Childhood maltreatment and adult suicidality: a comprehensive systematic review with meta-analysis

Abstract

This comprehensive systematic review and meta-analysis aims to quantify the association between different types of childhood maltreatment and suicidality. We searched five bibliographic databases, including Medline, PsychINFO, Embase, Web of Science and CINAHL, until January 2018. Random-effects meta-analysis was employed followed by univariable and multivariable meta-regressions. Heterogeneity was quantified using theI2statistic and formal publication bias tests were undertaken. The methodological quality of the studies was critically appraised and accounted in the meta-regression analyses. Data from 68 studies based onn= 261.660 adults were pooled. All different types of childhood maltreatment including sexual abuse [odds ratio (OR) 3.17, 95% confidence interval (CI) 2.76–3.64], physical abuse (OR 2.52, 95% CI 2.09–3.04) and emotional abuse (OR 2.49, 95% CI 1.64–3.77) were associated with two- to three-fold increased risk for suicide attempts. Similar results were found for the association between childhood maltreatment and suicidal ideation. Complex childhood abuse was associated with a particularly high risk for suicide attempts in adults (OR 5.18, 95% CI 2.52–10.63). Variations across the studies in terms of demographic and clinical characteristics of the participants and other core methodological factors did not affect the findings of the main analyses. We conclude that there is solid evidence that childhood maltreatment is associated with increased odds for suicidality in adults. The main outstanding challenge is to better understand the mechanisms which underpin the development of suicidality in people exposed to childhood maltreatment because current evidence is scarce.

Obsessive–Compulsive Disorder and Suicidal Experiences: The Role of Experiential Avoidance

“…This study had four main strengths with two key clinical implications. First, considering the high rates of the OCD symptoms in the community and in view of recent evidence suggesting that individuals who are not under the care of clinicians are at higher risk for engagement in suicidal ideation and behaviors (Angelakis et al, ), we focused primarily on people from the extant community in an effort to encourage the development of efficient community‐based interventions (for a detailed overview of the advances of the community‐based research, see Israel, Schulz, Parker, & Becker, ). Second, we incorporated a large representative community sample that was balanced in terms of demographic information including age, gender, occupation, and socioeconomic status.…”

A scoping review of adult survivors’ experiences of shame following sexual abuse in childhood

“…Two recent reviews by Carr, Duff, and Craddock (, ) similarly found that CSA survivors were at a higher risk of a range of psychosocial, physical and mental health difficulties. Systemic reviews have also specifically established that CSA is a risk factor for depression, anxiety, Post Traumatic Stress Disorder (PTSD) (Amado, Arce, & Herraiz, ; Hillberg, Hamilton‐Giachritsis, & Dixon, ); sexual exploitation (De Vries & Goggin, ), intimate partner violence (Li, Zhao, & Yu, ), suicidality (Angelakis, Gillespie & Panagioti, ), substance abuse (Halpern et al, ), and educational difficulties (Fry et al, ). Reviews have also demonstrated a range of psychosocial protective factors that can help reduce risk, including family and social supports, personal attributes, active coping style, a sense of personal influence, and externalising blame for the abuse (Carr, Duff, & Craddock, , ).…”

Perceptions of Past Parenting and Adult Attachment as Vulnerability Factors for Suicidal Ideation in the Context of the Integrated Motivational–Volitional Model of Suicidal Behavior

“…An important issue to be investigated in future studies would be widening the dimensions of parenting to include not only care and overprotection, but also abuse and childhood maltreatment. Findings from a recent meta‐analysis (Angelakis, Gillespie, & Panagioti, ) indicate that all types of childhood abuse are associated with increased risk for suicidal ideation and suicide attempts in adults independent of demographic, clinical, and methodological variations across the studies. The authors of the meta‐analysis suggest that the literature is still lacking in respect of empirical evidence for the mechanisms by which experiences of childhood maltreatment exert their detrimental and long‐lasting impact on suicide risk.…”

“…Its items are rated on a 5-point scale (from 1 = "Not at all like me" to 5 = "Very much like me") (e.g., "I find it difficult to depend on other people" and "I am comfortable having other people depend on me"). This measure has been used to assess different models/dimensions of adult attachment (Andersen et al, 2017;Roisman et al, 2007). For the present study (N = 717), we assessed dimensions of attachment anxiety (x = 0.859, SE = 0.008, CI = 0.842-0.876) and attachment avoidance (x = 0.813, SE = 0.011, CI = 0.791-0.836).…”

“…Therefore, the investigation of diathesis (vulnerability) factors is a fundamental step to understanding and preventing the emergence of suicidal thinking. There is growing evidence supporting the hypothesis that insecure orientations of attachment relationships may be a vulnerability factor for suicidal ideation and behavior (e.g., Aaltonen et al, 2016;Adam et al, 1996;Fergusson et al, 2000;Grunebaum et al, 2010;Levi-Belz et al, 2013;Lizardi et al, 2011;Sheftall et al, 2014;Stepp et al, 2008;Yaseen et al, 2014). Insecure attachment orientations are defined as strategies to manage distress when attachment figures (intimate others) are not present or not open and receptive when individuals are threatened by fearful or anxiety-provoking events.…”