Childhood abuse, family dysfunction strongly associated with suicide attempts


By Karla Gale

NEW YORK (Reuters Health) – Adverse childhood events, from abuse to incarceration of a family member, strongly influence the risk of suicide attempts throughout a person's life span, according to study results reported in the December 26th issue of the Journal of the American Medical Association.

Subjects of the study included 9367 female and 7970 male members of Kaiser Permanente's Health Appraisal Center in San Diego, California. Between 1995 and 1996 or in 1997, the participants completed confidential questionnaires regarding adverse childhood events (ACEs) that took place during their first 18 years of life.

Shanta R. Dube, of the Centers for Disease Control and Prevention in Atlanta, Georgia, and associates found that 64% of respondents reported at least one of the ACEs included in the survey: frequent emotional abuse, frequent physical abuse, any sexual abuse, other domestic violence, a household member who abused drugs or alcohol, a household member with mental illness or depression, parental separation or divorce, or incarceration of a household member.

The adjusted ACE score averaged 1.5 out of 8. The lifetime prevalence of having at least one suicide attempt among the entire cohort was 3.8%.

Among persons with an ACE score of 0, the prevalence was 1.1%. Risk was increased two- to five-fold by any adverse childhood experience. An ACE score of 7 or 8 increased the likelihood of suicide attempt before adulthood 51-fold, while for adult suicide attempts it increased the risk 30-fold.

"For every increase in the ACE score, the risk of suicide attempts increases by about 60%," the investigators report.

For this population, the lifetime attributable risk fraction (ARF), which the authors define as "an estimate of the proportion of the health problem (eg, attempted suicide) that would not have occurred if no persons had been exposed to the risk factor being assessed," was 67%.

"Our estimates of the ARFs are of an order of magnitude that is rarely observed in epidemiology and public health data," the investigators write.

Dube told Reuters Health, "The study didn't delve into any particular type of adverse event. We wanted to look at a broad range of different types because they are so common and interrelated."

"What this gives the healthcare professional is an indication of what types of experiences increase the risk of suicide attempts," she continued. "Assessing these types of adverse childhood experiences by questionnaire may help to alert primary care physicians to numerous potential health outcomes and health risk behaviors, as well as suicide attempts," Dube added.

In an associated commentary, Dr. Charles R. Keith, of Duke University Medical Center in Durham, North Carolina, rhetorically questions why many people with adverse life events do not become suicidal.

He postulates that other nurturing relationships, fortunate life events, or neurobiological developmental strengths confer protection against the self-destructive, depressive thought patterns that often accompany ACEs.

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