Reducing Suicide A National Imperative (2002) / Chapter Skim
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5 Childhood Trauma
5 Childhood Trauma
Pages 157-192
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From page 157... ...
Secondly, childhood trauma has emerged as a strong and independent risk factor for suicidal behavior in adolescents and adults (Browne and Finkelhor, 1986; Paolucci et al., 2001; Santa Mina and Gallop, 1998~. Therefore, understanding childhood trauma and its psychobiological effects has the potential to illuminate the pathway of causation from early trauma to later suicide.
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From page 158... ...
It then presents the evidence for childhood trauma as a risk factor for later suicidality. Childhood sexual abuse emerges as such a strong risk factor that the next section covers its quantitative contribution to the extent of suicide nationwide.
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From page 159... ...
In keeping with the epidemiological literature, childhood traumas do not include "stressful life events," which are generally defined as the breakdown of a close relationship, interpersonal conflict with parents or friends, schoolor work-related difficulties, and legal or disciplinary crises. Sexual and physical abuse have the strongest relationship to suicidality, but there are several reasons for this chapter's broad focus on many types of childhood trauma.
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From page 160... ...
Prevalence of Childhood Trauma National surveillance of child maltreatment is conducted annually through the National Child Abuse and Neglect Data System (NCANDS) .2 In 1999, an estimated 826,000 children in the U.S.
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From page 161... ...
Traumas arising within the household are also common: about 26 percent of adults reported having grown up in a households with substance abuse, 19 percent with mental illness, 12.5 percent with violence against their mother, and 3.4 percent with a household member being incarcerated (Felitti et al., 1998~. According to official crime statistics,5 about 30 per 1000 children (ages 12-17)
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From page 162... ...
Methodological Issues The study of childhood trauma is beset by methodological limitations (NRC, 1993~. These limitations have implications for efforts to understand the relationship between early childhood trauma and later suicidal behavior.
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From page 163... ...
These investigators caution that recall bias obscures true prevalence rates of child maltreatment, though it does not, it appears, significantly alter estimates of relative risk of child abuse for subsequent psychological disorders. A second limitation in the current research on childhood abuse is the use of inconsistent and imprecise definitions of maltreatment (NRC, 1993~.
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From page 164... ...
All of these methodological limitations must be kept in mind in attempts to link childhood trauma to health outcomes, including suicidality. CHILDHOOD TRAUMA AS A RISK FACTOR FOR SUICIDALITY Childhood trauma, especially child sexual abuse, has been identified as a strong risk factor for suicidality.
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From page 165... ...
The total number of subjects was more than 25,000. The unweighted and weighted effect sizes of child sexual abuse on suicide were 0.64 and 0.44,7 confirming a substantial link between child sexual abuse and suicide (defined as suicidal ideation or a suicide attempt)
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From page 166... ...
Findings for physically abused males were non-significant, and males were not assessed for suicide attempts and sexual abuse because too few males were affected. bAfter controlling for other factors.
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From page 167... ...
found that sexual abuse carried higher odds ratios for a suicide attempt than did physical abuse or neglect, after controlling for other contextual factors. Child sexual abuse also carried the highest odds ratio for suicide attempts in a prospective, population-based study in New Zealand (Fergusson et al., 2000b)
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From page 168... ...
It also found the population prevalence of child sexual abuse to be somewhat lower than other studies.8 Thus, the newer body of evidence suggests that once sexual abuse occurs, males appear to be at higher risk of suicide attempts, but findings are not uniform. For other types of childhood trauma, gender effects have not been reported in large, population-based studies.
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From page 169... ...
For traumas other than child sexual abuse, age of onset effects have generally not been investigated in community- or population-based studies. Dose-Response Relationships Research has established that the severity of childhood trauma is associated with a greater likelihood of suicide.
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From page 170... ...
and African American women (Kaslow et al., 2000~. A nationally representative study found that suicide attempts were more prevalent in adults with five or more childhood adversities, including child sexual abuse, physical abuse, psychological abuse, and parental suicide or psychopathology (Molnar et al., 2001a)
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From page 171... ...
There it stimulates the release of cortisol, a hormone with widespread actions on the brain and the rest of the body. Many of the biochemicals activated throughout the HPA axis have been studied in relation to childhood trauma exposure.
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From page 172... ...
Brain Development Significant alterations in the anatomy and physiology of the developing brain are proposed to result from childhood trauma. Some of the observed changes in brain development may be produced by chronically elevated catecholamine and cortisol levels, possibly through their effects on neuron metabolism or death, neurogenesis or migration patterns, and delays in myelination (reviewed by De Bellis, 2001~.
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From page 173... ...
Psychosocial and Behavioral Effects The psychosocial and behavioral consequences of childhood trauma can be severe. Apart from later effects on psychopathology or suicidal behavior, research has established a spectrum of more immediate effects, ranging from low self-esteem to substance use and delinquent behavior (for reviews, see Cicchetti and Toth, 1995; Cicchetti et al., 2000; Margolin and Gordis, 2000; NRC, 1993; Trickett and Putnam, 1998~.
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From page 174... ...
The following sections are meant to be illustrative rather than comprehensive about the adverse effects of childhood trauma. Cognitive and Psychological Effects Lower self-esteem is a major cognitive effect of several types of childhood trauma.
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Other cognitive outcomes of childhood trauma have received somewhat less attention. Maltreatment is associated with hopelessness (Allen and Tarnowski, 1989)
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From page 176... ...
. Intergenerational Transmission of Childhood Trauma The effects of child maltreatment and its relationship to suicide are compounded by the intergenerational transmission of abusive parenting.
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From page 177... ...
In a cohort of 1019 young adults (18 years old) , the study found that adjusted odds ratios were greatest for conduct disorder, substance use disorders, An comparison to young people not exposed to childhood sexual abuse, after adjustment for social, family, and contextual factors that are associated with child sexual abuse and increased risk of disorder.
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From page 178... ...
The largest was for conduct disorder: more than 18 percent of cases of conduct disorder would have been eliminated if sexual abuse had not occurred. Other childhood traumas, apart from sexual or physical abuse, are associated with psychopathology, but the evidence is more limited.
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From page 179... ...
This study's findings in relation to suicide attempts were discussed in an earlier section. PATHWAYS TO SUICIDALITY The preceding sections spotlight the grim and sometimes enduring impact of childhood trauma, especially sexual abuse and physical abuse, on mental health.
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From page 180... ...
The study sought to determine the extent to which social background, personality factors, mental illness, stressful life events, and childhood trauma contribute to suicide attempts.~4 The childhood traumas (occurring before 16 years) were most of those covered by this chapter: sexual abuse, physical abuse, attachment to parents, caregiver separation/divorce or death, and parental substance abuse.
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From page 181... ...
Since childhood traumas had an only mildly direct relationship to suicidal ideation, the study found support for the importance of cognitive factors as mediators between trauma and suicidal ideation. While the study was not of suicide attempts and was based on a unrepresentative sample, it is pioneering in its attempts to develop a cognitive pathway from childhood trauma to suicidality.
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From page 182... ...
These models represent a milestone in attempting to integrate the wide-ranging short-term and long-term effects of childhood trauma. They form an important departure point for integrative neuroscience research to examine biological, psychological, and behavioral measures and their interactions.
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From page 183... ...
Of the many types of childhood trauma, childhood sexual abuse is the strongest and most independent risk factor for suicide attempts, accounting for 9-20 percent of suicide attempts. · Exposure to trauma can affect the developing brain with potentially lifelong alterations in the physiological stress response system and
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From page 184... ...
· Early adversity increases the likelihood of developing mental illnesses associated with suicide risk, such as substance use, posttraumatic stress disorder, and depression. Understanding the precise pathways from childhood trauma to suicidality has been hampered by the paucity of longitudinal, population-based studies and the legal and ethical difficulties of asking children and adolescents about childhood sexual and physical abuse.
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From page 185... ...
1998. A longitudinal analysis of risk factors for child maltreatment: Findings of a 17-year prospective study of officially recorded and self-reported child abuse and neglect.
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From page 186... ...
1996. Treating Sexually Abused Children and Their Nonoffending Parents: A Cognitive Behavioral Approach.
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From page 187... ...
The prevalence of child sexual abuse: Integrative review adjustment for potential response and measurement biases. Child Abuse and Neglect, 21~4~: 391-398.
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2000. Treating sexually abused children with posttraumatic stress symptoms: A randomized clinical trial.
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2001b. Child sexual abuse and subsequent psychopathology: Results from the National Comorbidity Survey.
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1994. Stress, appraisal, and coping in child sexual abuse: A theoretical and empirical review.
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From page 191... ...
1994. Recall of childhood trauma: A prospective study of women's memories of child sexual abuse.
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From page 192... ...
Life is what I want; dutifulness is also what I want. If I cannot have both, I would rather take dutifulness than life.
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