Research paperNon-violent and violent forms of childhood abuse in the prediction of suicide attempts: Direct or indirect effects through psychiatric disorders?
Section snippets
. Introduction
Suicide is a leading cause of death worldwide (World Health Organization [WHO], 2014). Adverse childhood experiences (ACE), and in particular childhood verbal/emotional abuse, physical abuse, and sexual abuse have been identified as having both a direct and indirect influence on the development of suicidal behaviors (Short and Nemeroff, 2014). Several pathways linking childhood abuse to suicidal behaviors have been proposed, including biological, psychological, and behavioral mechanisms (see
Abuse, psychiatric disorders, and suicidality
One established pathway between childhood abuse and suicidal behavior is through psychiatric disorders. Childhood abuse experiences—both violent and non-violent—are powerful risk factors for the development of mental health problems. Afifi et al. (2008) found that the estimated attributable fractions for psychiatric disorders related to having experienced any violent form of childhood abuse (sexual, physical abuse, domestic violence) ranged from 22% to 32% among women and 20% to 24% among men.
The current study
Data for the current study were obtained from the two waves of the National Comorbidity Surveys (NCS-1 [baseline] and NCS-2 [10-year follow-up]). Controlling for several baseline risk factors, we examined the effects of retrospective reports of childhood violent abuse (parental physical abuse or rape by a family member) and non-violent childhood abuse (parental verbal abuse) in the prediction of suicide attempts over a ten-year period. Whereas we anticipated both violent and non-violent abuse
Internal Review Board (IRB)
Approval for the secondary data analyses of the NCS data sets was obtained from the University's IRB of the first author's University's affiliation.
NCS-1
The baseline NCS-1 is a nationwide epidemiological study of over 8000 respondents (Kessler, 1994). A representative sub-sample of participants (N=5877; aged 15–59, mean=33.2, SD=10.7) were interviewed with the entire psychosocial survey which was designed to assess the prevalence of DSM III-R (American Psychiatric Association [APA], 1987) psychiatric disorders.
NCS-2
NCS-2 is a 10-year follow-up that included 62% of the original NCS-1 respondents (Kessler, 2013). Of the 5463 respondents successfully
Procedures
Interviews were conducted by highly trained and closely supervised interviewers. To improve accuracy, there was a life review section at the beginning of the interview. Participants were provided with instructions designed to improve recall (Kessler et al., 2000) and validity of the self-reported abuse items (Sachs-Ericsson et al., 2005).
Demographics
Participants completed a demographic questionnaire to assess age, sex, race, and education.
DSM III-R Diagnoses
At baseline, participants’ DSM III-R psychiatric diagnoses were
Parental verbal abuse
Participants were asked: “When you were growing up, how often did someone in your household [parent/step-parent] do any of the things on this List to you: (Insulted or swore, Sulked or refused to talk, Stomped out of the room, Did or said something to, Threatened to hit, Smashed or kicked something in anger).” The response scale was as follows: (often=3, sometimes=2, rarely=1, or never=0)’? A dichotomous variable was then derived: never was coded (No=0), whereas often, sometimes, and rarely
Parental physical abuse
Participants were provided a list of specific behaviors related to physical abuse, and asked how often any of the things on the list happened to them when they were growing up in their family and who in the family perpetrated the abuse (e.g., parent/step-parent). These items included: Kicked, Bit or hit with a fist, Hit or tried to hit with something, Beat up, Choked, Burned or Scalded. The response scale was as follows: (often=3, sometimes=2, rarely=1, or never=0)? A dichotomous variable was
Parental psychiatric symptoms
Participants were asked about psychiatric symptoms of each biological parent. Psychiatric symptoms included an extensive list of symptoms of depression and anxiety (i.e., internalizing symptoms). Symptoms were assessed using the Family History Research Diagnostic Criteria (Andreasen et al., 1977), shown to have good interrater reliability (Zimmerman et al., 1988). Four variables representing the number of symptoms reported for the internalizing disorders and externalizing disorders for Mother
Suicidal attempt during the ten-year follow-up
The questions assessing suicidality at follow-up were analogous to those at baseline. For the purpose of the current study, we focused only on suicide attempts, since this variable is more proximal to risk of death by suicide. Participants were asked if they had made a suicide attempt at any time during the follow-up period (i.e., between NCS-1 and NCS-2; Yes=1, No=0).
DSM-IV diagnoses
DSM-IV disorders (APA, 2000) that occurred during the decade between the interviews (e.g., NCS-1 and NCS-2) were assessed using
Data analyses
First, descriptive statistics for the sample as a whole were examined, followed by comparisons among participants by abuse status (e.g., no abuse, non-violent abuse only, and any violent abuse). We then conducted a logistic regression analysis to determine the relationship between the childhood abuse variables and covariates in the prediction of suicide attempts. Finally, we tested two separate mediation models to determine if the number of the NCS-2 DSM-IV disorders mediated the relationship
Sample characteristics
By design, the participants (N=5001) were evenly divided by sex. The mean age at follow-up was 44 (SD=13.0) years. The majority of the sample was Caucasian (75.5%). Baseline rates of suicidal behaviors have been reported previously (Borges, 2008) for this sample: (13.3%) lifetime suicidal ideation, (4.0%) suicide plan, and (2.2%) suicide attempt.
ACEs variables are described in Table 1. Participants’ reports of parental verbal abuse were relatively high (48.7%). Among the sample, 6.9% reported
Discussion
Numerous studies have documented the pernicious effects of adverse childhood experiences (ACEs), including abuse, on adult suicidal behaviors (Brodsky and Stanley, 2008, Mortier et al., 2015, Sachs-Ericsson et al., 2016, Short and Nemeroff, 2014). The processes linking childhood abuse to suicide are likely complex (Sachs-Ericsson et al., 2016) and different mechanisms may link childhood violent abuse (e.g., physical abuse or rape) and non-violent abuse (e.g., verbal abuse) to suicidal behaviors
Conclusions
The mechanisms linking childhood abuse experiences to adult suicidal behavior are complex, affecting interrelated biological and psychological domains. Non-violent, parental verbal abuse may contribute to a negative self-schema and the development of psychiatric disorders that in turn contribute to suicidal behaviors. Violent abuse may contribute to the acquired capacity for suicidal behavior.
Acknowledgements
The authors would like to thank Katherine Musacchio Schafer, from the Department of Psychology at Florida State University, for her helpful comments on earlier drafts of this manuscript.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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2021, Journal of Affective DisordersCitation Excerpt :For instance, one study found that physical and violent sexual abuse were more predictive of suicide attempts than molestation and verbal abuse (Joiner Jr et al., 2007). Another study found that childhood physical and sexual abuse predicted higher rates of suicide attempts compared to childhood non-violent verbal abuse (Sachs-Ericsson et al., 2017). Thus, it has been imperative to account for multiple types of abuse (Joiner, 2007) and their co-occurrence (Stein et al., 2010).
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2020, Journal of Affective DisordersCitation Excerpt :Although research has shown that various forms of psychopathology predict suicidality and different forms of psychiatric disorders and environmental vulnerabilities are outcomes frequently associated with childhood maltreatment, the role of these factors as mediators between childhood maltreatment and suicidal thoughts and behaviors has infrequently been examined. In cross-sectional studies, researchers have examined anxiety, depression, and PTSD as potential mediators of the association between childhood abuse and suicidal ideation (Bahk et al., 2017; Lee, 2015; Lopez-Castroman et al., 2015) and a few longitudinal studies have examined relationships among childhood maltreatment, depression and suicidality (Brezo et al., 2008; Brown et al., 1999; Johnson et al., 2002; Miller et al., 2014; Sachs-Ericsson, 2017; Thompson et al., 2005, 2012). Using data from the National Comorbidity Study (NCS), Sachs-Ericsson et al.(2017) found that the number of NCS-2 DSM disorders served as an indirect pathway from non-violent child abuse to suicide attempts during a 10-year follow-up.
The role of childhood abuse for suicidality in the context of the interpersonal theory of suicide: An investigation in German psychiatric inpatients with depression
2019, Journal of Affective DisordersCitation Excerpt :Souza et al. (2016) hypothesized that suicidal behavior may act as a final coping strategy to deal with high emotional burden caused by emotional abuse. Sachs-Ericsson et al. (2017) argue that non-violent abuse leads to negative cognitive styles and psychiatric disorders, which are in turn related with suicidal behavior. Burns et al. (2010) showed the impact of emotional abuse on emotion dysregulation, which is well-known to be associated with deliberate self-harm (Gratz and Roemer, 2008).