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Childhood adversities as risk factors for onset and persistence of suicidal behaviour

  • Ronny Bruffaerts (a1), Koen Demyttenaere (a1), Guilherme Borges (a2), Josep Maria Haro (a3), Wai Tat Chiu (a4), Irving Hwang (a4), Elie G. Karam (a5), Ronald C. Kessler (a4), Nancy Sampson (a4), Jordi Alonso (a6), Laura Helena Andrade (a7), Matthias Angermeyer (a8), Corina Benjet (a9), Evelyn Bromet (a10), Giovanni de Girolamo (a11), Ron de Graaf (a12), Silvia Florescu (a13), Oye Gureje (a14), Itsuko Horiguchi (a15), Chiyi Hu (a16), Viviane Kovess (a17), Daphna Levinson (a18), Jose Posada-Villa (a19), Rajesh Sagar (a20), Kate Scott (a21), Adley Tsang (a22), Svetlozar M. Vassilev (a23), David R. Williams (a24) and Matthew K. Nock (a25)...

Abstract

Background

Suicide is a leading cause of death worldwide, but the precise effect of childhood adversities as risk factors for the onset and persistence of suicidal behaviour (suicide ideation, plans and attempts) are not well understood.

Aims

To examine the associations between childhood adversities as risk factors for the onset and persistence of suicidal behaviour across 21 countries worldwide.

Method

Respondents from nationally representative samples (η = 55 299) were interviewed regarding childhood adversities that occurred before the age of 18 years and lifetime suicidal behaviour.

Results

Childhood adversities were associated with an increased risk of suicide attempt and ideation in both bivariate and multivariate models (odds ratio range 1.2–5.7). The risk increased with the number of adversities experienced, but at a decreasing rate. Sexual and physical abuse were consistently the strongest risk factors for both the onset and persistence of suicidal behaviour, especially during adolescence. Associations remained similar after additional adjustment for respondents' lifetime mental disorder status.

Conclusions

Childhood adversities (especially intrusive or aggressive adversities) are powerful predictors of the onset and persistence of suicidal behaviours.

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Copyright

Corresponding author

Ronny Bruffaerts, Department of Neurosciences, University Psychiatric Center – Katholieke Universiteit Leuven (UPC-KUL), Herestraat 49, B-3000 Leuven, Belgium. Email: ronny.bruffaerts@med.kuleuven.be

Footnotes

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Declaration of interest

R.C.K. has been a consultant for GlaxoSmithKline, Kaiser Permanente, Pfizer, Sanofi-Aventis, Shire Pharmaceuticals, and Wyeth-Ayerst, has served on advisory boards for Eli Lilly & Company and Wyeth-Ayerst, and has had research support for his epidemiological studies from Bristol-Myers Squibb, Eli Lilly & Company, GlaxoSmithKline, Johnson & Johnson Pharmaceuticals, Ortho-McNeil Pharmaceuticals, Pfizer and Sanofi-Aventis.

Footnotes

References

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Childhood adversities as risk factors for onset and persistence of suicidal behaviour

  • Ronny Bruffaerts (a1), Koen Demyttenaere (a1), Guilherme Borges (a2), Josep Maria Haro (a3), Wai Tat Chiu (a4), Irving Hwang (a4), Elie G. Karam (a5), Ronald C. Kessler (a4), Nancy Sampson (a4), Jordi Alonso (a6), Laura Helena Andrade (a7), Matthias Angermeyer (a8), Corina Benjet (a9), Evelyn Bromet (a10), Giovanni de Girolamo (a11), Ron de Graaf (a12), Silvia Florescu (a13), Oye Gureje (a14), Itsuko Horiguchi (a15), Chiyi Hu (a16), Viviane Kovess (a17), Daphna Levinson (a18), Jose Posada-Villa (a19), Rajesh Sagar (a20), Kate Scott (a21), Adley Tsang (a22), Svetlozar M. Vassilev (a23), David R. Williams (a24) and Matthew K. Nock (a25)...
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eLetters

Childhood Adversities and Subsequent Suicidal Attempts in Adulthood

K.A.L.A. Kuruppuarachchi MD, FRCPsych(UK), Professor of Psychiatry
10 November 2010

The article on childhood adversities as risk factors for onset and persistence of suicidal behavior (Bruffaerts et al. 2010) highlights an important aspect of aetiology of suicide and it’s implications in suicidalprevention programmes.Even though this is a global phenomena most of the suicides occur in developing countries. In developing countries the highest rate is found among the young people below 30 years of age(Viyayakumar 2004). A varietyof reasons have been identified in the causation of suicide and suicidal attempts. In addition to the psychiatric ailments like depressive disorder other aetiological factors such as poor problem solving ability and coping skills and impulse control problems have been identified. More recently research on association between childhood adversities and subsequent adult mental health problems were carried out. The importance of focusing attention on multiple forms of childhood maltreatment and subsequent adverse mental health has been highlighted and the study has also shown that the emotionally abusive family environment accentuated diminution of mental health scores(Edwards et al. 2003). It has also been demonstrated that the young children reared in institutions had a substantial psychiatric morbidity and suggested that the psychiatric morbidity is associated with adverse care giving experiences and mitigating them may result in reduction in morbidity(Zeanah 2009).A study done in Sri Lanka has shown that there is a significant association between separation from the parents during childhood and subsequent suicidal attempts in young adulthood in otherwise healthy individuals (Kuruppuarachchi & Williams 2003). Many researchers and clinicians have thought of various mechanisms and ways of coping with thisdevastating problem all over the world and postulated and suggested various preventive programmes. Most of the research work in “suicidology “is done with regard to the risk factors and to a lesser degree on protective factors(Bertolote 2004). It has been stressed the importance of paying attention to the protective factors such as problem solving capacity, seeking help, good relationships in reducing stress in suicide- preventive programmes( Wasserman 2008). It has also been highlighted that good parenting facilitates by maximizing children’s potential and coping with life in a resilient way(Scott 2010).It is important to do more research work in this area globally in order tofurther understand the influence of adverse childhood environment in the causation of suicide and it’s implications in suicide prevention programmes. ReferencesBruffaerts R, Demyttenaere K, Borges G, Haro JM, Chiu WT. et al. Childhoodadversities as risk factors for onset and persistence of suicidal behavior. The British Journal of Psychiatry 2010 , 197, 20-27.Vijayakumar L. Suicide prevention : the urgent need in developing countries. World Psychiatry 2004, 3:3; 158-159.Edwards VJ, Holden GW, Felitti VJ, Anda RF. Relationship Between MultipleForms of Childhood Maltreatment and Adult Mental Health in Community Respondents: Results from the Adverse Childhood Experiences Study. American Journal of Psychiatry 2003; 160: 1453-1460.Zeanah CH, Egger HL, Smyke AT, Nelson CA, Fox NA. et al. Institutional Rearing and Psychiatric Disorders in Romanian Preschool Children. American Journal of Psychiatry 2009; 166: 777-785.Kuruppuarachchi KALA, Williams SS. A study of separation from parents in childhood and suicidal attempts in adulthood. Royal College of Psychiatrist’s Faculty of Child and Adolescent Psychiatry Annual Conference . September 2003 University of York, United Kingdom.Bertolote JM. Suicide prevention : at what level does it work? World Psychiatry, 2004 ; 3:3, 147-151.Wasserman D, Thanh HTT, Minh DPT, Goldstien M, Nordenskiold A, Wasserman C. Suicidal process, Suicidal communication and psychosocial situation of young suicide attempters in a rural Vietnamese community. World Psychiatry2008 ; 7: 47-53.Scott S. National dissemination of effective parenting programmes to improve child outcomes. The British Journal of Psychiatry 2010; 196: 1-3. ... More

Conflict of interest: None Declared

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Childhood Adversities and Suicide Risk: Different Effects for those with a Mental Disorder

Thomas H Richardson, Research Officer
14 July 2010

In July’s issue of the journal, Ronny Bruffaerts and colleagues (1) report an impressive study of more than 55 thousand individuals from 21 countries. The authors found that childhood adversities, in particular physical and sexual abuse, were predictive of suicidal behaviour.

Crucially, the study controlled for mental disorders in their analyses. It is necessary to do so as early adversities such as abuse and neglect have been linked to an increased risk of adult mental health problems especially mood, anxiety and substance use disorders (2). In turnthese mental disorders are associated with a high risk of suicide (3). Thus it was important to see if childhood adversities impact on suicide risk independent of mental disorder. Bruffaerts et al (1) found that after adjusting for lifetime mental disorders, odds ratios remained similar withmultiple adversities being significantly predictive of suicidal ideation and plan.

It is important that this relationship exists independent of mental disorder, but I believe it also important to know to what extent these adversities increase the risk of suicide in those with a mental disorder. There is evidence, for example, that risk factors for suicide differ between those with schizophrenia and the general population (4). It may bethat the early adverse events studied here have different effects on subsequent suicide risk in those with different mental disorders.

Perhaps the authors might consider re-doing their statistical analyses for the major mental disorders individually. Doing so would show whether childhood adversity predicts suicide risk in those with mental disorders, and whether the relationship is particularity strong for any specific clinical populations. This would aid the design and effective targeting of suicide prevention interventions in those with mental health problems.

1. Bruffaerts R, Demyttenaere K, Borges G, Haro JM, Chiu WT, Hwang I,et al. Childhood adversities as risk factors for onset and persistence of suicidal behaviour. Br J Psychiatry 2010; 197: 20–27.

2. McLaughlin KA, Green JG, Gruber MJ, Sampson NA, Zaslavsky AM, Kessler RC. Childhood Adversities and Adult Psychiatric Disorders in the National ComorbiditySurvey Replication II Associations with Persistence of DSM-IV Disorders. Arch Gen Psychiatry 2010; 6: 124-132.

3. Tong Y, Phillips MR. Cohort-specific risk of suicide for differentmental disorders in China. Br J Psychiatry 2010; 196: 467–473

4. Reutfors J, Brandt L, Jönsson EG, Ekbom A, Sparén P, Ösby, U. Riskfactors for suicide in schizophrenia: Findings from a Swedish population-based case-control study. Schiz Res 2009; 108: 231–237

The author has no conflict of interests to declare.

Thomas Richardson, Research Officer, Mental Health Research and Development Unit, University of Bath, Bath, BA2 7AY, UK. Email: T.H.Richardson@bath.ac.uk
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Conflict of interest: None Declared

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