Childhood sexual abuse and suicidal behavior: a meta-analysis

Longitudinal trajectories of suicidal ideation among child welfare-involved 7- to 12-year-old children

BACKGROUND

Young children involved in the child welfare system (CWS) are at high risk for suicidal ideation (SI) at a time when overall rates of suicide death in this age group are rising. Yet risk factors for and changes in SI over time are poorly understood in this population.

METHOD

We combined data from two large representative longitudinal studies of children involved in the United States CWS. We examined patterns of SI among children who were between ages 7 and 12 years at the initial survey wave (N = 2,186), assessed at three waves using a measure of SI in the past 2 weeks. We conducted a multinomial regression to understand the baseline demographic, child maltreatment, and mental health characteristics that distinguish the trajectories.

RESULTS

There were eight different subgroups (Non-Ideators, Late Ideators, Boomerang Ideators, Delayed Ideators, Desisters, Boomerang Non-Ideators, Late Desisters, and Persisters). Differences in race, type of maltreatment, sex, and mental health symptoms were identified when comparing Persisters (SI at all three waves) to other groups.

CONCLUSIONS

These findings can help researchers and practitioners to develop strategies for better identifying CWS-involved children who are in greatest need of suicide risk monitoring and intervention.

The Global Prevalence of Non-suicidal Self-injury, Suicide Behaviors, and Associated Risk Factors Among Runaway and Homeless Youth: A Meta-analysis

A meta-analysis was performed to determine pooled prevalence of non-suicidal self-injury (NSSI), suicide behaviors (including ideation, attempts), and associated risk factors among runaway and homeless youth (RHY). The databases PubMed, Scopus, Web of Science, and Cochrane Library were searched for relevant studies published from January 1995 to May 2023. Initially, 8465 papers were screened, resulting in 69 included studies. The results showed that among RHY, lifetime prevalence rates were 42% for NSSI, 38% for suicidal ideation, and 27% for suicide attempts. Lifetime prevalence of NSSI and suicide behaviors was higher among adolescent minors (aged 12-17 years) compared to young adults (aged 18-24 years). Also, NSSI and suicide behaviors were associated with having a childhood history of physical and sexual abuse. Developing an impactful community-based suicide prevention campaign tailored for RHY appears warranted. Peer groups and mentorship programs would provide invaluable support for young individuals, as supportive friendships protect against NSSI.

Association between traumatic events with suicidality among adolescents: A large-scale cross-sectional study of 260,423 participants

Traumatic events have significant negative impacts throughout one's life. We aimed to comprehensively examine the early associations between traumatic events and suicidality among adolescents. In a cross-sectional sample of 260,423 adolescents in Deyang, China in September 2021, we assessed individual traumatic events, cumulative types, and patterns, alongside suicide risk scores and ideation, attempts, or plans. Linear and Poisson regression models adjusted for demographic confounders evaluated the association. Robust associations existed between interpersonal violence-related traumatic events and higher suicidality, with physical abuse demonstrating the strongest correlation. Moreover, suicide risk scores displayed a clear trend, indicating a progressively stronger association with suicidality as cumulative traumatic event types increased. Four distinct traumatic patterns emerged, including low traumas, high physical abuse, high death/serious injuries of a loved one, and multiple traumas, with the latter showing the strongest association with suicidality. Notably, the stratified analysis showed these associations were more pronounced in females, urban residents, only children, left-behind children, and those aged 13-15, while weaker in participants from families with intact parental relationships and middle socioeconomic status. Understanding the role of demographic factors and traumatic patterns in identifying at-risk youth can enable early detection and targeted interventions for suicide-related concerns.

Psychiatric profiles in suicidal attempters: Relationships with suicide behaviour features

BACKGROUND

Suicide constitutes a major health concern worldwide, being a significant contributor of death, globally. The diagnosis of a mental disorder has been extensively linked to the varying forms of suicidal ideation and behaviour. The aim of our study was to identify the varying diagnostic profiles in a sample of suicide attempters.

METHODS

A sample of 683 adults (71.3% females, 40.10±15.74 years) admitted at a hospital emergency department due to a suicide attempt was recruited. Latent class analysis was used to identify diagnostic profiles and logistic regression to study the relationship between comorbidity profile membership and sociodemographic and clinical variables.

RESULTS

Two comorbidity profiles were identified (Class I: low comorbidity class, 71.3% of attempters; Class II: high comorbidity class, 28.7% of attempters). Class I members were featured by the diagnosis of depression and general anxiety disorder, and low comorbidity; by contrast, the high comorbidity profile was characterized by a higher probability of presenting two or more coexisting psychiatric disorders. Class II included more females, younger, with more depressive symptoms and with higher impulsivity levels. Moreover, Class II members showed more severe suicidal ideation, higher number of suicide behaviours and a greater number of previous suicide attempts (p<.01, for all the outcomes), compared to Class I members.

CONCLUSIONS

Psychiatric profiles may be considered for treatment provision and personalized psychiatric treatment in suicidal attempters as well as tackle suicide risk.

Identifying Trajectories of Maltreatment Revictimization and Juvenile Justice Outcome: A Latent Class Analysis of Subtype, Timing, and Chronicity

Continued exposure to abuse or neglect is a strong predictor for immediate and long-term negative developmental outcomes including developmental delays, disabilities, poor school performance, criminal behavior, and mental health issues. The purpose of this study was to identify distinct subgroups of children with repeat victimization based on maltreatment timing, subtype, and chronicity and to examine how the unique subgroups are related to youth's juvenile justice outcome. Using data from Longitudinal Studies of Child Abuse and Neglect, this study included 286 children (47% males, 41% blacks) with more than one report for substantiated maltreatment from birth to age 17. Latent class analysis was employed to identify heterogeneity in the patterns of maltreatment revictimization. Four latent classes emerged: (a) Prevailing Early Neglect (52.6%); (b) Co-occurring Maltreatments in Preschool Age (20.1%); (c) Incremental Neglect with Sexual Abuse in School Age (18.7%); and (d) Co-occurring Maltreatments in School Age (8.6%). Black children were overrepresented in Incremental Neglect with Sexual Abuse in School Age compared to white and other racial groups of children. Ordinal logistic regression analysis indicated that there was no significant difference in the juvenile justice outcome across four subgroups of children with revictimization. Our person-centered investigations of maltreatment subtype, timing, and chronicity highlight the need for precise assessment and prevention strategies based on a more nuanced understanding of various patterns of childhood maltreatment revictimization.

Childhood adversities and suicidal behavior in the general population. The cross-sectional PEGASUS-Murcia Project

INTRODUCTION

The aim of the present study is to estimate the lifetime prevalence of suicidal ideation, plans, and attempts in a regional representative sample and the association of these outcomes with sociodemographic factors, prior mental disorders, and childhood adversities.

MATERIAL AND METHODS

The PEGASUS-Murcia project is a cross-sectional survey of a representative sample of adults in Murcia that is part of the WHO World Mental Health Survey Initiative. The Composite International Diagnostic Interview (CIDI 3.0) was administered face-to-face to 2621 participants (67.4% response rate). The main outcomes were suicidal ideation, plans, and attempts. Lifetime prevalence, age of onset, and risk factors (sociodemographic variables, mental disorders, and childhood adversities) were examined using multiple discrete-time survival models.

RESULTS

Lifetime prevalence of suicidal ideation, plans and attempts were 8.0% (standard error, SE: 1.1), 2.1% (SE: 0.3), and 1.2% (SE: 1.1), respectively. Prevalence of any childhood adversities was 22.1% (SE: 1.3) in the total sample and, even higher, among those with suicide related outcomes (ranging between 36.8% and 53.7%). Female sex, younger age, prior (to onset of the outcome) lifetime prevalence of mood disorders, number of mental disorders, and exposure to childhood adversity were associated with significantly increased odds of suicidal ideation and plans.

CONCLUSIONS

Lifetime prevalence estimates of suicidality are similar to those in community epidemiological surveys. Childhood adversities and mental disorders, especially mood disorders, are important risk factors for suicidality. Early detection of these adversities and disorders should be targeted in suicide prevention programs.

Child Sexual Abuse: Forensic Medical Assessment of the Traumatic Injuries Over the Victim's Body

Child sexual abuse is a public health problem that affects children worldwide in all ethnic, educational, and socioeconomic groups. These assaults are extremely dangerous not only due to their direct physical traumas received at the time of the abuse, but they also have long-term consequences that can worsen the future quality of the victim's life. A retrospective study of all cases related to child sexual abuse for five years was performed by materials of the Clinic of Forensic Medicine and Deontology, Sofia, Bulgaria. Ninety-five cases involve children from both genders. The traumatic injuries were carefully examined and classified according to their localization over the victim's bodies and based on the time that had passed after the reported assaults. In cases of sexual violence, the most informative and pointing at the exact type of violence are the injuries situated in the anogenital area. Too often, there is a lack of physical findings, depending on the type of sexual violence or associated with the prolonged time that passes after the crime. Children are unaware of what they have to do after suffering such traumas, or they are scared to share their experience with different family members, which can lead to late forensic examination and lack of physical and biological findings, which are the most critical traces in the criminal prosecution of the crimes and this can be a possibility for the perpetrator not to be charged for his unlawful actions.

Prevention of child sexual abuse in the USA: a scoping review protocol of US legislative policies

INTRODUCTION

Child sexual abuse (CSA) poses a significant threat to the health and well-being of children in the USA and globally. Many states have introduced or implemented policies to address and prevent CSA, but little research has linked the effects of this legislation on the reduction of adult-perpetrated CSA. The objective of this scoping review is to identify US policies which aim to prevent CSA, explain the components of these types of legislation, review evidence of effectiveness, describe the populations included in the literature, and identify barriers and facilitators to the implementation of said policies.

METHODS AND ANALYSIS

This scoping review will follow Joanna Briggs Institute methodology for scoping reviews and will use the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist. Sources of peer-reviewed evidence from January 2000 to July 2023 will be included. Relevant publications will first be searched in PubMed/MEDLINE database, then 25 other databases. The reference lists of included studies and high-yield journals will be hand searched. Articles which focus on the types of CSA prevention policies and their effects will be included. Studies must clearly demonstrate a connection between policies and CSA outcomes. Title, abstract, full-text screening and extraction will be completed by a team of three researchers. Critical appraisal of the included studies will be performed. Extracted data will be displayed in tabular form and a narrative summary will describe the results of the review.

ETHICS AND DISSEMINATION

This scoping review will provide an extensive overview of legislative policies which aim to prevent CSA in the USA. Results of this review will inform future CSA prevention policies in the USA, particularly regarding policy development, evaluation and implementation. Results will be disseminated through a peer-reviewed publication.

Risk factors and protective factors for nonsuicidal self-injury in adolescents: A hospital- and school-based case-control study

OBJECTIVE

Nonsuicidal Self-Injury (NSSI) in China has increasingly interested clinicians, although few studies have investigated its risk and protective factors. This study examined the risk factors of NSSI among Chinese adolescents.

METHODS

The researchers recruited adolescent participants with NSSI from a hospital outpatient clinic to form a case group and recruited adolescents without NSSI who provided informed consent from the school to form a control group. Participants completed a questionnaire, and data were analyzed using logistic regression.

RESULTS

A total of 138 cases and 276 controls participated in this study. Binary multivariate logistic regression analysis with adjusting for age and sex showed that domestic violence (OR = 8.615, 95%CI: 3.081-24.091), parental overconcern (OR = 6.995, 95%CI: 3.447-14.192), guilt (OR = 4.949, 95%CI: 2.227-10.996), and school bullying (OR = 21.676, 95%CI: 6.799-69.109) increased the risk of NSSI, while peer support (OR = 0.068, 95%CI: 0.030-0.150) and living in an urban environment (OR = 0.157, 95%CI: 0.056-0.437) decreased the risk of NSSI.

CONCLUSION

Some psychosocial factors were confirmed to be independent risk and protective factors for NSSI in this study. However, the clinical significance of the results needs to be interpreted with caution due to sample size limitations.

Enduring Effects of Early Life Traumas on Adult Suicidal Ideation

Exposure to traumas early in life has been found to have a range of negative health effects later in adulthood, including a higher risk for suicidal behavior. Using data from the Waves I (1994/95) and IV (2008) of the National Longitudinal Study of Adolescent to Adult Health (N = 14,385; 49.35% female; Mage in Wave IV = 29), this study examines the effects of exposure to three different types of early life traumas-emotional abuse, physical abuse, and sexual abuse before the age of 18-on adult suicidal ideation. Guided by the stress process model incorporated with a life-course perspective, potential mediating roles of psychological distress, subjective powerlessness, and perceived social rejection were also investigated. A series of regression and Karlson-Holm-Breen (KHB) mediation analyses were performed using Stata 14 to assess the total, direct, and indirect effects. All three early life trauma measures were found to be significantly and independently associated with a higher risk of suicidal ideation in adulthood. A substantive portion (between 30 and 50%) of the effects was mediated by psychological distress (i.e., depression and anxiety), subjective powerlessness, and perceived social rejection. The general policy implications of this study include evaluating suicidal individuals for prior childhood abuse experiences and assessing abuse survivors for suicidality.

Mediators of the Relationship Between Adverse Childhood Experiences (ACEs) and Symptoms of Anxiety, Depression, and Suicidality among Adults

Adverse childhood experiences (ACEs) are consistently found to be negatively associated with physical, psychological, and psychosocial well-being throughout the lifespan. While previous research has established risk factors and noxious outcomes arising post-ACEs, less attention has been given to factors such as resilience, perceived social support, and subjective well-being that may help explain the relationship between ACEs and psychopathology. Hence, the objectives of this study are to examine: (1) the relationships among ACEs and symptoms of anxiety, depression, and suicidality in adulthood, and (2) whether resilience, social support, and subjective well-being mediate the relationship between ACEs and psychopathological symptoms. Cross-sectional data on ACEs, psychological factors, potential mediating variables, and sociodemographic factors were collected from a community sample of adults aged 18-81 (N = 296) via an on-line survey. Endorsing ACEs was significantly and positively correlated with symptoms of anxiety, depression, and suicidality. Results of parallel mediation analyses showed that social support, negative affect, and life satisfaction statistically mediated the relationships between ACEs and psychopathological outcomes in adulthood. These results highlight the importance of identifying potential mediators of the ACEs-psychopathological symptoms relationship to aid in the development of screening and intervention practices that could bolster developmental outcomes following traumatic childhood experiences.

Childhood Sexual Abuse and Military Sexual Trauma Interact to Increase Suicide Risk: Results from a Nationally Representative Veteran Sample

Childhood sexual abuse (CSA) and military sexual trauma (MST) are prevalent among veterans. Such exposures are associated with adverse mental-health sequelae, including elevated risk for suicidal thoughts and behaviors. Nonetheless, prior studies have largely focused upon discrete experiences of CSA or MST in circumscribed samples. In the current study, we analyzed data from a large, nationally representative sample of 4,069 US military veterans to examine main and interactive effects of CSA and MST in relation to suicidal thoughts and behaviors. After accounting for sociodemographics, psychiatric comorbidity, and trauma-related characteristics, we detected a significant interaction between MST and CSA as it related to report of past-year suicidal ideation, lifetime suicide attempt, and risk for future suicide attempt. These findings underscore the impact of sexual trauma throughout the lifespan, highlighting the continued importance of screening for trauma exposure and connecting veterans to appropriate, evidence-based treatment to decrease their risk for suicidal thoughts and behaviors.

[What is the contribution of smoking to the increased risk of suicide in young smokers? A systematic review]

OBJECTIVES

The correlation between smoking and suicide is well documented in the general population: there is an increased risk of suicide among tobacco smokers. However, the association between smoking and suicidal behaviors (ideations, plans, attempts) in youth is poorly elucidated. This is a systematic review of the literature examined data on the relationship between active and passive smoking and suicidal ideation (SI), suicide planning (SP), and suicide attempts (SA) among youth in the general population.

METHOD

Medline searches were performed for the period 1980-2020. Cross-sectional, case-control, prospective population-based studies of young people (age less than 18 years) were included in this review; studies of specific populations (patients with an identified pathology of any kind) were excluded.

RESULTS

This review included 43 studies: 23 studies on the association between active smoking and SI, SI and/or PS, TS; three studies on the association between passive smoking and suicidal behavior, three studies on the association between smoking and suicidal behavior in young people in psychiatric hospital settings, and five studies comparing the suicidal behavior of girls and boys. Analysis of the data collected lead to the conclusion that active or passive smoking is associated with suicidal behavior in young people. Smoking appears to contribute to psychopathological disorders, including depression, the use of other psychoactive substances, or psychosocial suffering which are often associated with an increased risk of suicide in young people. The correlations between smoking and the presence of mental disorders have been highlighted; tobacco use may contribute to the development of depression, anxiety and stress. Further studies are needed to verify the existence of a causal link between smoking and suicide.

CONCLUSION

Smoking is associated with the risk of suicidal behavior in young people; it should be included among the criteria for assessing suicidal risk in youth. Smoking cessation, which improves psychological well-being, should be further integrated into the prevention of suicidal behavior.

Suicidal Behaviors and Associated Factors Among Individuals with Gambling Disorders: A Meta-Analysis

The risk for suicidal behaviors including suicide ideations and attempts among individuals with gambling disorder (IWGDs) is high compared to the general population. Little is known about the interplay of mood disorders, alcohol use disorders, and suicidal behaviors among IWGDs. The study aimed to determine the prevalence, sociodemographic characteristics, risky behaviors, mental health disorders, and alcohol use disorders associated with suicide behaviors among IWGDs. Studies published between January 1 1995 and September 1 2022 were obtained from following databases: PubMed, Scopus, Web of Science and Cochrane Library databases. PECOS (population, exposures, comparison, outcome, and study design) criteria were used for selecting studies. The Newcastle-Ottawa Scale (NOS) was used for assessing risk of bias and rated each study in terms of exposure, outcome, and comparability. After initial assessment of 10,243 papers, a total of 39 studies met the eligibility criteria. Among IWGDs, the findings indicated a life-time pooled prevalence rate of 31% for suicide ideations (95% CI, 23-39%), 17% for suicide plans (95% CI, 0-34%), and 16% for suicide attempts (95% CI, 12-20%). Generally, suicide ideations among IWGDs were associated with having any financial debt and having chronic physical illnesses, as well as experiencing depression, mood disorders, and alcohol use disorders. Suicide attempts among IWGDs were associated with being older and having a childhood history of sexual abuse, as well as experiencing depression, mood disorders and alcohol use disorders. Interventions can help to facilitate seeking support among IWGDs by de-stigmatizing mental health disorders as well as improving the quality of care presented to individuals with psychiatric conditions.

Direct and Indirect Effects of Child Maltreatment on Suicidal Ideation among Chinese Left-Behind Children: Does Gender Make a Difference?

Previous studies indicate that maltreatment is related to children’s suicidal ideation, but the indirect mechanisms of left-behind children have been rarely investigated in the Chinese context. On the basis of a left-behind children sample (N = 1355; 57.1% females), this study aims to investigate the direct and indirect effects of maltreatment on suicidal ideation among Chinese left-behind children. The results of structural equation modeling (SEM) demonstrate that child maltreatment not only directly affects the suicidal ideation of left-behind children, but can also indirectly affect their suicidal ideation through the partially mediating role of self-efficacy. Moreover, a significant gender difference was found in the direct effect of maltreatment on suicidal ideation, with females experiencing stronger influence than males. Findings suggest that the effect of maltreatment on the suicidal ideation of left-behind children is mediated by self-efficacy and moderated by gender. Findings also highlight intervention directions for risk behaviors among left-behind children.

"Explode into small pieces": Suicidal ideation among child sexual abuse survivors

BACKGROUND

Child sexual abuse (CSA) has been acknowledged as predisposing survivors to an increased risk of suicidal ideation and attempts. Despite this risk being widely recognized, the study of suicidality has mainly focused on psychopathology, while less attention has been given to survivors' experiences and perceptions.

OBJECTIVE

This study aims to uncover the experiences and perceptions of suicidality among adult CSA survivors.

PARTICIPANTS AND SETTINGS

The sample consisted of 41 adult CSA survivors' written narratives of abuse that included references to suicide.

METHODS

Written narratives of CSA experiences were collected from 41 adult participants as part of the Israeli Independent Public Inquiry on CSA to change public policy. An inductive thematic analysis guided the exploration of the stories.

RESULTS

The findings portrayed several main themes regarding the survivors' experiences before, during and after suicidal thoughts and behaviors. These themes elucidated their motivations leading to suicidal attempts, including the wish to end one's self and suffering, self-blame, communicate the abuse and the request for recognition. Additionally, the survivors' stories illuminated their experiences following the suicidal attempts, depicting inadequate treatment and difficulties with the psychiatric labeling of a mental health disorder.

CONCLUSIONS

The findings of this study uncover new insights regarding the link between trauma, posttraumatic suffering, and suicidality within a social interaction context. Furthermore, these findings call medical and psychosocial health practitioners to view post-CSA suffering as trauma-related rather than personal psychopathology and to adjust practices to adapt to survivors' experiences and needs.

Childhood Sexual Abuse, Spirituality/Religion, Anxiety and Depression in a Jewish Community Sample: the Mediating Role of Religious Coping

Childhood sexual abuse (CSA) is a pervasive problem impacting a broad range of mental health outcomes. Previous research has shown that spiritual and religious (S/R) factors both positively and negatively relate to mental health issues among survivors of CSA, but mediating mechanisms of effect are unclear. The present study examined CSA, anxiety, depression, and positive/negative religious coping among 372 Jewish community members with and without CSA histories. Individuals who experienced CSA endorsed significantly higher anxiety and depression as well as negative religious coping than those without CSA. Negative religious coping mediated the relationship between CSA and anxiety and depression. We discuss clinical and social implications of these findings, including the need to address S/R factors in treatment of CSA, especially within religious communities. Further research examining abuser identity, survivors' disclosure experience, and other S/R mediators of effect is warranted.

Adverse Childhood Experiences, Suicidal/Self-Harming Thoughts, and Suicide Attempts Among LGB and Heterosexual Utahns

Current research suggests that sexual minorities living in Utah may be at higher risk for experiencing suicidal/self-harming thoughts and suicide attempts than heterosexuals in Utah. However, to date no research has been conducted examining potential reasons sexual minorities living in Utah may be at higher risk. Using two representative samples of Utahns, we examine (a) disparities in adverse childhood experiences (ACEs) between sexual minorities and heterosexual Utahn, (b) how ACEs and sexual orientation may predict recent suicidal/self-harming thoughts and lifetime prevalence of suicide attempts, and (c) how sexual orientation and ACEs might interact to predict suicidal outcomes. Results with each sample showed that sexual minority Utahns reported higher levels of ACEs and suicidal/self-harming thoughts than heterosexual Utahns. Both sexual orientation and ACEs uniquely predicted suicidality when both were entered into regression models, but no interaction effects were found between these predictors.

The role of attachment to the foster parent with regard to suicidal risk among adult survivors of childhood maltreatment

BACKGROUND

Childhood maltreatment is associated with an increased risk of insecure/disorganized attachment and in turn with suicidal risk (SR). Out-of-family placement is aimed at interrupting child exposure to further abuse and at providing the necessary security for proper development via the establishment of an alternative attachment relationship. However, the actual protective role of this type of care is not clear given the high rates of SR among institutionalized or foster children.

OBJECTIVE

The aim of this study was to examine whether 1) attachment to the biological parents mediates the association between abuse and SR and 2) attachment to a foster parent (whether from a foster home or an institution) moderates the effect of attachment to biological parents on SR.

PARTICIPANTS

The sample consisted of 77 adults (52 female; 25 male; mean age: 26.6 years) who received out-of-home care during childhood.

METHOD

The Childhood Trauma Questionnaire and the Mini International Neuropsychiatric Interview (for SR) were used. The Attachment Multiple Model Interview was also administered to assess attachment to each biological parent and to the foster parent.

RESULTS

Results show that attachment (security and disorganization) to the biological mother mediates the link between abuse and SR and that attachment to the foster parent moderates the link between attachment to the biological mother and SR.

CONCLUSIONS

Findings point to the importance of interventions aimed at supporting the establishment of a secure attachment relationship between children in care and their foster parents.

Associations Between Adverse Childhood Experiences and Prenatal Mental Health and Substance Use Among Urban, Low-Income Women

This study examined associations between Adverse Childhood Experiences (ACEs) and perinatal mental health and substance use among 98 low-income women (mean age 25.4 years; 93% Black/African American) referred to a mental health care manager in an urban women's clinic. Self-report and retrospective chart review data were utilized. Chi-squared and Fisher's Exact tests were performed to assess bivariate relationships between ACEs and mental health and substance use outcomes. Multivariate logistic regressions were used to examine the impact of ACEs on mental health and substance use, adjusting for marital status, education, and age. Findings indicate high levels of childhood adversity, specifically childhood abuse, are associated with negative perinatal mental health and substance use outcomes, including suicidal thoughts, anxiety, mood dysregulation, and tobacco and marijuana use. Inquiring about ACEs during prenatal care and/or in community health clinics may help identify patients' overall risk and provide opportunities for intervention for mothers and their infants.

Child Sexual Abuse and Problems Reported by Survivors of CSA: A Meta-Review

A systematic meta-review of reviews and meta-analyses on problems reported by survivors of Child Sexual Abuse (CSA) was conducted. The aim was to comprise a comprehensive overview of 1) problems reported by survivors of CSA, and 2) variables moderating these relations. Two raters independently conducted a search through PubMed, PsychINFO, Campbell Library, Cochrane Library and Web of Science. Twenty-five reviews and meta-analyses reporting on 53 problems related to CSA were analyzed. All fell into five domains: medical, psychological, sexual, repeated (self-)harm, and a final category of other problems. Thirty-six of all problems (68%) were consistently and significantly more commonly reported by CSA survivors as compared to individuals without a history of CSA. Most moderator analyses did not significantly influence these relationships. In conclusion, CSA is associated with various problems across different domains and overall, these problems are prevalent independent of specific characteristics of and circumstances surrounding the abuse.

Gender-Oriented Mental Health Prevention: A Reappraisal

Many studies have investigated the impact of gender on mental health, but only a few have addressed gender differences in mental health risk and prevention. We conducted a narrative review to assess the current state of knowledge on gender-specific mental health preventive interventions, along with an analysis of gender-based risk factors and available screening strategies. Out of 1598 articles screened using a comprehensive electronic search of the PubMed, Web-of-Science, Scopus, and Cochrane databases, 53 were included for review. Among risk factors for mental health problems, there are individual, familiar, social, and healthcare factors. Individual factors include childhood adversities, which show gender differences in distribution rates. However, current childhood abuse prevention programs are not gender-specific. Familiar factors for mental health problems include maternity issues and intimate partner violence, and for both, some gender-specific preventive interventions are available. Social risk factors for mental health problems are related to education, employment, discrimination, and relationships. They all display gender differences, but these differences are rarely taken into account in mental health prevention programs. Lastly, despite gender differences in mental health service use being widely known, mental health services appear to be slow in developing strategies that guarantee equal access to care for all individuals.

Sex education and self-poisoning in Sri Lanka: an explorative analysis

Background

Self-harm and suicide are important causes of morbidity and mortality in Sri Lanka, but our understanding of these behaviours is limited. Qualitative studies have implicated familial and societal expectations around sex and relationships. We conducted an explorative analysis using case-control data to investigate the association between sex education and self-poisoning in Sri Lanka.

Methods

Cases (N=298) were self-poisoning inpatients on a toxicology ward, Teaching Hospital Peradeniya. Controls (N=500) were sex and age frequency matched to cases and were outpatients/visitors to the same hospital. Participants were asked whether they had received sex education, and to rate the quality and usefulness of any sex education received. Logistic regression models adjusted for age, sex, and religion quantified the association between receipt, quality and usefulness of sex education and self-poisoning. We tested whether the associations differed by sex.

Results

Roughly 1-in-3 cases and 1-in-5 controls reported having not received sex education. Individuals who did not receive sex education were nearly twice as likely to have self-poisoned than those who did (OR 1.68 (95% CI 1.11-2.55)). Those who reported the sex education they received as not useful were more likely to have self-poisoned compared to those who reported it useful (OR 1.95 (95% CI 1.04-3.65)). We found no evidence of an association between self-poisoning and the self-rated quality of sex education, or that associations differed by participant sex.

Conclusion

As sex education is potentially modifiable at the population-level, further research should aim to explore this association in more depth, using qualitative methods and validated measurement tools.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12374-4.

Psychobiological Consequences of Childhood Sexual Abuse: Current Knowledge and Clinical Implications

A large body of research has documented the long-term harms of childhood sexual abuse (CSA) on an individual’s emotional-adaptive function and mental health. Recent studies have also provided evidence of the biological impact of CSA, implicating specific alterations in many systems, including the endocrine and immune systems, and in DNA and chromatin, in the pathogenesis of medical disorders. Although the effects of CSA are often examined with regard to the general impact of early-life traumatic experiences, the study of CSA per sè, as a trigger of specific pathogenic pathways, would be more appropriate to understand their long-term implications and develop tailored diagnostic and therapeutic strategies. Based on these premises, this narrative minireview summarizes the research on the short-term and long-term sequelae of CSA, focusing on dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, the effects on the immune system, and the changes to DNA through altered methylation. Also, we discuss the literature that examines dysfunctional DNA telomere erosion and oxidative stress markers as a sign of CSA. Finally, recent evidence of the intergenerational transmission of the effects of CSA is reported. The impact of CSA on brain connectivity and functions is out of the scope of this review, thus brain imaging studies are not included. The results of this minireview are discussed, considering their implications for prevention and clinical practice.

Association of Childhood Adversity With Morbidity and Mortality in US Adults: A Systematic Review

IMPORTANCE

Childhood adversity (CA) is a powerful determinant of long-term physical and mental health that is associated with elevated risk for chronic disease and psychopathology. However, the degree to which CA contributes to mortality as a preventable driver of ill-health and death is unknown.

OBJECTIVE

To estimate the contribution of CA to health behaviors, including smoking and sedentary behavior, as well as the annual mortality attributable to CA in the US through influences on leading causes of death (eg, cardiovascular disease).

EVIDENCE REVIEW

For this systematic review, the PsycINFO and MEDLINE databases were searched on November 15, 2019. The databases were searched for publications from inception (1806 for PsycINFO, 1946 for MEDLINE) to November 15, 2019. Meta-analyses of the associations between CA and morbidity outcomes were included. The population attributable fraction (PAF) was calculated from these associations along with the estimated US prevalence of CA. The PAF was then applied to the number of annual deaths associated with each cause of death to estimate the number of deaths that are attributable to CA. Additionally, the PAF was applied to the incidence of health behaviors to derive the number of cases attributable to CA. Exposure to 1 or more experiences of adversity before the age of 18 years was analyzed, including abuse, neglect, family violence, and economic adversity.

FINDINGS

A total of 19 meta-analyses with 20 654 832 participants were reviewed. Childhood adversity accounted for approximately 439 072 deaths annually in the US, or 15% of the total US mortality in 2019 (2 854 838 deaths), through associations with leading causes of death (including heart disease, cancer, and suicide). In addition, CA was associated with millions of cases of unhealthy behaviors and disease markers, including more than 22 million cases of sexually transmitted infections, 21 million cases of illicit drug use, 19 million cases of elevated inflammation, and more than 10 million cases each of smoking and physical inactivity. The greatest proportion of outcomes attributable to CA were for suicide attempts and sexually transmitted infections, for which adversity accounted for up to 38% and 33%, respectively.

CONCLUSIONS AND RELEVANCE

The results of this systematic review suggest that CA is a leading contributor to morbidity and mortality in the US and may be considered a preventable determinant of mortality. The prevention of CA and the intervention on pathways that link these experiences to elevated disease risk should be considered a critical public health priority.

Traumatic life-events and alcohol and drug use disorders among Mexican adolescents: Bidirectional associations over 8 years

BACKGROUND

Most research linking type of traumatic events to the incidence of alcohol and drug use disorders among adolescents are cross-sectional and no longitudinal research exists in low/middle income countries where violence is common. Studies on bidirectional associations are infrequent.

METHODS

We estimated prospective associations of 7 types of events and new occurrence of DSM-IV alcohol use disorders (AUD) and drug use disorders (DUD), as well as prospective associations between DSM-IV AUD, DUD and the new onset of 7 types of traumatic events, from a follow-up conducted in 2013 (n = 1071; ages 19-26) of the original Mexican Adolescent Mental Health Survey conducted in 2005 (ages 12-17), by using Relative Ratios (RR) and Hazard Ratios (HR) estimates.

RESULTS

After adjustments for mental disorders and demographics, "any traumatic event" increased the RR and HR of a new AUD and any substance use disorder (SUD). In HR estimates, bidirectional associations were found between "Ever committed or witnessed violence" and "Ever beaten up by spouse…" and AUD, DUD and SUD. DUD disorder increased HR for several events.

LIMITATIONS

Our sample is representative of the largest metropolitan area in Mexico but does not include other cities and other age groups that may differ in risk factors. Corrections for multiple tests suggests caution.

CONCLUSIONS

We found partial support for the self-medication hypothesis and weaker support for the risky behavior hypothesis, and only two traumatic events ("Ever beaten up by spouse, partner…" and "Ever committed or witnessed violence") showed evidence of a bidirectional association.

Traumatic life-events and suicidality among Mexican adolescents as they grow up: A longitudinal community survey

OBJECTIVE

Limited research exists on the impact of type and number of traumatic events on the incidence of suicide ideation and attempts (suicidality) among adolescents in low/middle income countries where violence is common.

METHOD

We estimated prospective associations of 7 types of events on the new occurrence of suicidality from a follow-up conducted in 2013 (n = 1071; ages 19-26) of the original Mexican Adolescent Mental Health Survey conducted in 2005 (ages 12-17), by using Hazard Ratios (HR) estimates.

RESULTS

For new onset of suicide ideation, those reporting "Ever raped or sexually assaulted" had the highest adjusted HR (3.8), followed by "Ever other traumatic event" (HR = 1.9), "Ever committed or witnessed violence" (HR = 1.7) and "Beaten as a child or witnessed physical fights at home" (HR = 1.5). For suicide attempt, those reporting "Ever beaten up by spouse, partner, someone else, mugged with a weapon, or stalked" (HR = 3.8) and "Ever other traumatic event" (HR = 2.0) had the higher hazards. Compared to those without a traumatic event, increased hazards of ideation and attempt were found for those reporting a greater number of types of events.

CONCLUSIONS

Our sample is representative of the largest metropolitan area in Mexico but does not include other cities or age groups that may differ in risk factors. Traumatic events that happened in the eight years between waves are not considered. Traumatic events increased the risk of suicidality, independent of common mental disorders. Identifying and addressing these events in clinical settings may therefore be important for preventing suicide in this population.

The EmpaTeach intervention for reducing physical violence from teachers to students in Nyarugusu Refugee Camp: A cluster-randomised controlled trial

BACKGROUND

School-based violence prevention interventions offer enormous potential to reduce children's experience of violence perpetrated by teachers, but few have been rigorously evaluated globally and, to the best of our knowledge, none in humanitarian settings. We tested whether the EmpaTeach intervention could reduce physical violence from teachers to students in Nyarugusu Refugee Camp, Tanzania.

METHODS AND FINDINGS

We conducted a 2-arm cluster-randomised controlled trial with parallel assignment. A complete sample of all 27 primary and secondary schools in Nyarugusu Refugee Camp were approached and agreed to participate in the study. Eligible students and teachers participated in cross-sectional baseline, midline, and endline surveys in November/December 2018, May/June 2019, and January/February 2020, respectively. Fourteen schools were randomly assigned to receive a violence prevention intervention targeted at teachers implemented in January-March 2019; 13 formed a wait-list control group. The EmpaTeach intervention used empathy-building exercises and group work to equip teachers with self-regulation, alternative discipline techniques, and classroom management strategies. Allocation was not concealed due to the nature of the intervention. The primary outcome was students' self-reported experience of physical violence from teachers, assessed at midline using a modified version of the ISPCAN Child Abuse Screening Tool-Child Institutional. Secondary outcomes included student reports of emotional violence, depressive symptoms, and school attendance. Analyses were by intention to treat, using generalised estimating equations adjusted for stratification factors. No schools left the study. In total, 1,493 of the 1,866 (80%) randomly sampled students approached for participation took part in the baseline survey; at baseline 54.1% of students reported past-week physical violence from school staff. In total, 1,619 of 1,978 students (81.9%) took part in the midline survey, and 1,617 of 2,032 students (79.6%) participated at endline. Prevalence of past-week violence at midline was not statistically different in intervention (408 of 839 students, 48.6%) and control schools (412 of 777 students, 53.0%; risk ratio = 0.91, 95% CI 0.80 to 1.02, p = 0.106). No effect was detected on secondary outcomes. A camp-wide educational policy change during intervention implementation resulted in 14.7% of teachers in the intervention arm receiving a compressed version of the intervention, but exploratory analyses showed no difference in our primary outcome by school-level adherence to the intervention. Main study limitations included the small number of schools in the camp, which limited statistical power to detect small differences between intervention and control groups. We also did not assess the test-retest reliability of our outcome measures, and interviewers were unmasked to intervention allocation.

CONCLUSIONS

There was no evidence that the EmpaTeach intervention effectively reduced physical violence from teachers towards primary or secondary school students in Nyarugusu Refugee Camp. Further research is needed to develop and test interventions to prevent teacher violence in humanitarian settings.

TRIAL REGISTRATION

clinicaltrials.gov (NCT03745573).

Childhood adversity links to self-reported mood, anxiety, and stress-related disorders

BACKGROUND

Child abuse has been identified within the DSM-5 as a putative etiologic risk for over two dozen psychiatric disorders.

METHODS

This study examined associations between self-reported diagnostic histories of six Mood, Anxiety and Stress-Related Disorders and childhood adversities measured using dichotomous ACE (Adverse Childhood Experiences) counts and dimensional indices of child abuse.

RESULTS

Adversity odds ratio were all significant (p < .001) and averaged as follows: sexual abuse, OR_M = 3.16; emotional abuse, OR_M = 2.62; physical abuse, OR_M = 2.41; maternal battering, OR_M = 2.15. An effort was made to differentiate between additive and interactive adversity risks. While significant adversity interactions were found, they tended to be modest in effect sizes and scope. The combination of sexual, physical and emotional abuse was associated with a maximal odds ratio and prevalence for Major Depression (OR = 5.13, 70.8%). The large impacts of unitary adversities limited the potential for large interactive effects.

LIMITATIONS

The cross-sectional analysis relied on retrospective self-reports that may not generalize fully to respondents differing in ethnicity, religion, sexual orientation, or other factors.

CONCLUSIONS

Childhood adversity in four different forms was associated with higher prevalence rates for six different mood and anxiety disorders. Childhood sexual and emotional abuse appeared to account for unshared variance in all of these lifetime diagnoses. Significant high risk adversity combinations were found for Major Depression (sexual/physical/ emotional), Post-Traumatic Stress Disorder (sexual/physical & physical/maternal battering), and Generalized Anxiety Disorder (physical/emotion/maternal battering).

Childhood abuse and neglect and self-reported symptoms of psychopathology through midlife

Although abuse and neglect in the early years of life have been reliably linked to poor mental health outcomes in childhood, only a few studies have examined whether the predictive significance of childhood abuse and neglect endures for symptoms of psychopathology into adulthood. Here we examined to what extent prospectively assessed child abuse and neglect is associated with self-reported symptoms of psychopathology measured from ages 23 through 39 years, controlling for early demographic covariates and self-reported symptoms of psychopathology measured at age 16 years. The sample included 140 participants from the Minnesota Longitudinal Study of Risk and Adaptation. Participants were 49% female and 69% White/non-Hispanic. At the time of their child's birth, 48% of the mothers were teenagers (M = 20.5 years, SD = 3.74), 65% were single, and 42% had completed less than a high school education. Results indicated that childhood abuse and neglect was robustly associated with symptoms of psychopathology in adulthood. Exploratory analyses focusing on specific parametrizations of abuse/neglect suggested that abuse perpetrated by maternal figures (rather than paternal or nonparental figures) was uniquely associated with high levels of self-reported symptoms of psychopathology in adulthood. We found no evidence that any subtype of abuse and/or neglect or abuse/neglect during any particular phase of development uniquely predicted symptoms of psychopathology after controlling for relevant covariates. These results highlight the long-lasting significance of childhood abuse and neglect for reports of mental health in adulthood. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Investigating the relationship between childhood sexual abuse, self-harm repetition and suicidal intent: mixed-methods study

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.

Association between Childhood Trauma and Suicidal Behavior in the General Population

This study aimed to investigate the associations between various types of childhood trauma and suicidal behavior in the general population in South Korea. This mental health survey included a total of 1,490 general citizens living in a metropolitan South Korean city who completed a questionnaire that assessed respondents' histories of childhood trauma before the age of 12 years, including bullying victimization, emotional abuse, sexual abuse, and physical abuse, as well as suicidal behavior, including current suicidal ideation and histories of suicide planning and attempts. The following psychiatric scales were administered: Hospital Anxiety and Depression Scale (HADS), Rosenberg Self-Esteem Scale (R-SES), Connor-Davidson Resilience Scale (CD-RISC), Perceived Stress Scale (PSS), and visual analogue scale of EuroQol 5D (EQ-5D). Participants who experienced any childhood trauma had significantly higher HADS and PSS scores, and significantly lower EQ-5D scores. Additionally, participants with any type of childhood trauma were significantly more likely to have current suicidal ideation and histories of planned and attempted suicide. Multivariate analyses adjusted for confounding variables indicated that bullying victimization and sexual abuse were associated significantly with all types of suicidal behavior. Physical abuse was associated significantly with histories of suicide planning and attempts. The present findings showed that any type of childhood trauma was associated with higher levels of suicidality, anxiety, depression, and perceived stress, as well as lower health-related quality of life, in the general population. In particular, associations between childhood trauma and suicidality were identified after adjustment for confounding variables.

Predictors of Unbearability, Unlovability, and Unsolvability in Veterans With Military-Sexual-Trauma-Related Posttraumatic Stress Disorder

Military sexual trauma (MST) and posttraumatic stress disorder (PTSD) both increase risk for suicidal self-directed violence (SDV). Suicide cognitions (i.e., unbearability, unlovability, and unsolvability) are strong predictors of future suicidal SDV. The present study investigated potential predictors of unbearability, unlovability, and unsolvability in veterans with MST-related PTSD. Suicide cognitions, depression, PTSD, quality of life, trauma-related negative cognitions, physical health functioning, mental health functioning, and childhood sexual assault were assessed in 12 male and 103 female veterans with MST-related PTSD. Higher depression scores, greater trauma-related negative cognitions about self, and poorer physical health functioning predicted increased unbearability scores. Greater trauma-related negative cognitions about self and self-blame, higher level of education, and higher depression scores predicted increased unlovability scores. Higher depression scores and greater trauma-related negative cognitions about self predicted increased unsolvability scores. In veterans with MST-related PTSD who express unbearability, unlovability, and unsolvability, assessing and addressing depression, trauma-related negative cognitions about self and self-blame, and physical health functioning may be an important step in reducing SDV.

"How many times did I not want to live a life because of him": the complex connections between child sexual abuse, disclosure, and self-injurious thoughts and behaviors

BACKGROUND

Meta-analyses have confirmed an association between child sexual abuse (CSA) and non-suicidal and suicidal self-injurious thoughts and behaviors (SITB), yet the mechanisms linking these factors are, to date, poorly understood. The goal of the current study is to explore one potential influencing factor acting in the association between CSA and SITB, which is the disclosure experience. Disclosure has been identified as a prominent factor in the healing process of survivors, with a lack of support following disclosures heightening negative outcomes. Exploring the impact of CSA disclosure on SITB is necessary to build effective prevention and intervention strategies.

METHODS

This qualitative study is part of a larger initiative spanning diverse research sites in Canada and in Ireland and aiming to lend voice to young people who were sexually abused in childhood/adolescence. Participants were recruited from community-based sexual abuse/assault agencies, hospital-based specialized clinics and child advocacy centres. The Long Interview Method, based on a branch of phenomenology, was used to guide research design and data collection. The current thematic analysis, informed by a stress-diathesis model, is based on a sample comprised of 21 ethnically diverse youth aged 15 to 25 who self-reported a sexual abuse experience in their childhood or teenage years and who, as part of the interview on their disclosure processes, revealed past or current SITB.

RESULTS

The thematic analysis led to the identification of four main themes that both confirmed past research and conceptual models on SITB, and provided new insights. Participants perceived a clear link between their CSA experience and SITB and other mental health issues. They offered their views on the meanings of SITB for CSA victims: to cope with abuse; to end the abuse; to express self-hatred and loneliness; and to let people know about their suffering. They described how negative disclosure experiences led to more nonsuicidal and suicidal SITB. Yet, participants also revealed that receiving support for their SITB created opportunities for CSA disclosure and support.

CONCLUSIONS

This study showed complex connections between CSA experiences, disclosure and nonsuicidal and suicidal SITB. Understanding the reciprocal influences between SITB, CSA disclosure and help-seeking could better equip mental health professionals and caregivers to provide support and foster healing and recovery in CSA victims.

A Systematic Review of Reviews of the Outcome of Noninstitutional Child Maltreatment

The aim of the systematic review described in this article was to synthesize available high-quality evidence on the outcomes of noninstitutional child maltreatment across the life span. A systematic review of previous systematic reviews and meta-analyses was conducted. Ten databases were searched. One hundred eleven papers which met stringent inclusion and exclusion criteria were selected for review. Papers were included if they reported systematic reviews and meta-analyses of longitudinal or cross-sectional controlled studies, or single-group cohort primary studies of the outcomes of child maltreatment in the domains of physical and mental health and psychosocial adjustment of individuals who were children lived mainly with their families. Using AMSTAR criteria, selected systematic reviews and meta-analyses were found to be of moderate or high quality. Searches, study selection, data extraction, and study quality assessments were independently conducted by two researchers, with a high degree of interrater reliability. The 111 systematic reviews and meta-analyses reviewed in this article covered 2,534 independent primary studies involving 30,375,962 participants, of whom more than 518,022 had been maltreated. The magnitude and quality of this evidence base allow considerable confidence to be placed in obtained results. Significant associations were found between a history of child maltreatment and adjustment in the domains of physical health, mental health, and psychosocial adjustment in a very wide range of areas. The many adverse outcomes associated with child maltreatment documented in this review highlight the importance of implementing evidence-based child protection policies and practices to prevent maltreatment and treat child abuse survivors.

Childhood Abuse and Suicidal Behaviors Among Chinese Migrant Workers: The Mediating Role of Alexithymia and Social Support

This study aims to investigate the lifetime prevalence of suicidal behaviors in a sample of Chinese migrant workers. It also examined the mediating role of alexithymia and social support in the link between childhood abuse and suicidal behaviors. A total of 1,563 migrant workers were surveyed by using cluster sampling. Results showed that the estimated lifetime prevalence of suicide ideation, plan, and attempt among Chinese migrant workers was 12.8%, 8.1%, and 4.6%, respectively. Structural equation modeling analyses revealed a significant positive association between childhood abuse and suicidal behaviors; this association was partially mediated by social support. A significant path from childhood abuse through alexithymia and social support to suicidal behaviors was also established. Findings of this study emphasize the importance of social support and alexithymia in understanding the possible mechanisms underlying the relationship between childhood abuse and suicidal behaviors and suggest possible avenues for suicide interventions.

Sex, Gender, and Suicidal Behavior

This chapter reviews gender differences in suicide, commonly known as the gender paradox in suicide. While men are more likely to complete suicide, suicide attempts are more frequent in women. Although there are exceptions, this paradox occurs in most countries over the world, and it is partially explained by the preference of men for more lethal methods. Nevertheless, there are differences in the known risk factors for suicide between men and women, and this chapter summarizes the more relevant findings for the gender paradox. Apart from previous attempts, which still is the strongest predictor of death by suicide, with a higher rate in males than in females, we will emphasize in the role of male depression. It is commonly recognized that over 90% of people who die by suicide had a psychiatric diagnosis, mostly depression, and male depression seems to be a distinct clinical phenotype challenging to recognize, which might contribute to the gender paradox. Finally, in light of all the information reviewed, some recommendations on prevention of suicide from a gender perspective in the clinical setting will be made.

Determinants of Suicidality in the European General Population: A Systematic Review and Meta-Analysis

Close to one million people commit suicide each year, with suicidal attempts being the main risk factor for suicide. The aim of this systematic review and meta-analysis is to achieve a greater understanding of suicidality in the general population of Europe by studying associated factors and their statistical significance with suicidality, as well as the effect of the temporal moment in which suicidality is observed in a relationship. A search strategy was carried out in electronic databases: Proquest's Psychology Database, Scopus, PsycINFO, Medline and Embase. Odds ratios (ORs), publication bias, influential studies on heterogeneity and analysis moderators were calculated. Twenty-six studies were included after meeting the inclusion criteria. Factors statistically associated with suicidality are female gender, age over 65 years, unemployment, low social support, adulthood adversity, childhood adversity, family history of mental disorder, any affective disorder, major depression, anxiety/stress/somatoform disorders, tobacco and substance use, any mental disorder and body mass index. As a limitation, a high heterogeneity between studies was found. Factors associated with suicidality in the general population are relevant for understanding the suicidal phenomenon.

Child Sexual Abuse and Suicidal Ideation: The Differential Role of Attachment and Emotional Security in the Family System

The objective of this study was to analyze the effects of attachment style and emotional security in the family system on suicidal ideation in a sample of young adult female victims of child sexual abuse (CSA). The possible effects of CSA characteristics and other types of child abuse on suicidal ideation were controlled for. The sample consisted of 188 female college students who had been victims of sexual abuse before the age of 18, as well as 188 randomly selected participants who had not experienced CSA. The results showed that both attachment and emotional security were associated with suicidal ideation, even when controlling for both the characteristics of abuse and the existence of other abuses. The strong relationships of emotional security and attachment style with suicidal ideation suggest the importance of early intervention with children who have been sexually abused and their families, in an effort to optimize their attachment style, as well as to decrease emotional insecurity to prevent the onset of symptomatology related to suicidal ideation.

Self-Blame, Shame, Avoidance, and Suicidal Ideation in Sexually Abused Adolescent Girls: A Longitudinal Study

Depressive symptoms, posttraumatic stress disorder, and suicidal ideation are among the most prevalent problems associated with sexual abuse. Based on the Traumagenic dynamic of stigmatization model, the aim of this study was to investigate whether self-blame, shame, and maladaptive coping strategies predicted posttraumatic stress disorder, depressive symptoms, and suicidal ideation among sexually abused adolescent girls using a longitudinal design. A total of 100 adolescent girls completed a series of questionnaires at the initial visit at the intervention center (T1) and 6 months later (T2). Path analysis reveals shame at T1 predicted posttraumatic stress disorder symptoms at T2 whereas self-blame at T1 predicted depressive symptoms at T2. Furthermore, avoidance coping at T1 and depressive symptoms at T2 predicted suicidal ideation at T2 and accounted for 54% of the variance. These findings suggest that interventions designed for sexually abused adolescent girls should target shame, self-blame, and avoidance coping to foster recovery in this vulnerable population.

The association between traumatic experiences and suicide attempt in patients treated at the Hospital de Pronto Socorro in Porto Alegre, Brazil

OBJECTIVE

To analyze associations between attempted suicide and childhood trauma.

METHODS

A seven month comparative case-control study (28 subjects - patients with suicide attempt; 56 controls - patients without suicide attempt). The following instruments were used: Childhood Trauma Questionnaire (CTQ), Mini International Neuropsychiatric Interview (MINI), and Medical Outcomes Study (MOS).

RESULTS

The group with suicide attempt had significantly higher scores for some variables: emotional abuse (p < 0.001), physical abuse (p < 0.001), emotional neglect (p < 0.001), and physical neglect (p < 0.001).

CONCLUSIONS

The results suggest that variables related to previous trauma may influence future suicide attempts. The adoption of preventive and therapeutic actions related to mistreatments during child development is a crucial factor in reduction of suicide risk.

More than words: The association of childhood emotional abuse and suicidal behavior

Background

All types of abuse and neglect have been associated with suicide attempts. However, the association between the level of each type of childhood trauma and suicidal behavior severity (including the progression from ideation to attempts), adjusting for their co-occurrence, is not yet clear.

Methods

We used a cross-sectional web-based survey collected from the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP) to investigate the isolated effects of each type of childhood trauma on suicidal behavior severity. The sample consisted of 71,429 self-selected volunteers assessed with the Childhood Trauma Questionnaire (CTQ) and the following key question: “Have you ever thought about or attempted to kill yourself?” (Suicidal Behavior Questionnaire, SBQ-17).

Results

After adjusting for demographic variables, and childhood trauma subtypes, severe emotional abuse (EA) was associated with suicidal ideation and attempts, mainly for serious suicide attempts (OR, 22.71; 95% CI, 2.32–222.05). We found associations of smaller magnitude for severe emotional neglect (EN) with serious suicide attempts, and for severe physical neglect (PN) and sexual abuse (SA) with attempts without really meaning to die. No meaningful trend for physical abuse (PA) was found. Using as reference group ideators, EA was associated with serious suicide attempts, with a peak at the 95th percentile (OR, 4.39; 95% CI, 2.04–9.41). We found associations of smaller magnitude for PN and SA, and no meaningful trend for EN and PA.

Conclusions

Suicidal behavior was strongly associated with emotional abuse in childhood, even when compared with ideators, suggesting that it is a relevant factor for the progression from ideation to attempts.

Specific traumatic events elevate the risk of a suicide attempt in a 10-year longitudinal community study on adolescents and young adults

Traumatic events (TEs) have been associated with suicide attempts (SAs). However, the empirical status of some TEs is inconclusive. This also concerns community adolescents and young adults, known to be a high-risk group for SAs. We examined associations between (a) a range of prior TEs (physical attack, rape/sexual abuse, serious accident, and witnessing somebody else experiencing a TE) and a subsequent SA, and (b) the number of prior TEs and an SA, and (c) we estimated attributable proportions of SAs, in relation to each TE. Over a 10-year period, the Early Developmental Stages of Psychopathology (EDSP) study prospectively assessed community members, aged 14-24 years at baseline. Starting with 3021 subjects, each individual was assessed up to four times. Assessment was based on the Munich-Composite International Diagnostic Interview. Temporal associations were estimated using the Cox model with time-dependent covariates. Attributable proportions were based on the results of the Cox models. All four TEs elevated the risk for a subsequent SA, adjusting for confounders. Highest risk was found for the combined TE rape/sexual abuse. Results showed that 56-90% of SAs could be attributed to TEs in the exposed group; on the population level, attributable proportions ranged between 6.9% and 23.5%. Different TEs have been shown to elevate the risk of an SA in a young community sample. Our results suggest that both health professionals and health policy decision-makers consider specific TEs and the number of prior TEs as risk factors for SAs.

Assessment of Additional Medical Costs Among Older Adults in Japan With a History of Childhood Maltreatment

IMPORTANCE

Childhood maltreatment can have significant consequences on health through the life course, but its association with health care costs in later life is not widely known.

OBJECTIVE

To assess whether a history of childhood maltreatment is associated with additional medical costs among older adults in Japan.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cross-sectional study used data from the Japan Gerontological Evaluation Study, 2013, linked with national health insurance claims data from April 2012 to March 2014 for 1 municipality that participated in the Japan Gerontological Evaluation Study, 2013. The municipality had more than 1.5 million residents, and 978 independent individuals aged 65 to 75 years were included in the analysis. Data were analyzed from October 2017 to February 2019.

EXPOSURES

Childhood maltreatment, including physical abuse, emotional neglect, emotional abuse, and witnessing intimate partner violence.

MAIN OUTCOMES AND MEASURES

Mean annual medical costs between April 2012 and March 2013 and between April 2013 and March 2014.

RESULTS

Among 978 independent older adults (mean [SD] age, 70.6 [2.9] years; 426 [43.6%] men), 44 (4.5%) witnessed intimate partner violence, 19 (1.9%) were physically abused, 104 (10.6%) were emotionally neglected, and 56 (5.7%) were emotionally abused in childhood. In total, 176 older adults (18.0%) experienced at least 1 type of childhood maltreatment. Mean annual medical costs of those who experienced any childhood maltreatment were significantly higher than of those who did not (difference, ¥136 456 [US$1255]; 95% CI, ¥38 155-¥234 757 [US$351-US$2160]; P = .007). Those who experienced emotional neglect incurred more mean medical costs than those who did not (difference, ¥161 400 [US$1484]; 95% CI, ¥42 779-¥280 021 [US$394-US$2576]; P = .008). The association of any childhood maltreatment with medical costs remained significant after controlling for age and sex (average marginal effect, ¥116 098 [US$1068]; SE, ¥53 620 [US$493]; 95% CI, ¥11 004-¥221 192 [US$101-US$2034]; P = .03). The estimated additional costs associated with childhood maltreatment would be more than ¥333 billion (US$3.1 million) per year nationwide.

CONCLUSIONS AND RELEVANCE

In this study, childhood maltreatment was associated with additional medical costs among older adults living in Japan. This finding underlines the importance of primary and secondary prevention of child maltreatment.

Current evidence of childhood traumatic experiences in psychosis - focus on gender differences

Childhood abuse is common among people with psychosis and it is associated with poor illness outcomes. Some forms of childhood abuse are more common in women, but the impact of gender and childhood abuse in psychosis has been little investigated and evidence has never been put into a congruent frame. Herein, we conducted a narrative review to assess the impact of gender and childhood abuse in psychosis. Research articles were identified (n = 44) using a comprehensive electronic search of PubMed, Web-of-Science, Scopus and Cochrane databases. Women appeared to be at greater risk of sexual abuse than men. Women with childhood abuse report more positive and mood symptoms, and more suicide attempts compared to men. In addition, women exposed to childhood abuse display an earlier age of onset compared to not exposed, but this association is not present in men. Conversely, men with childhood abuse show more negative symptoms, substance use and a poorer cognitive performance compared to women. It seems therefore confirmed that gender and childhood abuse may impact on the outcome of psychosis, since not all gender differences found in patients who had been abused in their childhood are accounted by the overall differences between men and women with psychosis.

Interaction between prospective risk factors in the prediction of suicide risk

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.

Preventing violence against children in schools (PVACS): protocol for a cluster randomised controlled trial of the EmpaTeach behavioural intervention in Nyarugusu refugee camp

BACKGROUND

We aim to test the effectiveness of the EmpaTeach intervention to prevent physical violence from teachers to students in Nyarugusu Refugee Camp, Tanzania. EmpaTeach is a 10-week, 14-session, classroom management and cognitive-behavioural therapy-based intervention for groups of teachers for delivery by lay personnel in resource-constrained settings.

METHODS

We will conduct a two-arm cluster randomized controlled trial (RCT) with parallel assignment and an approximately 1:1 allocation ratio. All primary and secondary schools in Nyarugusu will be invited to participate. Whole schools will be stratified according to whether they are Congolese or Burundian, and primary or secondary schools, then randomised to active intervention or wait-list control conditions via a public meeting with headteachers. We will collect survey data from n = 500 teachers and at least n = 1500 students before the intervention, soon after, and at least 6 months after the end of the intervention. The primary outcome measure will be students' self-reports of experience of physical violence from school staff in the past week, measured using a modified version of the International Society for the Prevention of Child Abuse and Neglect Screening Tool-Child Institutional at the first follow-up after the intervention. Secondary outcomes include emotional violence, depressive symptoms and educational test scores. Analysis will be intention to treat, using repeat cross-sectional data from individuals.

DISCUSSION

If successful, the EmpaTeach intervention would represent one of a handful of proven interventions to reduce violence from teachers to students in any setting. IRC provides an immediate platform for scale up of the intervention via its current work in more than 40 conflict-affected countries.

TRIAL REGISTRATION

NCT03745573 , registered November 19, 2018 at clinicaltrials.gov, https://clinicaltrials.gov/ct2/show/NCT03745573 .