with deliberate self-harm in adulthood and recent interpersonal violence. Women with a childhood sexual abuse history reported more childhood physical abuse, childhood emotional abuse, and parental conflict in the home, compared to women without a childhood sexual abuse history. The two groups were similar in severity of depression, but the women with a childhood sexual abuse history were more likely to have attempted suicide and/or engaged in deliberate self-harm. The women with a history of childhood sexual abuse also became depressed earlier in life, were more likely to have panic disorder, and were more likely to report a recent assault. Path analysis confirmed the contributory role of childhood sexual abuse to deliberate self-harm and the significance of childhood physical abuse for recent interpersonal violence. Childhood sexual abuse is an important risk factor to identify in women with depression. Depressed women with a childhood sexual abuse history constitute a subgroup of patients who may require tailored interventions to combat both depression recurrence and harmful and self-defeating coping strategies.
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The development of inhibitory control, one component of the executive functions, during childhood and adolescence was the focus of the present study. A group of 99 participants between 6 and 17 years of age were studied using the Stroop test. Results suggest the existence of age-related differences both in response times and errors that follow a nonlinear relationship. Interference increased in the first age groups, declining from around 10 years till 17 years. Data also suggest that word reading plays an important role in the performance of the task. When reading is blocked, linear relationships between age and interference measures emerge, showing an increase in inhibitory functions during childhood and adolescence.
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Childhood sexual abuse (CSA) is a worldwide problem. Although most studies on the long-term consequences of CSA have focused on women, sexual abuse of both boys and girls is common. Thus, a comparison of the long-term effects of CSA by gender of the victim will provide perspective on the need for future research, prevention activities, and treatment of survivors. A retrospective cohort study was conducted from 1995 to 1997 among 17,337 adult HMO members in San Diego, California. Participants completed a survey about abuse or household dysfunction during childhood, and multiple other health-related issues. Multivariate logistic regression was used to examine the relationships between severity of CSA (intercourse vs no intercourse) and long-term health and social problems (substance use and abuse, mental illness, and current problems with marriage and family) by gender of victim. Models controlled for exposure to other forms of adverse childhood experiences that co-occur with CSA. Among men, the relationship between the gender of the CSA perpetrator to the outcomes was also examined. Contact CSA was reported by 16% of males and 25% of females. Men reported female perpetration of CSA nearly 40% of the time, and women reported female perpetration of CSA 6% of the time. CSA significantly increased the risk of the outcomes. The magnitude of the increase was similar for men and women. For example, compared to reporting no sexual abuse, a history of suicide attempt was more than twice as likely among both men and women who experienced CSA (p<0.05). Compared with those who did not report CSA, men and women exposed to CSA were at a 40% increased risk of marrying an alcoholic, and a 40% to 50% increased risk of reporting current problems with their marriage (p<0.05). In this cohort of adult HMO members, experiencing CSA was common among both men and women. The long-term impact of CSA on multiple health and social problems was similar for both men and women. These findings strongly indicate that boys and girls are vulnerable to this form of childhood maltreatment; the similarity in the likelihood for multiple behavioral, mental, and social outcomes among men and women suggests the need to identify and treat all adults affected by CSA.
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This is a report on the research design and findings of a 23-year longitudinal study of the impact of intrafamilial sexual abuse on female development. The conceptual framework integrated concepts of psychological adjustment with theory regarding how psychobiological factors might impact development. Participants included 6- to 16-year-old females with substantiated sexual abuse and a demographically similar comparison group. A cross-sequential design was used and six assessments have taken place, with participants at median age 11 at the first assessment and median age 25 at the sixth assessment. Mothers of participants took part in the early assessments and offspring took part at the sixth assessment. Results of many analyses, both within circumscribed developmental stages and across development, indicated that sexually abused females (on average) showed deleterious sequelae across a host of biopsychosocial domains including: earlier onsets of puberty, cognitive deficits, depression, dissociative symptoms, maladaptive sexual development, hypothalamic-pituitary-adrenal attenuation, asymmetrical stress responses, high rates of obesity, more major illnesses and healthcare utilization, dropping out of high school, persistent posttraumatic stress disorder, self-mutilation, Diagnostic and Statistical Manual of Mental Disorders diagnoses, physical and sexual revictimization, premature deliveries, teen motherhood, drug and alcohol abuse, and domestic violence. Offspring born to abused mothers were at increased risk for child maltreatment and overall maldevelopment. There was also a pattern of considerable within group variability. Based on this complex network of findings, implications for optimal treatments are elucidated. Translational aspects of extending observational research into clinical practice are discussed in terms that will likely have a sustained impact on several major public health initiatives.
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Childhood sexual abuse has been consistently associated with suicidal behavior. We studied suicide attempt features in depressed individuals sexually abused as children. On average, sexual abuse started before age 9. It frequently coexisted with physical abuse. Suicide attempters more often had personality disorders and had endured abuse for longer, but did not differ in terms of other clinical characteristics from non-attempters. Earlier onset of sexual abuse and its duration were associated with more suicide attempts. However, when personality disorders were included in the regression model, only these disorders predicted number of attempts. The severity of sexual abuse and the coexistence of physical abuse were correlated with age at first suicide attempt. However, only severity of sexual abuse was marginally associated with age at first suicide attempt in the regression model. Finally, the earlier the age of onset of sexual abuse, the higher the intent, even after controlling for age, sex and personality disorders. This suggests that the characteristics of childhood sexual abuse, especially age of onset, should be considered when studying the risk for suicidal behavior in abused populations.
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A national sample of adult women was screened for a history of serious physical assault in childhood, major depressive episode, post-traumatic stress disorder, and substance abuse. Approximately 2.6% reported having experienced serious assaults in childhood, with fathers and stepfathers identified as having been the most frequent offenders. Compared to women reporting no such victimization, these women experienced more lifetime and current episodes of depression, posttraumatic stress, and substance abuse.
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Since the publication of the O'Carroll et al. (1996) nomenclature for suicidology, there have been a number of published letters and articles, as well as an active e-mail dialogue, in response to, and elaborating upon, this effort to establish a standard nomenclature for suicidology. This new nomenclature has been presented on a number of occasions at both national and international meetings. In this paper we provide the background, rationale, and methodology involved in the process of revising the O'Carroll et al. nomenclature, based on the feedback and discussions that have ensued over the past 10 years.Those who have written and studied the phenomenon of suicide have not defined the term so simply … how the word is defined has implications and large effects for statistics that are compiled on the official number of suicides, and for researchers, so that there is clear communication regarding what and who is being studied.Among writers in the field of suicidology there is no single common accepted definition … the term suicide refers not to a single action but more broadly to a great many varied behaviors. For example, one can speak of suicidal thoughts, intentions, ideation, gestures, attempts, completions, equivalents.Thus far, no single term, definition, or taxonomy has served to sufficiently represent the complex set of behaviors that have been suggested as suicidal. A standard set of terms and definitions are greatly needed to advance the science of suicidology and aid communication and understanding of the field.McIntosh (1985, pp. 18–19)
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A revised and refined version of the O'Carroll et al. (1996) nomenclature for suicidology is presented, with a focus on suicide-related ideations, communications, and behaviors. The hope is that this refinement will result in the development of operational definitions and field testing of this nomenclature in clinical and research settings. This revision would not have been possible without the international collaboration and dialogue addressing the nomenclature of suicidology since the O'Carroll et al. nomenclature appeared in 1996.Although it is doubtful that we will ever be able to construct universally unambiguous criteria to comprehensively characterize suicidal behaviors (and, overall, firmly establish the intention behind them), for scientific clarity it would be highly desirable that the set of definitions and the associated terminology be explicit and generalizable.De Leo, Burgis, Bertolote, Kerkhof, & Bille-Brahe, 2006, p. 5)
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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.
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The purpose of this study was to utilize data from the 2000 British National Survey of Psychiatric Morbidity, a randomized cross-sectional survey of the British population that included questions relating to the phenomena of suicidality and sexual abuse, to test the hypothesis that suicide attempts in women are significantly associated with a history of sexual abuse. Participants were male and female volunteers, ages 16 to 74 years old (N=8,580), interviewed in the 2000 British National Survey of Psychiatric Morbidity. Sexual abuse was strongly associated with a history of suicide attempts as well as of suicidal intent and was more common in women. The population attributable risk fraction was considerably greater in female respondents (28%) than in male respondents (7%), which is consistent with more prevalent exposure to sexual abuse among women. The effect of sexual abuse on suicidal attempts and suicidal intent was reduced by controlling for affective symptoms, suggesting that the effect of the former was likely to be mediated by affective changes. Sexual abuse is a significant antecedent of suicidal behavior, particularly among women. In identifying suicidal behavior, it is important to consider the possibility of sexual abuse, since it implies a need for focused treatment.
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The authors review the accumulating evidence from preclinical, clinical and postmortem studies suggesting that abnormality in serotonin systems may be associated with both attempts at suicide and aggression towards others and inanimate objects. Although these behaviors are multidetermined they often involve poor impulse control, which may reflect low central serotonin turnover. The need for further studies of possible peripheral biological markers for suicidal and impulsive behavior is discussed.
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This study identified potential risk factors for suicidal behavior in patients with borderline personality disorder defined by the Diagnostic Interview for Borderline Patients and by DSM-III-R criteria for patients who did and did not attempt suicide. Histories of suicide attempts and attempt characteristics were obtained by Schedule for Affective Disorders and Schizophrenia interviews from 84 patients with borderline personality disorder and were related to severity of borderline pathology, diagnostic comorbidity, and state and trait symptoms. There were 61 patients with a lifetime history of suicide attempts (72.6%), with an average of 3.39 (SD = 2.87) attempts per patient. Attempters were significantly older than nonattempters, with more impulse actions, antisocial personality disorder comorbidity, and state depression. State depression was significantly less severe in patients who had attempted suicide in the present episode (or past year) than in patients who had attempted suicide only in the past. A comorbid diagnosis of major depression, alcoholism, or drug use disorder did not distinguish attempters from nonattempters. Suicide attempt in the present episode was best predicted by the number of prior lifetime attempts. A highly serious intent to commit suicide was predicted by the number of lifetime attempts and subjective depression, while a low intent was predicted by a mixed subtype of borderline personality disorder plus schizotypal personality disorder and paranoid ideation. A high degree of medical lethality was predicted by number of lifetime attempts, older age, and hysteroid dysphoria, while low lethality attempts were associated with high degrees of anger. Risk factors for suicidal behavior in patients with borderline personality disorder include older age, prior suicide attempts, antisocial personality, impulsive actions, and depressive moods but not comorbid affective disorder, alcoholism, or drug use disorders.
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We investigated the relationship of DSM-III-R personality disorder (PD) diagnoses and traits to suicidal behavior in patients with Major Depressive Disorder (MDD). Axis I and Axis II criteria and suicidal behavior were assessed using structured interviews of 102 psychiatric inpatients. Subjects with comorbid MDD and Borderline PD (BPD: n = 30) were more likely than other patients to have a history of multiple suicide attempts, and were equally likely to have made a highly lethal attempt. Number of BPD and other Cluster B (dramatic/erratic) criteria were better predictors of past suicidal behavior than were depressive symptoms. We conclude that patients with BPD symptomatology are at risk for serious suicide attempts. Moreover, severity of comorbid Cluster B PD psychopathology should be considered when assessing suicide risk in MDD patients even in those without a PD diagnosis.
Article
The aims of this study were to examine the extent to which exposure to childhood sexual abuse (CSA) was associated with increased rates of sexual risk taking behaviors and sexual revictimization during adolescence. A birth cohort of 520 New Zealand born young women was studied at regular intervals from birth to the age of 18. At age 18 retrospective reports of CSA were obtained from sample members. Over the course of the 18 year study information was gathered on: (a) childhood, family, and related circumstances; and (b) the young women's history of sexual experiences from 14 to 18 years. Young women reporting CSA, and particularly severe CSA involving intercourse, had significantly higher rates of early onset consensual sexual activity, teenage pregnancy, multiple sexual partners, unprotected intercourse, sexually transmitted disease, and sexual assault after the age of 16. Logistic regression analyses suggested that the associations between CSA and sexual outcomes in adolescence arose by two routes. First, exposure to CSA was associated with a series of childhood and family factors including social disadvantage, family instability, impaired parent child relationships, and parental adjustment difficulties that were also associated with increased sexual vulnerability in adolescence. Second, there appeared to be a causal chain relationship between CSA and sexual experiences in which CSA was associated with early onset sexual activity which, in turn, led to heightened risks of other adverse outcomes in adolescence. The findings of this study suggest that those exposed to CSA have greater sexual vulnerability during adolescence. This appears to arise because: (a) the childhood and family factors that are associated with CSA are also associated with increased sexual risks during adolescence; and (b) exposure to CSA may encourage early onset sexual activity which places those exposed to CSA at greater sexual risk over the period of adolescence.
Article
This paper examines impulsivity as a central factor in moderate/superficial self-mutilation such as skin-cutting and burning. A sample of 165 subjects were divided into four groups, namely self-mutilators, patients with any modes of impulsive behavior other than self-mutilation, patients without any impulsive behavior, and normal probands. All were administered the 10th version of the Barratt Impulsiveness Scale, the State-Trait Anger Expression Inventory, and the Inventory for the Assessment of Factors of Aggressiveness. They also were interviewed carefully in regards to both impulsive and self-mutilative behavior. A d-fenfluramine challenge test was administered to 36 females and prolactin levels were measured. On the whole results implicate impulsive personality functioning as a major factor in subjects with moderate/superficial self-mutilative behavior whose trait pathology is similar to personality disordered patients with other modes of self-harming impulsive behavior.
Article
Depression is twice as common in women as in men, but the reason for this sexual dimorphism is unknown. This article reviews recent studies of the role of childhood sexual abuse in the subsequent development of major depressive disorder, and the biological and psychosocial mechanisms by which early stressors may contribute to adult-onset depression in women. Particular attention is paid to investigations of the long-term effects of early stress on hypothalamic-pituitary-adrenal (HPA) axis function. Studies were identified by means of computerized and manual searches; further references were obtained from the bibliographies of reviewed articles. Childhood sexual abuse is associated with adult-onset depression in both men and women, and occurrence of such abuse is more common in girls than in boys. There is evidence from both animal and human studies that early stressors produce long-term dysregulation of the HPA axis similar to that seen in depressed patients and that such dysregulation results in a differential response to stressors in adulthood. In addition, it appears that the HPA axis in females may be more susceptible to stress-induced dysregulation, which might contribute to an increased vulnerability to depression in adulthood. Childhood sexual abuse is an important early stressor that may predispose individuals to adult-onset depression by means of dysregulation of the HPA axis. Investigation of the mechanisms mediating the relationship between childhood sexual abuse and adult-onset depression, and the study of gender differences in exposure to this and other stressors, may improve our understanding of the etiology of depressive illness in general.
Article
Research shows that psychopathology, child sexual abuse and other childhood adversities are risk factors for suicide. However, few have investigated their joint and independent roles in the pursuit of a reliable, predictive model of suicidal behaviour. Data are from the National Comorbidity Survey (N = 5877), a nationally representative study of prevalence, risk factors, and social consequences of psychiatric disorders in the US. Discrete time survival analysis and population attributable risk methodologies were utilized. Among those sexually abused as children, odds of suicide attempts were 2-4 times higher among women and 4-11 times higher among men, compared with those not abused, controlling for other adversities. Odds ratios were reduced but most remained statistically significant after adjusting for lifetime psychiatric illnesses preceding suicide attempts. In the same predictive equation, 79% of serious suicide attempts among women could be attributed to psychiatric disorders while 12% was attributable to rape and 7% to molestation. The highest probability of a first attempt was during early adolescence for those who were sexually abused and had a lifetime disorder, but it was 8-12 years older for those sexually abused without any disorders. In the US, a strong association exists between child sexual abuse and suicidal behaviour, mediated by psychopathology. There is a substantial proportion of suicide risk attributable to child sexual abuse beyond the presence of psychopathology and other adversities. From a clinical standpoint, abuse survivors represent a high-risk population for suicidal behaviour. Further research into this preventable antecedent of suicide attempts is necessary.
Article
This study examined demographic and psychosocial correlates of suicidal ideation and suicide attempts in women with histories of sexual assault in childhood and/or adulthood identified from a national sample of women. Multivariate analyses showed that women with histories of sexual assault in both childhood and adulthood reported significantly greater odds of lifetime suicide attempts, controlling for demographic factors and other psychosocial characteristics. As predicted, younger age (marginal), stressful life events (marginal), depression, PTSD, and alcohol dependence symptoms were also significantly associated with suicidal ideation. Furthermore, number of lifetime traumatic events and depression were each associated with lifetime odds of suicide attempts. Implications for studying the role of sexual trauma and other psychosocial factors in relation to women's suicidal behavior are discussed.
Article
This study has two purposes. The first purpose is to describe the severity of sexual abuse reported by a well-defined sample of borderline inpatients. The second purpose is to determine the relationship between the severity of reported childhood sexual abuse, other forms of childhood abuse, and childhood neglect and the severity of borderline symptoms and psychosocial impairment. Two semistructured interviews of demonstrated reliability were used to assess the severity of adverse childhood experiences reported by 290 borderline inpatients. It was found that more than 50% of sexually abused borderline patients reported being abused both in childhood and in adolescence, on at least a weekly basis, for a minimum of 1 year, by a parent or other person well known to the patient, and by two or more perpetrators. More than 50% also reported that their abuse involved at least one form of penetration and the use of force or violence. Using multiple regression modeling and controlling for age, gender, and race, it was found that the severity of reported childhood sexual abuse was significantly related to the severity of symptoms in all four core sectors of borderline psychopathology (affect, cognition, impulsivity, and disturbed interpersonal relationships), the overall severity of borderline personality disorder, and the overall severity of psychosocial impairment. It was also found that the severity of childhood neglect was significantly related to five of the 10 factors studied, including the overall severity of borderline personality disorder, and that the severity of other forms of childhood abuse was significantly related to two of these factors, including the severity of psychosocial impairment. Taken together, the results of this study suggest that the majority of sexually abused borderline inpatients may have been severely abused. They also suggest that the severity of childhood sexual abuse, other forms of childhood abuse, and childhood neglect may all play a role in the symptomatic severity and psychosocial impairment characteristic of borderline personality disorder.
Article
OBJECTIVE To provide clinicians with current information on prevalence, risk factors, outcomes, treatment, and prevention of child sexual abuse (CSA). To examine the best-documented examples of psychopathology attributable to CSA. METHOD Computer literature searches of and for key words. All English-language articles published after 1989 containing empirical data pertaining to CSA were reviewed. RESULTS CSA constitutes approximately 10% of officially substantiated child maltreatment cases, numbering approximately 88,000 in 2000. Adjusted prevalence rates are 16.8% and 7.9% for adult women and men, respectively. Risk factors include gender, age, disabilities, and parental dysfunction. A range of symptoms and disorders has been associated with CSA, but depression in adults and sexualized behaviors in children are the best-documented outcomes. To date, cognitive-behavioral therapy (CBT) of the child and a nonoffending parent is the most effective treatment. Prevention efforts have focused on child education to increase awareness and home visitation to decrease risk factors. CONCLUSIONS CSA is a significant risk factor for psychopathology, especially depression and substance abuse. Preliminary research indicates that CBT is effective for some symptoms, but longitudinal follow-up and large-scale "effectiveness" studies are needed. Prevention programs have promise, but evaluations to date are limited.
Article
Studies show that childhood sexual and physical abuse predict repeated suicide attempts and self-mutilation. Little is known about the importance of sexual and physical abuse when compared to other severe childhood adversities with respect to chronic suicidal behavior. Seventy-four subjects, 65% of whom were women, consecutively admitted to a general hospital after having made a suicide attempt, were interviewed as part of the intake interview about prior suicide attempts and self-mutilation and received DSM-IV diagnoses. Sexual abuse, physical abuse, neglect, antipathy from parents, loss of parents, and severe discord in the family before the age of 18, were covered by the Childhood Experience of Care and Abuse (CECA) interview schedule. The prevalence of severe sexual abuse was 35%, severe physical abuse 18%, neglect 27%, antipathy 34%, loss of caregiver 37% and exposure to family violence 31%. Physical and sexual abuse were independently associated with repeated suicide attempts when controlling for the effects of the other childhood adverse factors. No other childhood adversity was related to chronic suicidal behavior. The odds ratio of exposure to sexual or physical abuse was highest among those who both repeated suicide attempts and self-mutilated. Physical and sexual abuse are significantly and independently associated with repeated suicidal behavior.