The Relation Between Child Maltreatment and Adolescent Suicidal Behavior: A Systematic Review and Critical Examination of the Literature

Abstract

A large body of research suggests that child maltreatment (CM) is associated with adolescent suicidal ideation and attempts. These studies, however, have not been critically examined and summarized in a manner that allows us to draw firm conclusions and make recommendations for future research and clinical work in this area. In this review, we evaluated all of the research literature to date examining the relationship between CM and adolescent suicidal ideation and attempts. Results generally suggest that childhood sexual abuse, physical abuse, emotional abuse, and neglect are associated with adolescent suicidal ideation and attempts across community, clinical, and high-risk samples, using cross-sectional and longitudinal research designs. In most studies, these associations remain significant when controlling for covariates such as youth demographics, mental health, family, and peer-related variables. When different forms of CM are examined in the same multivariate analysis, most research suggests that each form of CM maintains an independent association with adolescent suicidal ideation and suicide attempts. However, a subset of studies yielded evidence to suggest that sexual abuse and emotional abuse may be relatively more important in explaining suicidal behavior than physical abuse or neglect. Research also suggests an additive effect—each form of CM contributes unique variance to adolescent suicide attempts. We discuss the current limitations of this literature and offer recommendations for future research. We conclude with an overview of the clinical implications of this research, including careful, detailed screening of CM history, past suicidal behavior, and current suicidal ideation, as well as the need for integrated treatment approaches that effectively address both CM and adolescent suicidal ideation and suicide attempts.

Alexithymia as a mediator of the relationship between child sexual abuse and psychological distress in adolescence: A short-term longitudinal study

“…Pervasive psychological difficulties have been identified among adolescent victims of CSA with close to two-thirds of CSA victims reporting suicidal ideations (Brabant et al, 2013). Following a systematic review of 52 studies, Miller et al (2013) found that CSA was associated with adolescent suicidal ideation and suicide attempts in community as well as clinical samples, relying on both cross-sectional and longitudinal designs, even when controlling for demographics and possible confounder variables (youth mental health, family adversities). Devries et al (2014) in a meta-analysis of longitudinal and twin studies concluded that CSA was associated with increased risk of suicide attempts after controlling for genetic risk factors and family adversity.…”

Exposure to physical and sexual violence and suicidal ideation among schoolchildren

“…Physical and sexual abuse during childhood was found to be strongly associated with suicidal ideation in adolescents even when socio-demographic, mental health, and family variables that could influence this relationship are accounted for 17 . Results from previous studies state that sexual abuse victims show 2 to 3 times more risk of presenting suicidal ideation as a symptom 18 , and that physical abuse is a significant predictor of suicidal ideation also when confounding variables are controlled 28,29 .…”

“…Among the great amount of discussion regarding suicidal behavior and ideation risk and protective factors, some associations stand out. Higher rates of suicide are registered among girls when compared to boys 10,12,14 , among adolescents who are exposed to physical and sexual violence [17][18][19] , who come from dysfunctional families with histories of psychopathology, and alcohol and drugs abuse 7,9,16 , and who abuse of alcohol and other drugs 12,20,21 . On the other hand, many studies have suggested that attending to religious institutions, being more exposed to religious beliefs, and paying more importance to religion reduces the chances of suicidal ideation, suicide attempts, and suicide itself [22][23][24][25][26][27] .…”

“…Available data indicates direct associations between physical and sexual violence, and suicidal thoughts in adolescents 11,17,19,28,29 . Physical and sexual abuse during childhood was found to be strongly associated with suicidal ideation in adolescents even when socio-demographic, mental health, and family variables that could influence this relationship are accounted for 17 .…”

Da punição corporal ao abuso físico de crianças/adolescentes: caracterização, níveis de gravidade e variáveis psicossociais associadas

“…As consequências mais citadas são: prejuízo na regulação das emoções e maior agressividade (Chang, Dodge, Schwartz & McBride-Chang, 2003;Simons & Wurtele, 2010, Kim-Spoon et al, 2012; maior labilidade emocional e sintomas internalizantes (Kim-Spoon, Cicchetti, & Rogosh, 2013); maior probabilidade de desenvolver transtornos de personalidade (Cohen et al, 2013); maior probabilidade de desenvolver transtornos depressivos recorrentes ; maior probabilidade de ideação e tentativas de suicídio na adolescência (Miller, Esposito-Smythers, Weinsmoore & Renshaw, 2013 …”