Suicidal behavior and associated factors in sexually abused adolescents

Objectives

The aim of the present study is to determine the rate of suicidal ideation and suicide attempts in sexually abused adolescents and to determine the factors associated with suicidal behavior.

Method

106 adolescents between the ages of 12–18 (94 girls, 12 boys) who were exposed to sexual abuse and referred for the preparation of forensic reports were included in the study. The investigators retrospectively examined the case files, forensic reports and social worker reports.

Results

It has been found that in cases exposed to sexual abuse, suicidal ideation developed in 63.2% (n = 67) of the individuals and 24.5% (n = 26) of them attempted suicide. The rate of suicidal ideation and suicide attempts was higher in cases who live separately from one or both parents, those who have ASD or PTSD after sexual abuse, cases in which abuse involved penetration, cases who were abused by someone known or someone from the family, cases where sexual abuse was accompanied by coercion and physical violence, and those who were exposed to abuse continuously. Among girls, in cases who have suicide history before sexual abuse and those who were abused by more than one abuser, the rate of suicidal ideation was higher.

Conclusion

It has been shown in many studies that sexual abuse in childhood increases the risk of suicidal behavior. Consideration of the factors associated with suicidal behavior in victims of sexual abuse will be helpful to clinicians in preventing suicide attempts.     

Repeated suicide attempts

Attempted suicide is an act associated with childhood sexual abuse, depression, bipolar illness, substance abuse, and other diagnoses, as documented in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (American Psychiatric Association [APA], 1994). Three women, who attended a group to decrease their depression and increase their self-esteem and who had histories of multiple suicide attempts, agreed to participate in interviews designed to determine the common factors associated with their suicide attempts and to examine the assertion that their suicide attempts were an addiction, similar to their addictions to alcohol and drugs. The common factors found were depression, substance use disorders with early abuse and risky behaviors, history of sexual abuse, faulty relationships, alteration of mood with a suicide plan, and distorted and illogical thinking and motivation. The similarities to addiction also were described. Based on the complexity of factors that emerged and the addictive nature of the suicide attempts, treatment for similar patients needs to be multidimensional and ongoing to allow sufficient time to monitor progress and address the numerous factors involved.     

Association between physical partner violence, posttraumatic stress, childhood trauma, and suicide attempts in a community sample of women

Our objective was to estimate the prevalence of intimate partner violence (IPV) and to explore its association with childhood maltreatment, substance misuse, posttraumatic stress, and suicidal behavior in a representative community sample of women. IPV was operationalized as a "physical attack or beating by a spouse, boyfriend, or live-in partner." We surveyed 637 women in Memphis, Tennessee, by telephone survey. Sixteen percent reported ever experiencing IPV by a male partner, and 75% endorsed multiple assaultive acts. Of abused women, 5.9% met current PTSD diagnostic criteria, and an additional 11.8% were assessed with subthreshold symptoms. Abused women were more likely than other women to be divorced, to have less than 13 years education, to endorse high levels of childhood victimization, to have abused drugs and alcohol, and to have attempted suicide. Twenty-three percent of IPV+ (abused) women reported a suicide attempt at some time in their lives compared with 3% of IPV- (nonabused) women (p < .0001). Further, multiple logistic regression analysis showed that childhood sexual and emotional abuse and low educational attainment were the only significant predictors of IPV. These results suggest that in women who endorse IPV, careful inquiry of past abuse, trauma-related symptoms, suicidal behavior, and drug use may be important, so that interventions can be both timely and appropriate.     

Collective efficacy, family attachment, and urban adolescent suicide attempts

The suicide rate among American adolescents between the ages of 14-25 has dramatically increased during the last 50 years, and this fact has been the focus of extensive social-scientific investigation. To date, however, research focusing on the joint effects of mental health, family, and contextual-level predictors on adolescents' suicidal behaviors is scarce. Drawing on Durkheim's classic macro-level approach to suicide and collective efficacy theory, we use data from the Project on Human Development in Chicago Neighborhoods (PHDCN) to examine the effect of informal social controls on adolescents' suicide attempts. Analyzing reports from 990 youth, we examine the hypothesis that neighborhood-level collective efficacy and family-level integration and social control independently affect suicide attempts. We also examine the extent to which they interact in their effects on suicidal behavior. Overall, results from multilevel logit models support the Durkheimian expectation that family attachment reduces the probability that adolescents will attempt suicide. The effect of collective efficacy is interactive in nature. Specifically, we find that collective efficacy significantly enhances the protective effect of family attachment and support on adolescent suicidal behaviors. We discuss findings within the context of social control theory.     

Cyberbullying perpetration and victimization among adolescents in Hong Kong

Cyberbullying is a growing concern worldwide. Using a sample of 1917 secondary adolescents from seven schools, five psychometric measures (self-efficacy, empathy level, feelings regarding a harmonious school, sense of belonging to the school, and psychosocial wellbeing) and five scales regarding bullying experiences (cyber- and traditional bullying perpetration and victimization; reactions to cyberbullying victimization) were administered to explore the prevalence of cyberbullying in Hong Kong. Findings indicated that male adolescents were more likely than female adolescents to cyberbully others and to be cyber-victimized. Cyberbullying perpetration and victimization were found to be negatively associated with the adolescents' psychosocial health and sense of belonging to school. Cyber- and traditional bullying were positively correlated. Multivariate analyses indicated that being male, having a low sense of belonging to school, involvement in traditional bullying perpetration, and experiencing cyber-victimization were associated with an increased propensity to cyberbully others.     

Cyberbullying,internet and SNS usage types,and perceived social support: a comparison of different age groups

This study examined the relationship between cyberbullying and perceived social support, usage of the internet, and usage of social networking services (SNS). Whereas previous research has generally focused on adolescents, the current study attempted a comparative analysis among groups of adolescents, university students, and working adults. The analysis showed a positive relationship between usage of the internet for information and cyberbullying victimization, as well as a negative relationship between the usage of SNS for reading purposes and cyberbullying perpetration and victimization. Experiences with cyberbullying as perpetrator and victim were found to be more numerous with higher numbers of online friends, while a negative relationship was observed between offline perceived social support and acts of cyberbullying. For the adolescent group, acts of cyberbullying were more common with less reading of SNS. For university students, a positive relationship was found between perceived social support and acts of perpetration and victimization. For working individuals, acts of perpetration and victimization were found to be more common with larger numbers of online and offline friends. In all three groups, a negative relationship was found between acts of cyberbullying and offline perceived support. Theoretical and managerial implications as well as directions for future research are discussed.     

Perpetrator or Victim? Relationships Between Intimate Partner Violence and Well‐Being

In national surveys, around half of intimate partner violence perpetrators are also victims of partner assaults. However, data on intimate partner violence victimization and perpetration are rarely examined together. This study examines the relationships between perpetration, victimization, and three psychosocial variables—depression, self‐esteem, and substance abuse—that have been constructed in prior research as both causes and consequences of partner violence. Results indicate that associations between substance abuse and self‐esteem and partner violence perpetration are mediated by controlling for victimization, but depression is associated with both victimization and perpetration. Associations between mutual violence and depression and substance abuse are greater among women than men, supporting the position that gender symmetry in reported violence perpetration does not imply symmetry in outcomes.     

Risk factors for suicide attempts among African American women experiencing recent intimate partner violence

The purposes of this study were to identify risk factors for suicide attempts among 200 African American abused women (100 attempters, 100 nonattempters) and to test a cumulative risk model to determine if a woman's likelihood of making a suicide attempt increased as the number of risk factors increased. Results revealed that attempters were significantly more likely than nonattempters to report high levels of depressive symptoms, hopelessness, drug abuse, and childhood abuse and neglect. Results from the cumulative risk model revealed a linear association between the number of risk factors and the odds of making a suicide attempt. Compared to women with no risk factors, women with two risk factors, women with three risk factors, and women with four to five risk factors were 10, 25, and 107 times, respectively, more likely to attempt suicide. The identification of risk variables highlights the importance of designing interventions to address these factors in order to reduce the risk of suicidal behavior in abused, African American women.     

African‐American Women and Suicide: A Review and Critique of the Literature

This paper reviews the literature on African‐American women’s suicide rates. This topic is often neglected due to African‐American women’s low rates of suicide occurrence. This review seeks to answer the call for increased scientific inquiry on matters related to African‐American women and suicide. The author begins by identifying complex dynamics surrounding African‐American women’s unique social position in order to establish a better understanding of how socio‐cultural influences are addressed in the literature in relation to the suicide paradox. Both theoretical and empirical studies are thoroughly assessed in order to identify the risk and protective factors exclusive to African‐American women. The literature concludes that a history of mental disorders, particularly depression, a history of physical and emotional abuse, and a history of alcohol and substance abuse have all proven significant in increasing the risk of suicidal behavior among African‐American women. Untreated depression continues to be the leading cause of suicide among African‐American women. Contrarily, the literature identifies religious/spiritual beliefs, strong social ties, low rates of suicide acceptability, and unique coping strategies developed as a result of longstanding oppressive conditions as primary reasons for African‐American women’s exceptionally low suicide rates.     

Direct and vicarious violent victimization and juvenile delinquency: an application of general strain theory

Using a national probability sample of adolescents (12–17), this study applies general strain theory to how violent victimization, vicarious violent victimization, and dual violent victimization affect juvenile violent/property crime and drug use. In addition, the mediating effect and moderating effect of depression, low social control, and delinquent peer association on the victimization–delinquency relationship is also examined. Based on SEM analyses and contingency tables, the results indicate that all three types of violent victimization have significant and positive direct effects on violent/property crime and drug use. In addition, the expected mediating effects and moderating effects are also found. Limitations and future directions are discussed.     

Typologies of Violence Among Youth Who Encounter Child Welfare Systems

This study explored patterns of violent delinquent behaviors using latent class analysis (LCA). The study sample consisted of 1,013 11- to 17-year-olds who participated in Wave 1 of the second National Survey of Child and Adolescent Well-Being (NSCAW II). LCA was used to identify distinct patterns of violent delinquent behavior among youth involved in the child welfare system. The study found a model consisting of the two following classes: violent and normative. The study also examined how exposure to domestic violence, youths’ mental health, and youths’ substance abuse function as characteristics of the latent classes. Results showed members of the violent class were significantly more likely to report clinically significant depression and substance abuse. Racial differences did exist, showing members of the violent class were more likely to be Black than members of the normative class. The study found no differences on whether members of each class had been physically or sexually abused, experienced physical neglect, been exposed to domestic violence, or having a substance abusing parent, or a substantiated child maltreatment investigation. Results from this study could illuminate opportunities for prevention and intervention resources.     

Sexual abuse,family violence,and female delinquency: findings from a longitudinal study

The current study examines the effects of three forms of childhood victimization on self-reported delinquency and aggression in adolescent girls. These analyses are based on a longitudinal sample of 141 mother-daughter pairs participating in a study about marital violence and child development. When the children were school aged, mothers and children provided reports describing (a) child exposure to marital violence, (b) escalated physical abuse against the child, and (c) child sexual abuse. Children were followed up into adolescence and re-interviewed. Self-reports of delinquency (violent and nonviolent), running away, and violence against parents were collected. Results indicate that out of the three forms of victimization, child sexual abuse emerged as the strongest predictor of girls' violent and nonviolent criminal behavior. Girls with a history of physical abuse in childhood were most likely to assault their parents. Witnessing marital violence failed to contribute further to delinquency, beyond the adverse association with childhood sexual abuse. Findings highlight a unique avenue for delinquency in girls via childhood sexual exploitation.     

The association between suicidal ideation and childhood and adult victimization

Despite the burgeoning literature on suicidal behavior, there are meager data available on the relationship between suicidal ideation and emotional abuse in childhood; adult physical or sexual victimization; and adult re-victimization in those with a history of childhood maltreatment. This study addressed these gaps in the literature. In a sample of 494 female undergraduates, current suicidal ideation was assessed dichotomously using an item from the SCL-90 and victimization was assessed retrospectively with validated multi-item measures. Analyses revealed an association between suicidal ideation and emotional and physical abuse in childhood and a history of partner violence. No relationship was found between childhood sexual abuse or forced sex in adulthood and suicidal ideation. Additionally, results of multiple logistic regression analyses did not support the hypothesis that the relationship between childhood victimization and SI is moderated by re-victimization in adulthood.     

The impact of mental health issues, substance use, and exposure to victimization on pregnancy rates among a sample of youth with past-year foster care placement

The purpose of this study is to (1) compare youth entering substance abuse treatment with and without a history of foster care placement to determine any differences in mental health, substance use, and exposure to victimization, and (2) determine if mental health, substance use, and/or exposure to victimization predict past pregnancy among the sample with a history of foster care placement. The pooled dataset consisted of 17,124 adolescents (12-17 years of age) who completed the Global Appraisal of Individual Needs at intake for substance abuse treatment in 2009. Of these, 366 (2.1%) reported having been in foster care in the past year. When compared with a non-foster care sample, the foster care sample reported significantly higher internal mental distress scores, behavior complexity scores, and general victimization scores, after controlling for race, gender, and level of care. Problems associated with substance use did not differ between groups, though regular tobacco use was present at a higher rate in the foster care sample. Multivariate logistic regression results revealed that, within the foster care sample, internal mental distress and gender predicted past pregnancy. There may be room for intervention within substance abuse treatment centers for youth with a history of foster care, who may be at risk for pregnancy if their levels of internal mental distress are high.     

Abuse, support, and depression among homeless and runaway adolescents

This study examines the effectiveness of social support networks on psychological well-being among 602 homeless and runaway adolescents. The respondents were interviewed in shelters, drop-in centers, and on the streets in cities of four Midwestern states (Missouri, Iowa, Nebraska, and Kansas). The path model was used to test the direct effect of family abuse and precocious independence on adolescent depressive symptoms and indirect effects through social support networks. Results indicate that although abusive family origins contribute directly to depressive symptoms there are indirect effects of family abuse and early independence through social support networks. Family abuse and early independence drive homeless adolescents to rely on peers for social support. While support from friends on the street reduces depression, association with deviant peers increases depression.     

Cyberbullying perpetration among Chinese adolescents: The role of interparental conflict,moral disengagement,and moral identity

The current study examined the relationships among interparental conflict, moral disengagement, moral identity, and cyberbullying perpetration among adolescents. Participants were 649 Chinese high school students (aged 11–19 years, 48% girls). Hierarchical multiple regression analysis and SPSS macro PROCESS were conducted to test the proposed the moderated mediation model. Results showed that moral disengagement was positively correlated with adolescents' cyberbullying perpetration behavior. Moral identity was negatively related to cyberbullying perpetration behavior. Moral disengagement and moral identity mediated the effect of interparental conflict on cyberbullying perpetration. Moreover, moral identity moderated the indirect effect of interparental conflict on cyberbullying perpetration behavior through moral disengagement. These findings suggest that interparental conflict could foster cyberbullying perpetration through adolescents' moral disengagement and moral identity. In addition, a strong moral identity can buffer the negative effect of moral disengagement on cyberbullying perpetration.     

Threatened and attempted suicide by partner-violent male respondents petitioned to family violence court

The authors examined threatened and attempted suicide among partner-violent male respondents in a family court domestic violence intervention court based on the reports of 101 women petitioning the court for orders of protection. Suicidal behavior was prevalent; 45.5% of respondents had a history of threatened suicide and 12.9% had a history of suicide attempts. Most recent threats were clustered in the previous 6 months (70.5%) with one-fourth occurring within a week of the petition, potentially indicating a desperate response to a deteriorating relationship. Attempts were not clustered in recent months. Men with a history of threatened or attempted suicide were shown to have been more violent at the index offense and greater domestic violence severity overall, potentially indicating a subsample of more severely partner-violent men also at particularly heightened risk for suicide. The study of suicidal behavior in partner-violent men may inform the prevention of suicide and severe domestic violence.     

Bullying and suicide in high school students: Findings from the 2015 California youth risk behavior survey

ABSTRACT

School bullying and cyberbullying have been linked to suicidal behaviors through depression and alcohol, tobacco, marijuana, and other drug use. However, how these associations may differ across racial/ethnic groups remains relatively unknown. Using data from the 2015 California Youth Risk Behavior Survey, this study aims to examine two questions in different racial/ethnic subgroups: (1) Does bullying affect suicide? and (2) Does bullying have an indirect effect on suicide through depression and use of alcohol, tobacco, marijuana and other drugs? The sample consisted of 1,765 Californian youth attending grades 9–12. Logistic regression analyses indicate that being bullied is associated with increased odds of suicide across all racial/ethnic groups; depression mediates the effect of bullying on suicide for all racial/ethnic groups; alcohol use mediates the effect only for Hispanic youth; other drug use mediates the effect only for White youth; marijuana and tobacco use have no mediating role. These findings suggest that bullying may lead to suicide through different risk behaviors for youths of different racial/ethnic groups. Professionals who work with bullied youths need to treat depression more effectively to prevent suicide in service planning and provision. They also need to be aware of the racial/ethnic differences in the risk behaviors intercorrelated with bullying and suicide and provide appropriate treatment to the youth of specific race/ethnicity.     

Child maltreatment, revictimization, and violent behavior

The study investigates the cumulative impact of child maltreatment and victimization in adolescence on violent behavior in young adulthood in a nonclinical high-risk sample. The sample consists of 1,526 incarcerated young men (14 to 24 years) who were interviewed with standardized instruments during their prison term. Violent and nonviolent offenders with and without repeated victimization experiences throughout the life cycle were compared. Results show that child maltreatment doubles the risk for violent victimization in adolescence. Repeated victimization experiences in adolescence heighten the risk for later violent offending. This is the case for officially registered violence and self-reported violent behavior. In addition, child maltreatment increased the probability of self-reported violence as well. However, the interaction effect of victimization in childhood and victimization in early adolescence counteracted the main effects. Being repeatedly victimized throughout the early life cycle slightly reduced the probability of being a frequent offender.     

Antidepressants & suicide: putting the risk in perspective

Suicidal thoughts are a symptom of depression, and completed suicide is a tragic complication of depressive illness. Although pharmacotherapy is effective for the treatment of depression, the U.S. Food and Drug Administration has ordered that all antidepressant medications carry a warning indicating that they are associated with an increased risk of suicidal thinking, feeling, and behavior in children, adolescents, and young adults. These warnings have received much attention in the general media and have caused much controversy and debate about the relative safety of these commonly used drugs and the appropriateness of their use, especially in younger patients. In this article, I will discuss this issue with the goal of putting the risk in perspective.