Skip to main content

Advertisement

SpringerLink
Log in

Longitudinal Relations Between Childhood Maltreatment, Emotion Regulation Difficulties, and Suicidal Ideation and Non-Suicidal Self-Injury: An 18-Month Investigation of Psychiatrically Hospitalized Adolescents

  • Published:
Research on Child and Adolescent Psychopathology Aims and scope Submit manuscript

Abstract

Within the Dimensional Model of Adversity and Psychopathology, extant research shows that exposure to threat—including emotional, physical, and sexual abuse—is linked to psychopathology among adolescents; problems with emotion regulation may, at least in part, explain this association. Both theoretical and empirical work also suggests that emotion regulation difficulties—particularly access to emotion regulation strategies—may mediate the relation between threat and self-injurious thoughts and behavior, though no studies to date have explicitly tested this model. The current study tested relations between threat, limited access to emotion regulation strategies, and self-injurious thoughts and behaviors among high-risk youth across an 18-month follow-up. The sample consisted of 180 adolescents (Mage = 14.89; SD = 1.35; ages 12–17; 71.7% female; 78.9% White; 55.0% heterosexual) recruited from an inpatient psychiatric unit. Threat was assessed at baseline using the abuse subscales from Childhood Trauma Questionnaire. Access to emotion regulation strategies was assessed using the Difficulties in Emotion Regulation Scale at baseline, 6-, and 12-months. Presence (versus absence) of non-suicidal self-injury and suicidal ideation severity were assessed at baseline, 12-, and 18-months using the Self-Injurious Thoughts and Behaviors Interview and the Suicidal Ideation Questionnaire-JR, respectively. After accounting for baseline levels of the mediator, outcome, and depressive symptoms, structural equation models supported the role of 12-month access to emotion regulation strategies as a mediator between baseline threat and 18-month suicidal ideation and non-suicidal self-injury. Treatment aimed at bolstering access to emotion regulation strategies may help reduce suicide risk among youth who have experienced childhood abuse.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

Data available upon request.

Notes

  1. Using this procedure, the 12-month SI model initially calculated a small, non-significant negative residual variance for baseline emotional abuse (σ = -0.18, p = 0.978). In line with SEM conventions, this residual was constrained to zero, which did not significant degrade model fit (S-B \(\Delta \chi^{2}\)(1) = 0.002, p = 0.969; see Kolenikov & Bollen, 2012). Therefore, this altered model with a constrained residual variance for baseline emotional abuse became the model from which the most parsimonious model was obtained for the 12-month SI outcome.

  2. As significant predictors of SITBs (Cha et al., 2018), sex and sexual identity were included in the initial models. However, the pattern of results was equivalent to those presented here. For parsimony and space considerations, results were reported without these predictors in the model.

References

  • Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217–237.

    Article  PubMed  Google Scholar 

  • Babcock Fenerci, R. L., Jenkins, G. A., Gilbert, A. C., Schettini, E., Musella, K., MacPherson, H., ... & Dickstein, D. P. (2022). Maltreatment history and reasons for self‐injurious behavior among adolescents engaged in non‐suicidal self‐injury versus adolescents who attempted suicide. Suicide and Life‐Threatening Behavior, 52(5), 898–907.

  • Bernstein, D. P., & Fink, L. (1998). Childhood trauma questionnaire: A retrospective self-report: Manual. Psychological Corporation.

  • Cain, M. K., Zhang, Z., & Bergeman, C. S. (2018). Time and other considerations in mediation design. Educational and Psychological Measurement, 78(6), 952–972. https://doi.org/10.1177/0013164417743003

  • Campos, J. J., Campos, R. G., & Barrett, K. C. (1989). Emergent themes in the study of emotional development and emotion regulation. Developmental Psychology, 25(3), 394.

    Article  Google Scholar 

  • Cha, C. B., Franz, P. J., Guzmán, E. M., Glenn, C. R., Kleiman, E. M., & Nock, M. K. (2018). Annual research review: suicide among youth – epidemiology, (potential) etiology, and treatment. The Journal of Child Psychology and Psychiatry, 59(4), 460–482. https://doi.org/10.1111/jcpp.12831

  • Cloitre, M., Miranda, R., Stovall-McClough, K. C., & Han, H. (2005). Beyond PTSD: Emotion regulation and interpersonal problems as predictors of functional impairment in survivors of childhood abuse. Behavior Therapy, 36(2), 119–124.

    Article  Google Scholar 

  • Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159. https://doi.org/10.1037/0033-2909.112.1.155

  • Cole, P. M., Martin, S. E., & Dennis, T. A. (2004). Emotion regulation as a scientific construct: Methodological challenges and directions for child development research. Child Development, 75(2), 317–333.

    Article  PubMed  Google Scholar 

  • Cole, P. M. (2014). Moving ahead in the study of the development of emotion regulation. International Journal of Behavioral Development, 38(2), 203–207.

    Article  Google Scholar 

  • Dvir, Y., Ford, J. D., Hill, M., & Frazier, J. A. (2014). Childhood maltreatment, emotional dysregulation, and psychiatric comorbidities. Harvard Review of Psychiatry, 22(3), 149.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ehrenreich, J. T., Goldstein, C. R., Wright, L. R., & Barlow, D. H. (2009). Development of a unified protocol for the treatment of emotional disorders in youth. Child & Family Behavior Therapy, 31(1), 20–37.

    Article  Google Scholar 

  • Elliott, A. N., & Carnes, C. N. (2001). Reactions of nonoffending parents to the sexual abuse of their child: A review of the literature. Child Maltreatment, 6(4), 314–331.

    Article  PubMed  Google Scholar 

  • Godbout, N., Briere, J., Sabourin, S., & Lussier, Y. (2014). Child sexual abuse and subsequent relational and personal functioning: The role of parental support. Child Abuse & Neglect, 38(2), 317–325. https://doi.org/10.1016/j.chiabu.2013.10.001

  • Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. https://doi.org/10.1007/s10862-008-9102-4

    Article  Google Scholar 

  • Grossman, A. H., Park, J. Y., Frank, J. A., & Russell, S. T. (2021). Parental responses to transgender and gender nonconforming youth: Associations with parent support, parental abuse, and youths’ psychological adjustment. Journal of Homosexuality, 68(8), 1260–1277.

    Article  PubMed  Google Scholar 

  • Gunnar, M. R., & Quevedo, K. M. (2007). Early care experiences and HPA axis regulation in children: A mechanism for later trauma vulnerability. Progress in Brain Research, 167, 137–149.

    Article  Google Scholar 

  • Goldston, D. B., Daniel, S. S., Reboussin, B. A., Reboussin, D. M., Frazier, P. H., & Harris, A. E. (2001). Cognitive risk factors and suicide attempts among formerly hospitalized adolescents: A prospective naturalistic study. Journal of the American Academy of Child & Adolescent Psychiatry, 40(1), 91–99.

    Article  Google Scholar 

  • Gómez, J. M. (2019). High betrayal adolescent sexual abuse and nonsuicidal self-injury: The role of depersonalization in emerging adults. Journal of Child Sexual Abuse, 28(3), 318–332.

    Article  PubMed  Google Scholar 

  • Harder, J. A. (2020). The multiverse of methods: Extending the multiverse analysis to address data-collection decision. Perspectives on Psychological Science, 15(5), 1158–1177. https://doi.org/10.11772/1745691620917678

  • Hatkevich, C., Penner, F., & Sharp, C. (2019). Difficulties in emotion regulation and suicide ideation and attempt in adolescent inpatients. Psychiatry Research, 271, 230–238. https://doi.org/10.1016/j.psychres.2018.11.038

    Article  PubMed  Google Scholar 

  • John, O. P., & Gross, J. J. (2004). Healthy and unhealthy emotion regulation: Personality processes, individual differences, and life span development. Journal of Personality, 72(6), 1301–1334.

    Article  PubMed  Google Scholar 

  • Joiner, T. E., Ribeiro, J. D., & Silva, C. (2012). Nonsuicidal self-injury, suicidal behavior, and their co-occurrence as viewed through the lens of the interpersonal theory of suicide. Current Directions in Psychological Science, 21(5), 342–347.

    Article  Google Scholar 

  • Kaplan, C., Tarlow, N., Stewart, J. G., Aguirre, B., Galen, G., & Auerbach, R. P. (2016). Borderline personality disorder in youth: The prospective impact of child abuse on non-suicidal self-injury and suicidality. Comprehensive Psychiatry, 71, 86–94.

    Article  PubMed  PubMed Central  Google Scholar 

  • Keeshin, B. R., Strawn, J. R., Luebbe, A. M., Saldaña, S. N., Wehry, A. M., DelBello, M. P., & Putnam, F. W. (2014). Hospitalized youth and child abuse: A systematic examination of psychiatric morbidity and clinical severity. Child Abuse & Neglect, 38(1), 76–83.

    Article  Google Scholar 

  • Kim, S. G., Weissman, D. G., Sheridan, M. A., & McLaughlin, K. A. (2023). Child abuse and automatic emotion regulation in children and adolescents. Development and Psychopathology, 35(1), 157–167.

    Article  PubMed  Google Scholar 

  • King, C. A., Kerr, D. C., Passarelli, M. N., Foster, C. E., & Merchant, C. R. (2010). One-year follow-up of suicidal adolescents: Parental history of mental health problems and time to post-hospitalization attempt. Journal of Youth and Adolescence, 39(3), 219–232.

    Article  PubMed  Google Scholar 

  • Kline, R. B. (2016). Principles and practices of structural equation modeling (4th ed.). Guildford.

  • Kolenikov, S., & Bollen, K. A. (2012). Testing negative error variances: Is a Heywood case a symptom of misspecification? Sociological Methods & Research, 41(1), 124–167. https://doi.org/10.1177/0049124112442138

  • Kovacs, M. (2011). Children’s Depression Inventory-2 (CDI-2) (2nd Ed.). Multi-Health Systems, Inc.

  • Lambert, H. K., King, K. M., Monahan, K. C., & McLaughlin, K. A. (2017). Differential associations of threat and deprivation with emotion regulation and cognitive control in adolescence. Development and Psychopathology, 29(3), 929–940.

    Article  PubMed  Google Scholar 

  • Larson, R. W., Moneta, G., Richards, M. H., & Wilson, S. (2002). Continuity, stability, and change in daily emotional experience across adolescence. Child Development, 73, 1154–1165.

    Article  Google Scholar 

  • Linehan, M. M., Heard, H. L., & Armstrong, H. E. (1993). Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Archives of General Psychiatry, 50(12), 971–974.

    Article  PubMed  Google Scholar 

  • Little, R. J. A. (1988). A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association, 83(404), 1198–1202.

    Article  Google Scholar 

  • Little, R. J. A., & Rubin, D. B. (2020). Statistical analysis with missing data (3rd Ed.). Wiley.

  • Masten, A. S., & Cicchetti, D. (2010). Developmental cascades. Development and Psychopathology, 22(3), 491–495.

    Article  PubMed  Google Scholar 

  • McLaughlin, K. A., Hatzenbuehler, M. L., Xuan, Z., & Conron, K. J. (2012). Disproportionate exposure to early-life adversity and sexual orientation disparities in psychiatric morbidity. Child Abuse & Neglect, 36(9), 645–655.

    Article  Google Scholar 

  • McLaughlin, K. A., Weissman, D., & Bitrán, D. (2019). Childhood adversity and neural development: A systematic review. Annual Review of Developmental Psychology, 1, 277.

    Article  PubMed  PubMed Central  Google Scholar 

  • Miller, A. B., Esposito-Smythers, C., Weismoore, J. T., & Renshaw, K. D. (2013). The relation between child maltreatment and adolescent suicidal behavior: A systematic review and critical examination of the literature. Clinical Child and Family Psychology Review, 16, 146–172. https://doi.org/10.1007/s10567-013-0131-5

    Article  PubMed  PubMed Central  Google Scholar 

  • Miller, A. B., Sheridan, M. A., Hanson, J. L., McLaughlin, K. A., Bates, J. E., Lansford, J. E., ... & Dodge, K. A. (2018). Dimensions of deprivation and threat, psychopathology, and potential mediators: A multi-year longitudinal analysis. Journal of Abnormal Psychology, 127(2), 160.

  • Muthén, L. K., & Muthén, B. O. (1998–2017). Mplus user’s guide (8th Ed.). Muthén & Muthén.

  • Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007). Self-Injurious Thoughts and Behaviors Interview: Development, reliability, and validity in an adolescent sample. Psychological Assessment, 19(3), 309–317. https://doi.org/10.1037/1040-3590.19.3.309

    Article  PubMed  Google Scholar 

  • Perez, J., Venta, A., Garnaat, S., & Sharp, C. (2012). The Difficulties in Emotion Regulation Scale: Factor structure and association with nonsuicidal self-injury in adolescent inpatients. Journal of Psychopathology and Behavioral Assessment, 34, 393–404. https://doi.org/10.1007/s10862-012-9292-7

    Article  Google Scholar 

  • Rabinovitch, S. M., Kerr, D. C., Leve, L. D., & Chamberlain, P. (2015). Suicidal behavior outcomes of childhood sexual abuse: Longitudinal study of adjudicated girls. Suicide and Life-Threatening Behavior, 45(4), 431–447.

    Article  PubMed  Google Scholar 

  • Rasmussen, S. A., Fraser, L., Gotz, M., MacHale, S., Mackie, R., Masterton, G., ... & O'Connor, R. C. (2010). Elaborating the cry of pain model of suicidality: Testing a psychological model in a sample of first‐time and repeat self‐harm patients. British Journal of Clinical Psychology, 49(1), 15–30.

  • Rathus, J. H., & Miller, A. L. (2014). DBT skills manual for adolescents. Guilford Publications.

  • Rathus, J. H., & Miller, A. L. (2002). Dialectical behavior therapy adapted for suicidal adolescents. Suicide and Life-threatening Behavior, 32(2), 146–157.

    Article  PubMed  Google Scholar 

  • Reynolds, W. M. (1987). Suicidal Ideation Questionnaire. Psychological Assessment Resources.

  • Satorra, A., & Bentler, P. M. (2010). Ensuring positiveness of the scaled difference chi-square test statistic. Psychometrika, 75(2), 243–248. https://doi.org/10.1007/s11336-009-y

    Article  PubMed  PubMed Central  Google Scholar 

  • Selby, E. A., Anestis, M. D., & Joiner, T. E. (2008). Understanding the relationship between emotional and behavioral dysregulation: Emotional cascades. Behaviour Research and Therapy, 46(5), 593–611.

    Article  PubMed  Google Scholar 

  • Sheridan, M. A., & McLaughlin, K. A. (2014). Dimensions of early experience and neural development: Deprivation and threat. Trends in Cognitive Sciences, 18(11), 580–585.

    Article  PubMed  PubMed Central  Google Scholar 

  • Steegen, S., Tuerlinckx, F., Gelman, A., & Vanpaemel, W. (2016). Increasing transparency through a multiverse analysis. Perspectives on Psychological Science, 11(5), 702–712. https://doi.org/10.1177/1745691616658637

    Article  PubMed  Google Scholar 

  • Thompson, R. A. (1994). Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development, 25–52.

  • Titelius, E. N., Cook, E., Spas, J., Orchowski, L., Kivisto, K., O’Brien, K., ... & Seymour, K. E. (2018). Emotion dysregulation mediates the relationship between child maltreatment and non-suicidal self-injury. Journal of Aggression, Maltreatment & Trauma, 27(3), 323–331.

  • Weissman, D. G., Bitran, D., Miller, A. B., Schaefer, J. D., Sheridan, M. A., & McLaughlin, K. A. (2019). Difficulties with emotion regulation as a transdiagnostic mechanism linking child maltreatment with the emergence of psychopathology. Development and Psychopathology, 31(3), 899–915.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wolff, J. C., Davis, S., Liu, R. T., Cha, C. B., Cheek, S. M., Nestor, B. A., Frazier, E. A., Schaffer, M. M., & Spirito, A. (2018). Trajectories of suicidal ideation among adolescents following psychiatric hospitalization. Journal of Abnormal Child Psychology, 46, 355–363. https://doi.org/10.1007/s10802-017-0293-6

    Article  PubMed  PubMed Central  Google Scholar 

  • Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E., Jr. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575. https://doi.org/10.1037/a0018697

    Article  PubMed  PubMed Central  Google Scholar 

  • Venta, A., & Sharp, C. (2014). Extending the concurrent validity of the Self-Injurious Thoughts and Behaviors Interview to inpatient adolescents. Journal of Psychopathology and Behavioral Assessment, 36, 675–682.

    Article  Google Scholar 

  • Yen, S., Weinstock, L. M., Andover, M. S., Sheets, E. S., Selby, E. A., & Spirito, A. (2013). Prospective predictors of adolescent suicidality: 6-month post-hospitalization follow-up. Psychological Medicine, 43(5), 983–993.

    Article  PubMed  Google Scholar 

  • You, et al. (2018). Emotion dysregulation and nonsuicidal self-injury: A meta-analytic review. Neuropsychiatry, 8, 733–748.

    Article  Google Scholar 

  • Zeman, J., Cassano, M., Perry-Parrish, C., & Stegall, S. (2006). Emotion regulation in children and adolescents. Journal of Developmental & Behavioral Pediatrics, 27(2), 155–168.

    Article  Google Scholar 

Download references

Acknowledgements

The content is solely the responsibility of the author and does not necessarily represent the official views of the funding agency.

Funding

Preparation of this manuscript was supported in part by the National Institute of Mental Health of the National Institutes of Health under Award Numbers R01MH101138, R01MH115905, RF1MH120830, R01MH124899, and F32MH127795.

Author information

Author notes

  1. Jennifer A. Poon and Roberto López Jr. contributed equally to this work as first authors.

Authors and Affiliations

  1. Bradley Hospital/Warren T. Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, 02903, USA

    Jennifer A. Poon

  2. Emma Pendleton Bradley Hospital, East Providence, USA

    Jennifer A. Poon

  3. George Mason University, Fairfax, USA

    Roberto López Jr

  4. Suffolk University, Boston, USA

    Lynne Marie-Shea

  5. Massachusetts General Hospital, Boston, USA

    Richard T. Liu

  6. Harvard Medical School, Boston, USA

    Richard T. Liu

Authors
  1. Jennifer A. Poon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roberto López Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lynne Marie-Shea
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Richard T. Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer A. Poon.

Ethics declarations

Conflicts of Interest

None.

Ethical Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the the Rhode Island Hospital Institutional Review Board.

Informed Consent

Informed consent was obtained from parents/legal guardians and child assent was obtained from all adolescent participants.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Poon, J.A., López, R., Marie-Shea, L. et al. Longitudinal Relations Between Childhood Maltreatment, Emotion Regulation Difficulties, and Suicidal Ideation and Non-Suicidal Self-Injury: An 18-Month Investigation of Psychiatrically Hospitalized Adolescents. Res Child Adolesc Psychopathol 51, 1315–1326 (2023). https://doi.org/10.1007/s10802-023-01067-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-023-01067-8

Keywords

Search

Navigation