Association of Child Abuse Exposure With Suicidal Ideation, Suicide Plans, and Suicide Attempts in Military Personnel and the General Population in Canada

Abstract

IMPORTANCE Recent evidence indicates a high prevalence of child abuse exposure in modern US veterans, which may explain in part their higher likelihood of suicide relative to civilians. However, the relationship between child abuse exposure and suicide-related outcomes in military personnel relative to civilians is unknown. Furthermore, the associations among deployment-related trauma, child abuse exposure, and suicide-related outcomes in military personnel have not been examined. OBJECTIVES To determine whether child abuse exposure is more prevalent in Canadian Armed Forces (CAF) personnel compared with the Canadian general population (CGP); to compare the association between child abuse exposure and suicidal ideation, suicide plans, and suicide attempts among the CAF and CGP; and to determine whether child abuse exposure has an additive or interaction effect on the association of deployment-related trauma and past-year suicidal ideation and suicide plans among Regular Forces personnel. DATA, SETTING, AND PARTICIPANTS Data were collected from the following 2 nationally representative data sets: the 2013 Canadian Forces Mental Health Survey (CFMHS) for the CAF (8161 respondents; response rate, 79.8%) and the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH) for the CGP (23 395 respondents; response rate, 68.9% [of these, 15 981 age-matched participants were drawn]). Data were collected from April 15 to August 31, 2013, for the CFMHS and January 2 to December 31, 2012, for the CCHS-MH. Data were analyzed from October 2014 to October 22, 2015. Statistical weights were applied to both data sets. MAIN OUTCOMES AND MEASURES Child abuse exposure, including physical abuse, sexual abuse, and exposure to intimate partner violence, and deployment-related trauma were assessed in relation to suicide-related outcomes. RESULTS Data were analyzed from 24 142 respondents aged 18 to 60 years (Regular Forces, 86.1% male and 13.9% female; Reserve Forces, 90.6% male and 8.9% female; and CGP, 49.9% male and 50.1% female). Any child abuse exposure was higher in the Regular Forces (47.7%; 95% CI, 46.4%-49.1%) and Afghanistan mission-deployed Reserve Forces (49.4%; 95% CI, 46.3%-51.5%) compared with the CGP (33.1%; 95% CI, 31.8%-34.4%). All types of child abuse exposures were associated with increased odds of suicidal ideation, suicide plans, and suicide attempts in the CGP (range of adjusted odds ratios [AORs], 3.0 [95% CI, 2.3-3.9] to 7.7 [95% CI, 5.7-10.3]; P < .05) and CAF (range of AORs, 1.7 [95% CI, 1.0-2.9] to 6.3 [95% CI, 4.2-9.5]; P < .05), with many associations significantly weaker in military personnel relative to civilians. Additive effects for past-year suicide ideation (AOR, 2.7; 95% CI, 1.8-4.2) and past-year suicide plans (AOR, 4.6; 95% CI, 2.3-9.2) but not interactive effects for past-year suicide ideation (AOR, 1.2; 95% CI, 0.7-2.2) and past-year suicide plans (AOR, 0.8; 95% CI, 0.3-2.2) were noted between deployment-related trauma and child abuse exposure among Regular Forces personnel. CONCLUSIONS AND RE...

The association between different traumatic life events and suicidality

“…Similarly, studies have found strong associations between interpersonal trauma and suicidality, especially sexual trauma (Stein et al, 2010) and childhood trauma (Afifi et al, 2016; Dube et al, 2001). Among those who had experienced sexual trauma or childhood trauma in our study, we found an association with suicidality in both genders, which was stronger for men.…”

“…For example, a study based on the WHO’s mental health surveys implemented in 21 countries ( n  = 102,245) and investigating a range of traumatic events and suicidal behaviour (Stein et al, 2010) found that the strongest associations were found for violence-related events. In addition, previous studies have shown increased risk of suicidal behaviour subsequent to adverse and traumatic life events during childhood (Afifi et al, 2016; Bruffaerts et al, 2010), for both suicidal ideation (Stansfeld et al, 2017) and suicide attempts (Dube et al, 2001; Enns et al, 2006; Ford & Gomez, 2015). Furthermore, studies have found that non-interpersonal events such as the loss of a loved one can increase the risk of self-injury (Bylund Grenklo et al, 2013), suicide attempts and suicides (Jakobsen & Christiansen, 2011; Niederkrotenthaler, Floderus, Alexanderson, Rasmussen, & Mittendorfer-Rutz, 2012).…”

Dissociative symptoms mediate the relation between PTSD symptoms and functional impairment in a sample of military members, veterans, and first responders with PTSD

“…In addition, dissociative symptoms mediated the relation between childhood trauma and PTSD severity (Evren et al, 2011). Given these findings, and findings of high levels of childhood abuse among military members and veterans when compared with the general population (Afifi et al, 2016; Koola et al, 2013; Seifert, Polusny, & Murdoch, 2011), it is possible that dissociative symptoms may stem, in part, from childhood abuse rather than trauma experienced as part of a military or first responder service, thus leading to functional impairment. However, the results of the present study indicated that dissociative symptoms mediated the relation between PTSD symptoms and functional impairment after controlling for exposure to ACEs, suggesting that while ACEs may be associated with functional impairment, they do not account for the mediating role of dissociative symptoms.…”

“…In addition, reported levels of exposure to childhood abuse are significantly higher among military members and veterans when compared with the general population (Afifi et al, 2016; McCauley, Blosnich, & Dichter, 2015). Importantly, childhood abuse is associated with suicide and suicide attempts (Afifi et al, 2016), high utilization of mental health care services and perceived need for mental health care (Turner et al, 2017), and reduced health-related quality of life (Katon et al, 2015) among military members.…”

“…Importantly, childhood abuse is associated with suicide and suicide attempts (Afifi et al, 2016), high utilization of mental health care services and perceived need for mental health care (Turner et al, 2017), and reduced health-related quality of life (Katon et al, 2015) among military members. Although less research has been conducted among first responders, emerging work suggests that early physical abuse is related to worse mental health outcomes in these populations (Komarovskaya et al, 2014).…”