Suicide and fatal drug overdose in child sexual abuse victims: a historical cohort study

Abstract

Objective: To determine the rate and risk of suicide and accidental fatal drug overdose (ie, overdose deemed not to have been suicide) in individuals who had been medically ascertained as having been sexually abused during childhood. Design: A historical cohort linkage study of suicide and accidental drug‐induced death among victims of child sexual abuse (CSA). Setting and patients: Forensic medical records of 2759 victims of CSA who were assessed between 1964 and 1995 were obtained from the Victorian Institute of Forensic Medicine and linked with coronial data representing a follow‐up period of up to 44 years. Main outcome measures: Rates of suicide and accidental fatal drug overdose recorded in coronial databases between 1991 and 2008, and rates of psychiatric disorders and substance use recorded in public mental health databases. Results: Twenty‐one cases of fatal self‐harm were recorded. Relative risks for suicide and accidental fatal overdose among CSA victims, compared with age‐limited national data for the general population, were 18.09 (95% CI, 10.96–29.85; population‐attributable risk, 0.37%), and 49.22 (95% CI, 36.11–67.09; population‐attributable risk, 0.01%) respectively. Relative risks were higher for female victims. Similar to the general population, CSA victims who died as a result of self‐harm were predominantly aged in their 30s at time of death. Most had contact with the public mental health system and half were recorded as being diagnosed with an anxiety disorder. Conclusion: Our data highlight that CSA victims are at increased risk of suicide and accidental fatal drug overdose. CSA is a risk factor that mediates suicide and fatal overdose.

Associations between childhood trauma and non-fatal overdose among people who inject drugs

“…Of note, another study of opiate users found that a history of sexual and/or physical abuse was associated with non-fatal overdose in participants who had also attempted suicide (Maloney, Degenhardt, Darke, & Nelson, 2009). Our finding regarding sexual abuse is particularly alarming given evidence that people who have experienced childhood sexual abuse are considerably more likely to die of overdose, compared to those without a history of sexual abuse (Cutajar et al, 2010). …”

Cost-utility analysis of different treatments for post-traumatic stress disorder in sexually abused children

“…The current evidence suggests that in comparison to the rates of suicides in the general population, children and adolescents suffering from PTSD or depression and especially from PTSD associated with co-morbid depression demonstrate higher rates of suicides [4,49-52]. The model includes age-related probabilities of suicide for each of the following health states: the PTSD + depression, PTSD only and Depression only to capture the long-term consequences of mental health interventions in terms of reduced rates of suicide.…”

“…Suicide rates associated with other mental health conditions (Markov states "PTSD + depression", "PTSD only" and "Depression only") were obtained from the published literature [4,49-51]. …”

Childhood Determinants of Adult Psychiatric Disorder

“…Weich's 2009 review of cohort studies found only two with appropriate data; they found strong associations with suicidal ideation and attempts. The Victoria study data particularly high-lighted the high rates of suicide and accidental (presumed) fatal drug overdose [295]. A related phenomenon - self injurious behaviour has also been linked to child abuse in two reviews from 2008 and 2009 [296, 297], though in the latter case, the authors had little confidence in respect of child sexual abuse.…”