Developmental pathways from child maltreatment to adolescent suicide-related behaviors: The internalizing and externalizing comorbidity hypothesis

Abstract

Child maltreatment is a robust risk factor for suicidal ideation and behaviors during adolescence. Elevations in internalizing and externalizing symptomology have been identified as two distinct developmental pathways linking child maltreatment and adolescent risk for suicide. However, recent research suggests that the co-occurrence of internalizing and externalizing symptomology may form a distinct etiological pathway for adolescent risk behaviors. Using the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN) sample (N= 1,314), the present study employed a person-centered approach to identify patterns of concurrent change in internalizing and externalizing psychopathology over five time points from early childhood to adolescence in relation to previous experiences of child maltreatment and subsequent suicidal ideation and behaviors. Results indicated four distinct bivariate externalizing and internalizing growth trajectories. Group membership in a heightened comorbid internalizing and externalizing symptom trajectory mediated the association between childhood abuse and adolescent suicidal ideation and suicidal behaviors. These findings suggest that the concurrent development of externalizing and internalizing symptoms in childhood and adolescence may constitute a unique developmental trajectory that confers risk for suicide-related outcomes.

Childhood externalizing, internalizing and comorbid problems: distinguishing young adults who think about suicide from those who attempt suicide

“…Of note, children presenting with comorbid problems were more likely to be male and to be exposed to the highest levels of adversity (e.g., non-intact family, young mother). This is in line with prior large-sample studies showing that comorbidity in childhood was more prevalent in males and linked to having experienced the highest level of psychosocial problems such as family hardship, and living in a single-parent or low-income household (Duprey et al, 2019;Hannigan et al, 2018;Wiggins et al, 2015;Winsper et al, 2019).…”

Interactive effects of childhood maltreatment and tonic respiratory sinus arrhythmia on young adults’ depressive symptoms

“…Many empirical studies showed that experiencing childhood maltreatment is related to an increased risk of various types of psychopathology, such as physical and mental health, internalizing/externalizing problems, as well as psychiatric symptoms (Duprey et al, 2020;Jaffee, 2017;Tubman et al, 2021). For example, a strong positive association between childhood maltreatment and symptoms of depression has been evidenced in both cross-sectional (Novelo et al, 2018;Struck et al, 2020) and longitudinal research (Hovens et al, 2016;Widom et al, 2007).…”

Search for solutions, learning, simulation, and choice processes in suicidal behavior

“…More broadly, the associations of depression, hopelessness, and neuroticism with suicide can be understood in terms of the internalizing spectrum, which emerges in meta-analysis as an important liability factor (Franklin et al, 2017), though its effect may be more robust in early-onset suicidal behavior (Szücs et al, 2020). Finally, there is preliminary evidence that the interaction between internalizing and externalizing psychopathology facilitates suicidal behavior (Duprey et al, 2020), consistent with the motivational-volitional theory of suicide (O'Connor & Kirtley, 2018) and internalizing-externalizing comorbidity in borderline personality disorder (BPD; Eaton et al, 2011).…”