Skip to main content
Intended for healthcare professionals
Restricted access
Research article
First published online June 6, 2023

Childhood Maltreatment, Executive Function, and Suicide Attempts in Adolescents

Abstract

Evidence suggests that child maltreatment is a risk factor for adolescent suicidal behavior. However, the differential influence of distinct forms of child maltreatment on adolescent suicide attempts is understudied and the factors that might exacerbate or ameliorate these associations warrant attention. We examined the associations between two distinct forms of child maltreatment (threat and deprivation) and suicide attempt history, and investigated whether executive function domains moderated these associations. Participants were 119 adolescents (M = 15.24, SD = 1.46, 72.3% female) recruited from an inpatient psychiatric hospital during hospitalization for suicidal thoughts and behaviors. Results indicated that the executive function domains of initiation, shifting, and planning/organization moderated the associations between threat and suicide attempt history. Associations between threat and suicide attempt history were significant only when initiation and shifting T-scores were lower (OR = 1.22, p = .03 and OR = 1.32, p = .01, respectively). The association between threat and suicide attempt history trended toward significance when planning/organization T-scores were lower (OR = 1.15, p = .10). None of the executive function domains moderated the link between deprivation and suicide attempt history. Findings highlight the need for research investigating whether initiation, shifting, and planning/organization might be amendable to intervention in the context of threat-related child maltreatment.

Get full access to this article

View all access and purchase options for this article.

References

Alqueza K. L., Pagliaccio D., Durham K., Srinivasan A., Stewart J. G., Auerbach R. P. (2021). Suicidal thoughts and behaviors among adolescent psychiatric inpatients. Archives of Suicide Research, 27(2), 353–366. https://doi.org/10.1080/13811118.2021.1999874
Ammerman B. A., Serang S., Jacobucci R., Burke T. A., Alloy L. B., McCloskey M. S. (2018). Exploratory analysis of mediators of the relationship between childhood maltreatment and suicidal behavior. Journal of Adolescence, 69, 103–112. https://doi.org/10.1016/j.adolescence.2018.09.004
Aral A., Say G. N., Gerdan G., Usta M. B., Aral A. E. (2020). The role of sociodemographic, clinical and neuropsychological variables in suicide attempts in depressed adolescents. Noro Psikiyatri Arsivi, 57(4), 312–317. https://doi.org/10.29399/npa.24776
Baggetta P., Alexander P. A. (2016). Conceptualization and operationalization of executive function. Mind, Brain, and Education, 10(1), 10–33. https://doi.org/10.1111/mbe.12100
Baldwin J. R., Arseneault L., Caspi A., Moffitt T. E., Fisher H. L., Odgers C. L., Ambler A., Houts R. M., Matthews T., Ougrin D., Richmond-Rakerd L. S., Takizawa R., Danese A. (2019). Adolescent victimization and self-injurious thoughts and behaviors: A genetically sensitive cohort study. Journal of the American Academy of Child and Adolescent Psychiatry, 58(5), 506–513. https://doi.org/10.1016/j.jaac.2018.07.903
Barrera M., Calderón L., Bell V. (2013). The cognitive impact of sexual abuse and PTSD in children: A neuropsychological study. Journal of Child Sexual Abuse, 22(6), 625–638. https://doi.org/10.1080/10538712.2013.811141
Basharpoor S., Ahmadi S. (2021). The pattern of structural relationships executive function, ego resilience, and moral identity in predicting self-efficacy for quitting people Drug dependents: The mediating role of mindfulness. Military Caring Sciences, 8(2), 169–182. https://doi.org/10.52547/mcs.8.2.169
Bernstein D. P., Stein J. A., Newcomb M. D., Walker E., Pogge D., Ahluvalia T., Stokes J., Handelsman L., Medrano M., Desmond D., Zule W. (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse & Neglect, 27(2), 169–190. https://doi.org/10.1016/s0145-2134(02)00541-0
Brokke S. S., Landrø N. I., Haaland V. Ø. (2020). Cognitive control in suicide ideators and suicide attempters. Frontiers in Psychology, 11, 595673. https://doi.org/10.3389/fpsyg.2020.595673
Brown S. M., Rienks S., McCrae J. S., Watamura S. E. (2019). The co-occurrence of adverse childhood experiences among children investigated for child maltreatment: A latent class analysis. Child Abuse & Neglect, 87, 18–27. https://doi.org/10.1016/j.chiabu.2017.11.010
Burke T. A., Ammerman B. A., Knorr A. C., Alloy L. B., McCloskey M. S. (2018). Measuring acquired capability for suicide within an ideation-to-action framework. Psychology of Violence, 8(2), 277–286. https://doi.org/10.1037/vio0000090
Burton C. Z., Vella L., Weller J. A., Twamley E. W. (2011). Differential effects of executive functioning on suicide attempts. The Journal of Neuropsychiatry and Clinical Neurosciences, 23(2), 173–179. https://doi.org/10.1176/jnp.23.2.jnp173
Busso D. S., McLaughlin K. A., Sheridan M. A. (2017). Dimensions of adversity, physiological reactivity, and externalizing psychopathology in adolescence: Deprivation and threat. Psychosomatic Medicine, 79(2), 162–171. https://doi.org/10.1097/PSY.0000000000000369
Casey B., Jones R. M., Levita L., Libby V., Pattwell S. S., Ruberry E. J., Soliman F., Somerville L. H. (2010). The storm and stress of adolescence: Insights from human imaging and mouse genetics. Developmental Psychobiology, 52(3), 225–235. https://doi.org/10.1002/dev.20447
Chen H., Hong L., Tong S., Li M., Sun S., Xu Y., Liu J., Feng T., Li Y., Lin G., Lu F., Cai Q., Xu D., Zhao K., Zheng T. (2023). Cognitive impairment and factors influencing depression in adolescents with suicidal and self-injury behaviors: A cross-sectional study. BMC Psychiatry, 23(1), 247. https://doi.org/10.1186/s12888-023-04726-8
Cicchetti D. (1993). Defining child maltreatment: The interface between policy and researchs. Child abuse, child development, and social policy. Ablex.
Cohen J. A., Mannarino A. P., Deblinger E. (2012). Trauma-focused CBT for children and adolescents: Treatment applications. Guilford Press.
Conway P. M., Erlangsen A., Teasdale T. W., Jakobsen I. S., Larsen K. J. (2017). Predictive validity of the Columbia-suicide severity rating scale for short-term suicidal behavior: A Danish study of adolescents at a high risk of suicide. Archives of Suicide Research: Official Journal of the International Academy for Suicide Research, 21(3), 455–469. https://doi.org/10.1080/13811118.2016.1222318
Cross D., Fani N., Powers A., Bradley B. (2017). Neurobiological development in the context of childhood trauma. Clinical Psychology: A Publication of the Division of Clinical Psychology of the American Psychological Association, 24(2), 111–124. https://doi.org/10.1111/cpsp.12198
Diehl A. S., Prout M. F. (2002). Effects of posttraumatic stress disorder and child sexual abuse on self‐efficacy development. The American Journal of Orthopsychiatry, 72(2), 262–265. https://doi.org/10.1037/0002-9432.72.2.262
Duke N. N. (2018). Adolescent adversity and concurrent tobacco, alcohol, and marijuana use. American Journal of Health Behavior, 42(5), 85–99. https://doi.org/10.5993/AJHB.42.5.8
Gioia G. A., Isquith P. K., Guy S. C., Kenworthy L. (2000). Test review behavior rating inventory of executive function. Child Neuropsychology, 6(3), 235–238. https://doi.org/10.1076/chin.6.3.235.3152
Goldstein S., Naglieri J. A., Princiotta D., Otero T. M. (2014). Introduction: A history of executive functioning as a theoretical and clinical construct. Handbook of executive functioning (pp. 3–12). Springer.
Gong M., Zhang S., Li W., Wang W., Wu R., Guo L., Lu C. (2020). Association between childhood maltreatment and suicidal ideation and suicide attempts among Chinese adolescents: The moderating role of depressive symptoms. International Journal of Environmental Research and Public Health, 17(17), 6025. https://doi.org/10.3390/ijerph17176025
Gratch I., Fernandes S. N., Bell K.-A., Pollak O. H., Fox K. R., Tezanos K., Ebo T., Cha C. B. (2021). Self-injurious thoughts and behaviors interview–revised (SITBI-R): Reliability, validity, and inter-informant agreement in an adolescent sample. Journal of Clinical Child & Adolescent Psychology, 51(4), 484–494. https://doi.org/10.1080/15374416.2021.1901229
Henry L. M., Gracey K., Shaffer A., Ebert J., Kuhn T., Watson K. H., Gruhn M., Vreeland A., Siciliano R., Dickey L., Lawson V., Broll C., Cole D. A., Compas B. E. (2021). Comparison of three models of adverse childhood experiences: Associations with child and adolescent internalizing and externalizing symptoms. Journal of Abnormal Psychology, 130(1), 9–25. https://doi.org/10.1037/abn0000644
Horwitz A. G., Czyz E. K., King C. A. (2015). Predicting future suicide attempts among adolescent and emerging adult psychiatric emergency patients. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 44(5), 751–761. https://doi.org/10.1080/15374416.2014.910789
Inscoe A. B., Donisch K., Cheek S., Stokes C., Goldston D. B., Asarnow J. R. (2021). Trauma-informed care for youth suicide prevention: A qualitative analysis of caregivers’ perspectives. Psychological Trauma, 14(4), 653–660. https://doi.org/10.1037/tra0001054
Jin M. J., Kim J. S., Kim S., Hyun M. H., Lee S.-H. (2017). An integrated model of emotional problems, beta power of electroencephalography, and low frequency of heart rate variability after childhood trauma in a non-clinical sample: A path analysis study. Frontiers in Psychiatry, 8, 314. https://doi.org/10.3389/fpsyt.2017.00314
Joiner T. E. (2005). Why people die by suicide. Harvard University Press.
Kavanaugh B. C., Dupont-Frechette J. A., Jerskey B. A., Holler K. A. (2017). Neurocognitive deficits in children and adolescents following maltreatment: Neurodevelopmental consequences and neuropsychological implications of traumatic stress. Applied Neuropsychology. Child, 6(1), 64–78. https://doi.org/10.1080/21622965.2015.1079712
Keeshin B. R., Strawn J. R., Luebbe A. M., Saldaña S. N., Wehry A. M., DelBello M. P., Putnam F. W. (2014). Hospitalized youth and child abuse: A systematic examination of psychiatric morbidity and clinical severity. Child Abuse & Neglect, 38(1), 76–83. https://doi.org/10.1016/j.chiabu.2013.08.013
Klika J. B., Rosenzweig J., Merrick M. (2020). Economic burden of known cases of child maltreatment from 2018 in each state. Child and Adolescent Social Work Journal, 37(3), 227–234. https://doi.org/10.1007/s10560-020-00665-5
Kobulsky J. M., Kepple N. J., Jedwab M. (2018). Abuse characteristics and the concordance of child protective service determinations and adolescent self-reports of abuse. Child Maltreatment, 23(3), 269–280. https://doi.org/10.1177/1077559518771743
Krivitzky L., Bosenbark D. D., Ichord R., Jastrzab L., Billinghurst L. (2019). Brief report: Relationship between performance testing and parent report of attention and executive functioning profiles in children following perinatal arterial ischemic stroke. Child Neuropsychology: A Journal on Normal and Abnormal Development in Childhood and Adolescence, 25(8), 1116–1124. https://doi.org/10.1080/09297049.2019.1588957
Lindsey M. A., Sheftall A. H., Xiao Y., Joe S. (2019). Trends of suicidal behaviors among high school students in the United States: 1991–2017. Pediatrics, 144(5), e20191187. https://doi.org/10.1542/peds.2019-1187
Mahone E. M., Zabel T. A., Levey E., Verda M., Kinsman S. (2002). Parent and self-report ratings of executive function in adolescents with myelomeningocele and hydrocephalus. Child Neuropsychology: A Journal on Normal and Abnormal Development in Childhood and Adolescence, 8(4), 258–270. https://doi.org/10.1076/chin.8.4.258.13510
Mak C., Whittingham K., Cunnington R., Boyd R. N. (2018). Efficacy of mindfulness-based interventions for attention and executive function in children and adolescents—a systematic review. Mindfulness, 9(1), 59–78. https://doi.org/10.1007/s12671-017-0770-6
Mars B., Heron J., Klonsky E. D., Moran P., O'Connor R. C., Tilling K., Wilkinson P., Gunnell D. (2019). Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: A population-based birth cohort study. The Lancet. Psychiatry, 6(4), 327–337. https://doi.org/10.1016/S2215-0366(19)30030-6
Martin L., Kidd M., Seedat S. (2019). The effects of childhood maltreatment and anxiety proneness on neuropsychological test performance in non-clinical older adolescents. Journal of Affective Disorders, 243, 133–144. https://doi.org/10.1016/j.jad.2018.09.009
Miller A. B., Esposito-Smythers C., Weismoore J. T., Renshaw K. D. (2013). The relation between child maltreatment and adolescent suicidal behavior: A systematic review and critical examination of the literature. Clinical Child and Family Psychology Review, 16(2), 146–172. https://doi.org/10.1007/s10567-013-0131-5
Nangle J.-M., Clarke S., Morris D. W., Schwaiger S., McGhee K. A., Kenny N., Murphy K., Gill M., Corvin A., Donohoe G. (2006). Neurocognition and suicidal behaviour in an Irish population with major psychotic disorders. Schizophrenia Research, 85(1-3), 196–200. https://doi.org/10.1016/j.schres.2006.03.035
Negriff S., Gordis E. B., Susman E. J., Kim K., Peckins M. K., Schneiderman J. U., Mennen F. E. (2020). The young adolescent project: A longitudinal study of the effects of maltreatment on adolescent development. Development and Psychopathology, 32(4), 1440–1459. https://doi.org/10.1017/S0954579419001391
Nichols H. (2021). Executive function and communication in children who have experienced adverse childhood experiences. Vanderbilt University.
Nock M. K., Holmberg E. B., Photos V. I., Michel B. D. (2007). Self-injurious thoughts and behaviors interview: Development, reliability, and validity in an adolescent sample. Psychol Assess, 19(3), 309–317. https://doi.org/10.1037/1040-3590.19.3.309
O’Connor D. B., Green J. A., Ferguson E., O’Carroll R. E., O’Connor R. C. (2017). Cortisol reactivity and suicidal behavior: Investigating the role of hypothalamic-pituitary-adrenal axis responses to stress in suicide attempters and ideators. Psychoneuroendocrinology, 75, 183–191. https://doi.org/10.1016/j.psyneuen.2016.10.019
Onat M., İnal Emiroğlu N., Baykara B., Özerdem A., Özyurt G., Öztürk Y., Şahin Ü., Ildız A., Kaptancık Bilgiç B., Hıdıroğlu Ongun C., Pekcanlar Akay A. (2019). Executive functions and impulsivity in suicide attempter adolescents with major depressive disorder. Psychiatry and Clinical Psychopharmacology, 29(3), 332–339. https://doi.org/10.1080/24750573.2018.1541647
Penner F., Gambin M., Sharp C. (2019). Childhood maltreatment and identity diffusion among inpatient adolescents: The role of reflective function. Journal of Adolescence, 76, 65–74. https://doi.org/10.1016/j.adolescence.2019.08.002
Posner K., Brown G. K., Stanley B., Brent D. A., Yershova K. V., Oquendo M. A., Currier G. W., Melvin G. A., Greenhill L., Shen S., Mann J. J. (2011). The Columbia–suicide severity rating scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. The American Journal of Psychiatry, 168(12), 1266–1277. https://doi.org/10.1176/appi.ajp.2011.10111704
Radloff L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. https://doi.org/10.1177/014662167700100306
Roos L. E., Kim H. K., Schnabler S., Fisher P. A. (2016). Children’s executive function in a CPS-involved sample: Effects of cumulative adversity and specific types of adversity. Children and Youth Services Review, 71, 184–190. https://doi.org/10.1016/j.childyouth.2016.11.008
Rueness J., Myhre Md M. C., Strøm I. F., Wentzel-Larsen T., Dyb G., Thoresen S. (2020). Child abuse and physical health: A population-based study on physical health complaints among adolescents and young adults. Scandinavian Journal of Public Health, 48(5), 511–518. https://doi.org/10.1177/1403494819848581
Sánchez-Sansegundo M., Portilla-Tamarit I., Rubio-Aparicio M., Albaladejo-Blazquez N., Ruiz-Robledillo N., Ferrer-Cascales R., Zaragoza-Martí A. (2020). Neurocognitive functioning and suicidal behavior in violent offenders with schizophrenia spectrum disorders. Diagnostics, 10(12), 1091. https://doi.org/10.3390/diagnostics10121091
Sattler K. M., Font S. A. (2018). Resilience in young children involved with child protective services. Child Abuse & Neglect, 75, 104–114. https://doi.org/10.1016/j.chiabu.2017.05.004
Sekowski M., Gambin M., Cudo A., Wozniak-Prus M., Penner F., Fonagy P., Sharp C. (2020). The relations between childhood maltreatment, shame, guilt, depression and suicidal ideation in inpatient adolescents. Journal of Affective Disorders, 276, 667–677. https://doi.org/10.1016/j.jad.2020.07.056
Sheridan M. A., McLaughlin K. A. (2014). Dimensions of early experience and neural development: Deprivation and threat. Trends in Cognitive Sciences, 18(11), 580–585. https://doi.org/10.1016/j.tics.2014.09.001
Sheridan M. A., Peverill M., Finn A. S., McLaughlin K. A. (2017). Dimensions of childhood adversity have distinct associations with neural systems underlying executive functioning. Development and Psychopathology, 29(5), 1777–1794. https://doi.org/10.1017/S0954579417001390
Sosnowski D. W., Rojo-Wissar D. M., Smail E. J., Musci R. J., Wilcox H. C., Johnson S. B. (2022). Expanding on threat and deprivation: Empirical examination of adversity dimensions and psychiatric outcomes among emerging adults. Emerging Adulthood, 11(2), 431–443. https://doi.org/10.1177/21676968221114260
Stewart J. G., Kim J. C., Esposito E. C., Gold J., Nock M. K., Auerbach R. P. (2015). Predicting suicide attempts in depressed adolescents: Clarifying the role of disinhibition and childhood sexual abuse. Journal of Affective Disorders, 187, 27–34. https://doi.org/10.1016/j.jad.2015.08.034
Tunno A. M., Inscoe A. B., Goldston D. B., Asarnow J. R. (2021). A trauma-informed approach to youth suicide prevention and intervention. Evidence-Based Practice in Child and Adolescent Mental Health, 6(3), 316–327. https://doi.org/10.1080/23794925.2021.1923089
U.S. Department of Health & Human Services (2022). Child maltreatment 2020. Children’s Bureau An office Administration on children, youth and families. https://www.acf.hhs.gov/cb/data-research/child-maltreatment
Wang D., Jiang Q., Yang Z., Choi J.-K. (2021). The longitudinal influences of adverse childhood experiences and positive childhood experiences at family, school, and neighborhood on adolescent depression and anxiety. Journal of Affective Disorders, 292, 542–551. https://doi.org/10.1016/j.jad.2021.05.108
Wang X., Lu J., Liu Q., Yu Q., Fan J., Gao F., Han Y., Liu X., Yao R., Zhu X. (2022). Childhood experiences of threat and deprivation predict distinct depressive symptoms: A parallel latent growth curve model. Journal of Affective Disorders, 319, 244–251. https://doi.org/10.1016/j.jad.2022.09.061
Watt T. T., Sharp S. F. (2002). Race differences in strains associated with suicidal behavior among adolescents. Youth & Society, 34(2), 232–256. https://doi.org/10.1177/004411802237865
Xing X., Wang M. (2018). The moderating role of HPA activity in the relations between parental corporal punishment and executive function in Chinese school-aged children. Psychology of Violence, 8(4), 418–426. https://doi.org/10.1037/vio0000143
Zelazny J., Melhem N., Porta G., Biernesser C., Keilp J. G., Mann J. J., Oquendo M. A., Stanley B., Brent D. A. (2019). Childhood maltreatment, neuropsychological function and suicidal behavior. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 60(10), 1085–1093. https://doi.org/10.1111/jcpp.13096

Cite article

Cite article

Cite article

OR

Download to reference manager

If you have citation software installed, you can download article citation data to the citation manager of your choice

Share options

Share

Share this article

Share with email
EMAIL ARTICLE LINK
Share on social media

Share access to this article

Sharing links are not relevant where the article is open access and not available if you do not have a subscription.

For more information view the Sage Journals article sharing page.

Information, rights and permissions

Information

Published In

Article first published online: June 6, 2023

Keywords

  1. child maltreatment
  2. executive function
  3. suicide

Rights and permissions

© The Author(s) 2023.
Request permissions for this article.
PubMed: 37279026

Authors

Affiliations

Shaquanna Brown
Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
Katherine M. Tezanos
Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
Nicole R. Nugent
Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA

Notes

Shaquanna Brown, Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence 02906, RI, USA. Email: [email protected]

Metrics and citations

Metrics

Journals metrics

This article was published in Child Maltreatment.

VIEW ALL JOURNAL METRICS

Article usage*

Total views and downloads: 314

*Article usage tracking started in December 2016


Articles citing this one

Receive email alerts when this article is cited

Web of Science: 1 view articles Opens in new tab

Crossref: 0

There are no citing articles to show.

Figures and tables

Figures & Media

Tables

View Options

Get access

Access options

If you have access to journal content via a personal subscription, university, library, employer or society, select from the options below:


Alternatively, view purchase options below:

Purchase 24 hour online access to view and download content.

Access journal content via a DeepDyve subscription or find out more about this option.

View options

PDF/ePub

View PDF/ePub

Full Text

View Full Text