Childhood maltreatment linked to increased suicide behaviors among children, young adults

Certain types of childhood maltreatment were linked to suicide behaviors among children and young adults, according to results of a systematic review and meta-analysis published in JAMA Network Open.

“Increasing evidence suggests that childhood maltreatment is strongly associated with self-harm, suicide behavior, lower resilience to mental health problems and greater impulsivity,” Ioannis Angelakis, PhD, of the School of Psychology at University of South Wales in the U.K., and colleagues wrote. “The severe negative psychological consequences of experiencing childhood abuse and/or neglect often continue into adulthood in the form of substantial mental health problems, including depression, anxiety and posttraumatic stress disorder.

“In addition, these individuals may engage in behaviors that negatively affect their health, including risky sexual behavior or using drugs and/or alcohol,” they added. “Hence, experiences of child maltreatment significantly contribute to societal costs by increasing the mental and physical health care provision needs for those who have experienced abuse and neglect.”

Five prior reviews that examined the association between childhood maltreatment and suicide behavior among children and young adults were limited by a lack of meta-analyses to quantify existing evidence, particularly for suicide behaviors that were not attempts, as well as restrictive inclusion criteria for certain research designs, which led to numerous studies conducted in this area being excluded.

In the current study, Angelakis and colleagues aimed to evaluate the association between suicide behaviors among children and young adults and their exposure to core types of childhood maltreatment, such as sexual, physical and emotional abuse and/or neglect. They searched five databases for quantitative studies that examined the link between the core types of childhood abuse and/or neglect and suicide ideation, plans and attempts and were published between January 1980 and December 2019. The analysis included 79 studies with 337,185 youths, with a mean age of 15.67 years.

Results showed significant associations between higher suicide attempt rates and sexual abuse (OR = 3.41; 95% CI, 2.9-4), physical abuse (OR = 2.18; 95% CI, 1.75-2.71), emotional abuse (OR = 2.21; 95% CI, 1.37-3.57), emotional neglect (OR = 1.93; 95% CI, 1.36-2.74), physical neglect (OR = 1.79; 95% CI, 1.27-2.53) and combined abuse (OR = 3.38; 95% CI, 2.09-5.47). Moreover, these forms of childhood maltreatment were linked to as much as a 2.5 times higher risk for suicide ideation, and sexual abuse specifically with a four times higher risk for suicide plans. Community sample-based studies or those with lower methodological quality were associated more strongly with suicide attempts among those who reported experiences of sexual abuse. Young age was linked to both suicide attempts and ideation.

“The review confirmed evidence of this important association in children and young adults to 24 years of age,” Angelakis and colleagues wrote. “Overall, these data suggest that childhood maltreatment is a central social welfare problem that may lead to suicide behaviors. Therefore, research, clinical and policy actions should be taken with a particular focus on (1) raising public awareness, (2) informing existing policies and (3) amending treatment protocols for achieving optimal results with respect to childhood maltreatment.”

In a related editorial, Brett Burstein, MDCM, PhD, MPH, of the department of pediatrics, and Brian Greenfield, MD, of the department of psychiatry, both at Montreal Children’s Hospital, highlighted a path forward for future research in this area.

“Future studies must focus on developing interventions well upstream of suicidality, when [adverse childhood experiences] (ACEs) have first been identified, and that orient suicide prevention care to community resources temporally closer to the abuse before the ED presentation,” they wrote. “Community and school authorities should be further empowered to identify and refer at-risk children and adolescents to community mental health clinicians, who in turn need to be sensitized to the strong and direct association between these risk factors and suicidality. The work of Angelakis [and colleagues] should serve as a springboard for future investigations, including an examination of when ACEs weaken children’s and young adults’ emotional immunities to subsequent life stresses and interact synergistically with biologically based psychiatric disorders and ultimately suicide.”