Abstract
Traumatic events (TEs) have been associated with suicide attempts (SAs). However, the empirical status of some TEs is inconclusive. This also concerns community adolescents and young adults, known to be a high-risk group for SAs. We examined associations between (a) a range of prior TEs (physical attack, rape/sexual abuse, serious accident, and witnessing somebody else experiencing a TE) and a subsequent SA, and (b) the number of prior TEs and an SA, and (c) we estimated attributable proportions of SAs, in relation to each TE. Over a 10-year period, the Early Developmental Stages of Psychopathology (EDSP) study prospectively assessed community members, aged 14–24 years at baseline. Starting with 3021 subjects, each individual was assessed up to four times. Assessment was based on the Munich-Composite International Diagnostic Interview. Temporal associations were estimated using the Cox model with time-dependent covariates. Attributable proportions were based on the results of the Cox models. All four TEs elevated the risk for a subsequent SA, adjusting for confounders. Highest risk was found for the combined TE rape/sexual abuse. Results showed that 56–90% of SAs could be attributed to TEs in the exposed group; on the population level, attributable proportions ranged between 6.9% and 23.5%. Different TEs have been shown to elevate the risk of an SA in a young community sample. Our results suggest that both health professionals and health policy decision-makers consider specific TEs and the number of prior TEs as risk factors for SAs.
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References
World Health Organization (WHO) (2014) Preventing suicide: a global imperative. World Health Organization, Geneva
Franklin JC, Ribeiro JD, Fox KR et al (2017) Risk factors for suicidal thoughts and behaviors: a meta-analysis of 50 years of research. Psychol Bull 143:187–232. https://doi.org/10.1037/bul0000084
Victor SE, Klonsky ED (2014) Correlates of suicide attempts among self-injurers: a meta-analysis. Clin Psychol Rev 34:282–297. https://doi.org/10.1016/j.cpr.2014.03.005
Castellví P, Miranda-Mendizábal A, Parés-Badell O et al (2017) Exposure to violence, a risk for suicide in youths and young adults. A meta-analysis of longitudinal studies. Acta Psychiatr Scand 135:195–211. https://doi.org/10.1111/acps.12679
Serafini G, Muzio C, Piccinini G et al (2015) Life adversities and suicidal behavior in young individuals: a systematic review. Eur Child Adolesc Psychiatry 24:1423–1446. https://doi.org/10.1007/s00787-015-0760-y
Liu RT, Miller I (2014) Life events and suicidal ideation and behavior: a systematic review. Clin Psychol Rev 34:181–192. https://doi.org/10.1016/j.cpr.2014.01.006
Zatti C, Rosa V, Barros A et al (2017) Childhood trauma and suicide attempt: a meta-analysis of longitudinal studies from the last decade. Psychiatry Res 256:353–358. https://doi.org/10.1016/j.psychres.2017.06.082
Liu J, Fang Y, Gong J et al (2017) Associations between suicidal behavior and childhood abuse and neglect: a meta-analysis. J Affect Disord 220:147–155. https://doi.org/10.1016/j.jad.2017.03.060
Miller AB, Esposito-Smythers C, Weismoore JT, Renshaw KD (2013) The relation between child maltreatment and adolescent suicidal behavior: a systematic review and critical examination of the literature. Clin Child Fam Psychol Rev 16:146–172. https://doi.org/10.1007/s10567-013-0131-5
Stein DJ, Chiu WT, Hwang I et al (2010) Cross-national analysis of the associations between traumatic events and suicidal behavior: findings from the WHO World Mental Health Surveys. PLoS One 5:e10574. https://doi.org/10.1371/journal.pone.0010574
O’Connor RC, Kirtley OJ (2018) The integrated motivational–volitional model of suicidal behaviour. Philos Trans R Soc B Biol Sci 373:20170268. https://doi.org/10.1098/rstb.2017.0268
O’Connor RC, Portzky G (2018) The relationship between entrapment and suicidal behavior through the lens of the integrated motivational–volitional model of suicidal behavior. Curr Opin Psychol 22:12–17. https://doi.org/10.1016/j.copsyc.2017.07.021
Joiner T (2005) Why people die by suicide, 1st edn. Harvard University Press, Cambridge
Brown J, Cohen P, Johnson JG, Smailes EM (1999) Childhood abuse and neglect: specificity of effects on adolescent and young adult depression and suicidality. J Am Acad Child Adolesc Psychiatry 38:1490–1496. https://doi.org/10.1097/00004583-199912000-00009
Afifi TO, Enns MW, Cox BJ et al (2008) Population attributable fractions of psychiatric disorders and suicide ideation and attempts associated with adverse childhood experiences. Am J Public Health 98:946–952
Fergusson DM, Horwood LJ, Lynskey MT (1996) Childhood sexual abuse and psychiatric disorder in young adulthood: II. Psychiatric outcomes of childhood sexual abuse. J Am Acad Child Adolesc Psychiatry 35:1365–1374. https://doi.org/10.1097/00004583-199610000-00024
Gomez SH, Tse J, Wang Y et al (2017) Are there sensitive periods when child maltreatment substantially elevates suicide risk? Results from a nationally representative sample of adolescents. Depress Anxiety 34:734–741. https://doi.org/10.1002/da.22650
Fergusson DM, Woodward LJ, Horwood LJ (2000) Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood. Psychol Med 30:23–39
Benjet C, Menendez D, Albor Y et al (2017) Adolescent predictors of incidence and persistence of suicide-related outcomes in young adulthood: a longitudinal study of Mexican Youth. Suicide Life Threat Behav. https://doi.org/10.1111/sltb.12397
Nrugham L, Holen A, Sund AM (2010) Associations between attempted suicide, violent life events, depressive symptoms, and resilience in adolescents and young adults. J Nerv Ment Dis 198:131–136. https://doi.org/10.1097/NMD.0b013e3181cc43a2
Jeon HJ, Park J-I, Fava M et al (2014) Feelings of worthlessness, traumatic experience, and their comorbidity in relation to lifetime suicide attempt in community adults with major depressive disorder. J Affect Disord 166:206–212. https://doi.org/10.1016/j.jad.2014.05.010
Choi NG, DiNitto DM, Marti CN, Segal SP (2017) Adverse childhood experiences and suicide attempts among those with mental and substance use disorders. Child Abuse Negl 69:252–262. https://doi.org/10.1016/j.chiabu.2017.04.024
Martin MS, Dykxhoorn J, Afifi TO, Colman I (2016) Child abuse and the prevalence of suicide attempts among those reporting suicide ideation. Soc Psychiatry Psychiatr Epidemiol 51:1477–1484. https://doi.org/10.1007/s00127-016-1250-3
Fergusson DM, McLeod GFH, Horwood LJ (2013) Childhood sexual abuse and adult developmental outcomes: findings from a 30-year longitudinal study in New Zealand. Child Abuse Negl 37:664–674. https://doi.org/10.1016/j.chiabu.2013.03.013
Molnar BE, Berkman LF, Buka SL (2001) Psychopathology, childhood sexual abuse and other childhood adversities: relative links to subsequent suicidal behaviour in the US. Psychol Med. https://doi.org/10.1017/s0033291701004329
Devries KM, Mak JYT, Child JC et al (2014) Childhood sexual abuse and suicidal behavior: a meta-analysis. Pediatrics 133:e1331–e1344. https://doi.org/10.1542/peds.2013-2166
Beesdo-Baum K, Knappe S, Asselmann E et al (2015) The “Early Developmental Stages of Psychopathology (EDSP) study”: a 20-year review of methods and findings. Soc Psychiatry Psychiatr Epidemiol 50:851–866. https://doi.org/10.1007/s00127-015-1062-x
Lieb R, Isensee B, von Sydow K, Wittchen HU (2000) The Early Developmental Stages of Psychopathology Study (EDSP): a methodological update. Eur Addict Res 6:170–182. https://doi.org/10.1159/000052043
Wittchen HU, Perkonigg A, Lachner G, Nelson CB (1998) Early Developmental Stages of Psychopathology Study (EDSP): objectives and design. Eur Addict Res 4:18–27. https://doi.org/10.1159/000018921
Wittchen H, Pfister H (1997) DIA-X-Interviews: Manual für Screening-Verfahren und Interview; Interviewheft Längsschnittuntersuchung (DIA-X-Lifetime); Ergänzungsheft (DIA-X-Lifetime); Interviewheft Querschnittsuntersuchung (DIA-X-12 Monate); Ergänzungsheft (DIA-X-12 Monate). PC-Programm. Swets & Zeitlinger, Frankfurt
Perkonigg A, Kessler RC, Storz S, Wittchen H-U (2000) Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatr Scand 101:46–59. https://doi.org/10.1034/j.1600-0447.2000.101001046.x
Reed V, Gander F, Pfister H et al (1998) To what degree does the Composite International Diagnostic Interview (CIDI) correctly identify DSM-IV disorders? Testing validity issues in a clinical sample. Int J Methods Psychiatr Res 7:142–155. https://doi.org/10.1002/mpr.44
Wittchen HU, Lachner G, Wunderlich U, Pfister H (1998) Test-retest reliability of the computerized DSM-IV version of the Munich Composite International Diagnostic Interview (M-CIDI). Soc Psychiatry Psychiatr Epidemiol 33:568–578. https://doi.org/10.1007/s001270050095
R Core Team (2017) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna
Lumley T (2016) Survey: analysis of complex survey samples. R-package version 3.31-5. https://cran.rproject.org/web/packages/survey/index.html
Therneau TM (2015) Survival: a package for survival analysis in S. R-package version 2.38. https://cran.rproject.org/web/packages/survival/index.html
Nock MK, Borges G, Bromet EJ et al (2008) Suicide and suicidal behavior. Epidemiol Rev 30:133–154. https://doi.org/10.1093/epirev/mxn002
McChesney GC, Adamson G, Shevlin M (2015) A latent class analysis of trauma based on a nationally representative sample of US adolescents. Soc Psychiatry Psychiatr Epidemiol 50:1207–1217. https://doi.org/10.1007/s00127-015-1075-5
Wunderlich U, Bronisch T, Wittchen HU, Carter R (2001) Gender differences in adolescents and young adults with suicidal behaviour. Acta Psychiatr Scand 104:332–339. https://doi.org/10.1111/j.1600-0447.2001.00432.x
Wunderlich U, Bronisch T, Wittchen HU (1998) Comorbidity patterns in adolescents and young adults with suicide attempts. Eur Arch Psychiatry Clin Neurosci 248:87–95. https://doi.org/10.1007/s004060050023
Asselmann E, Wittchen H-U, Lieb R et al (2017) Incident mental disorders in the aftermath of traumatic events: a prospective-longitudinal community study. J Affect Disord 227:82–89. https://doi.org/10.1016/j.jad.2017.10.004
Natarajan S, Lipsitz SR, Rimm E (2007) A simple method of determining confidence intervals for population attributable risk from complex surveys. Stat Med 26:3229–3239. https://doi.org/10.1002/sim.2779
Miché M, Hofer PD, Voss C et al (2018) Mental disorders and the risk for the subsequent first suicide attempt: results of a community study on adolescents and young adults. Eur Child Adolesc Psychiatry 27:839–848. https://doi.org/10.1007/s00787-017-1060-5
Bruffaerts R, Demyttenaere K, Borges G et al (2010) Childhood adversities as risk factors for onset and persistence of suicidal behaviour. Br J Psychiatry 197:20–27. https://doi.org/10.1192/bjp.bp.109.074716
Borges G, Benjet C, Medina-Mora ME et al (2008) Traumatic events and suicide-related outcomes among Mexico City adolescents. J Child Psychol Psychiatry 49:654–666. https://doi.org/10.1111/j.1469-7610.2007.01868.x
Grossman M, Lee V, Van Neste KJ et al (2000) Psychological adjustment of critically injured patients three months after an unexpected, potentially life-threatening accident. J Clin Nurs 9:801–815. https://doi.org/10.1046/j.1365-2702.2000.00420.x
Gibson LE, Leitenberg H (2000) Child sexual abuse prevention programs: do they decrease the occurrence of child sexual abuse? Child Abuse Negl 24:1115–1125. https://doi.org/10.1016/S0145-2134(00)00179-4
Vladutiu CJ, Martin SL, Macy RJ (2011) College- or university-based sexual assault prevention programs: a review of program outcomes, characteristics, and recommendations. Trauma Violence Abuse 12:67–86. https://doi.org/10.1177/1524838010390708
Mikton C, Butchart A (2009) Child maltreatment prevention: a systematic review of reviews. Bull World Health Org 87:353–361. https://doi.org/10.2471/BLT.08.057075
Zalsman G, Hawton K, Wasserman D et al (2016) Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry 3:646–659
Cook A, Spinazzola J, Ford J et al (2005) Complex trauma in children and adolescents. Psychiatr Ann 35:390–398. https://doi.org/10.3928/00485713-20050501-05
Bruffaerts R, Kessler RC, Demyttenaere K et al (2015) Examination of the population attributable risk of different risk factor domains for suicidal thoughts and behaviors. J Affect Disord 187:66–72. https://doi.org/10.1016/j.jad.2015.07.042
Acknowledgements
This work is part of the Early Developmental Stages of Psychopathology (EDSP) study and is funded by the German Federal Ministry of Education and Research (BMBF) Project nos. 01EB9405/6, 01EB9901/6, EB01016200, 01EB0140, and 01EB0440. Part of the field work and analyses were also additionally supported by Deutsche Forschungsgemeinschaft (DFG) Grants LA1148/1-1, WI2246/1-1, WI 709/7-1, and WI 709/8-1. Principal investigators are Dr. Hans-Ulrich Wittchen and Dr. Roselind Lieb, who take responsibility for the integrity of the study data. Core staff members of the EDSP group are Dr. Kirsten von Sydow, Dr. Gabriele Lachner, Dr. Axel Perkonigg, Dr. Peter Schuster, Dr. Michael Höfler, Dipl.-Psych. Holger Sonntag, Dr. Tanja Brückl, Dipl.-Psych. Elzbieta Garczynski, Dr. Barbara Isensee, Dr. Agnes Nocon, Dr. Chris Nelson, Dipl.-Inf. Hildegard Pfister, Dr. Victoria Reed, Dipl.-Soz. Barbara Spiegel, Dr. Andrea Schreier, Dr. Ursula Wunderlich, Dr. Petra Zimmermann, Dr. Katja Beesdo-Baum, Dr. Antje Bittner, Dr. Silke Behrendt, and Dr. Susanne Knappe. Scientific advisors are Dr. Jules Angst (Zurich), Dr. Jürgen Margraf (Basel), Dr. Günther Esser (Potsdam), Dr. Kathleen Merikangas (NIMH, Bethesda), Dr. Ron Kessler (Harvard University, Boston), and Dr. Jim van Os (Maastricht University). Dr. Katja Beesdo-Baum and Catharina Voss are currently funded by the BMBF (Project nos. 01ER1303, 01ER1703).
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Miché, M., Hofer, P.D., Voss, C. et al. Specific traumatic events elevate the risk of a suicide attempt in a 10-year longitudinal community study on adolescents and young adults. Eur Child Adolesc Psychiatry 29, 179–186 (2020). https://doi.org/10.1007/s00787-019-01335-3
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DOI: https://doi.org/10.1007/s00787-019-01335-3