Early exposure to emotional violence “significantly” increases the chances that youths will contemplate suicide, according to new research from three countries conducted by Washington University in St. Louis’ Brown School.
“We find the odds of suicide ideation are consistently and significantly greater for adolescents who report overexposure to emotional violence,” said Lindsay Stark, associate professor and co-author of the study “A Sex-disaggregated Analysis of How Emotional Violence Relates to Suicide Ideation in Low- and Middle-income Countries,” published in the journal Child Abuse & Neglect.
The same consistency is not observed for any other form of maltreatment across countries, found Stark and co-author Ilana Seff of Columbia University.
Stark and Seff reviewed national data drawn from 9,300 adolescents and young adults aged 13-24 in the Violence Against Children Surveys, a collaborative effort by the U.S. Centers for Disease Control and Prevention, UNICEF, country governments and other bilateral and multilateral organizations.
They collected surveys from Haiti, Kenya and Tanzania containing detailed information on young people’s experiences with physical, emotional and sexual violence, as well as their mental health and well-being.
Questions about emotional violence included whether adults had ever threatened to abandon the children, made them feel unwanted, or humiliated them in front of others. Stark and Seff found an association between youth with those experiences and the ones who considered suicide.
Approximately 26 to 45 percent of respondents, depending on sex and country, reported having ever experienced emotional violence.
Self-reported suicide ideation was consistently higher for females in all countries; nearly 27 percent, 15 percent and 8 percent of females had ever considered suicide in Haiti, Kenya and Tanzania, respectively, compared to 8 percent, 7 percent and 6 percent of males.
“We find there exists a significant relationship between exposure to emotional violence and suicide ideation for both males and females in all countries in the sample,” the authors wrote in the paper.
“No other form of child maltreatment was found to be associated with suicide ideation in more than one country, suggesting that emotional violence may actually be more powerful than physical and sexual abuse in its impact on adolescent suicide behaviors in low- and middle-income countries.”
The analysis suggests that mental health practitioners should offer suicide prevention programs to those with a history of emotional abuse.
s suicide is one of the top 20 causes of death worldwide [1], there has been substantial effort to understand, predict, and prevent it. Klonsky and May [2] argue that research on risk for suicide has often conflated why people feel suicidal with why they act on suicidal thoughts.
In a large international study of almost 85,000 individuals in 17 countries [3], approximately one-third of individuals reporting suicide ideation had a suicide attempt.
For clinicians, who are most likely to encounter individuals who are already experiencing suicide ideation, it is most relevant to understand factors that predict (to inform risk assessment) or explain (to inform risk management) who will act on these thoughts.
Many studies report higher rates of suicide ideation and attempts among those who experienced child abuse [4–10].
However, none have examined whether it is a risk factor for acting on suicide ideation.
These studies may, therefore, be uninformative to clinicians, as many predictors of suicide ideation do not predict who will attempt suicide [2, 11, 12].
Various theories suggest that individuals who experience child abuse are at increased risk of accumulating additional risk factors for suicide, and that they more likely to act on thoughts of suicide ideation [11, 13, 14].
For example, Joiner’s interpersonal–psychological theory of suicide posits that the progression from suicide ideation to an attempt requires an acquired capacity for suicide, which “results from exposure and attendant habituation to the pain and fear involved in physical self-harm” [14] (p. 643).
Empirical tests of acquired capacity for suicide has typically been operationalized in terms of prior suicide attempts and non-suicidal self-harm.
However, it is also postulated that experiencing painful and fear-inducing behaviours, including being a victim of abuse or witnessing others’ pain and injury can increase capacity for suicide [14, 15], suggesting an independent association between child abuse and suicide attempts.
Few other predictors of suicide attempts among suicide ideators have been identified. Only the presence of a suicide plan [3, 12] and a history of self-harm or suicide have consistently been shown to predict the progression from suicide ideation to an attempt [3, 14, 16, 17].
Factors, such as mental illness [3, 12, 14, 18–21], substance abuse [3, 12, 19], sex [3, 12, 20–22], age [3, 12, 21, 22], marital status [3, 19], social interactions and belonging [14, 19], and life stressors [14, 18] have had conflicting findings.
Other potential risk factors, such as financial strain [23, 24] and physical illness [25, 26], have not been studied as factors that may distinguish suicide ideators and attempters.
More information: Ilana Seff et al. A sex-disaggregated analysis of how emotional violence relates to suicide ideation in low- and middle-income countries, Child Abuse & Neglect (2019). DOI: 10.1016/j.chiabu.2019.05.008. https://www.researchgate.net/publication/333320918_A_sex-disaggregated_analysis_of_how_emotional_violence_relates_to_suicide_ideation_in_low-and_middle-income_countries
Journal information: Child Abuse & Neglect
Provided by Washington University in St. Louis
