Childhood Pain Spurs Suicide Attempts

But most trauma passes without self-harm, study shows

THURSDAY, Dec. 27, 2001 (HealthDayNews) -- Confirming what many will likely find intuitive, government researchers say traumatic childhood events, from sexual and physical abuse to the divorce of one's parents, significantly increase the odds that a person will attempt suicide.

Enduring more than one painful experience multiplies the odds of a suicide attempt, and those with seven adverse episodes as children had a 51-fold higher risk of trying to take their own lives as teens and a 30-fold higher risk of doing so as adults, the study says.

Still, the vast majority of people who suffer childhood traumas don't try to take their own lives, the research shows. The findings by researchers at the Centers for Disease Control and Prevention (CDC), appear in this week's Journal of the American Medical Association.

Suicide is among the nation's 10 leading causes of death in America, accounting for more than 30,000 fatalities each year, health officials say. Suicide is the third-leading cause of death among people aged 15 to 24, reports the CDC.

Earlier research has shown a strong link between childhood emotional trauma and later health problems, such as smoking and drug and alcohol abuse.

In the latest work, CDC epidemiologist Shanta Dube and her colleagues queried 17,337 men and women, whose average age was 56, enrolled in a California health maintenance plan. Subjects were asked about their negative experiences as children and their later history of suicide attempts.

Adverse childhood events (ACEs) included emotional, physical and sexual abuse, drug or alcohol abuse at home, mental illness and spending time in prison. Domestic violence, parental separation and divorce also were on the list.

Sixty-four percent of the people surveyed said they'd experienced one or more negative events, and 661, or almost 4 percent, said they'd tried to take their own lives at least once.

People who said they'd suffered one trauma were two to five times more likely to report making a suicide attempt as teens or adults than those with happier childhoods, the researchers say.

As the number of traumatic events increased, so did the odds of suicide attempts. For the 159 people with seven or more negative childhood experiences, the odds of attempting suicide as a teen or an adult were 51 and 30 times higher, respectively, than those with no ACEs.

Depression and substance abuse were among the strong predictors of suicide attempts, the researchers say.

Many suicide attempts were less determined than others -- taking pills or cutting wrists vs. shooting oneself, for example. Mental health experts consider some attempts "cries for help." Since everyone in the CDC study survived their attempts, and Dube's group didn't collect information on the methods used, the researchers say at least some of the efforts were not meant to be deadly.

However, Dube says the fact that they did try to take their own lives certainly increased their odds of succeeding. "What we can say is that attempting suicide is in itself a risk factor for completed suicide," she says.

Although the average number of suicide attempts was 1.6 per person, Dube and her colleagues didn't look at whether those with higher ACE scores were at greater risk of multiple tries. "We need to look at that closely," says Dube. "Even at least once is a dramatic type of behavior," she says.

Dr. Charles Keith, a teen suicide expert at Duke University Medical Center, in Durham, N.C., says the findings aren't particularly novel. But, he says they do point to an important fact about childhood emotional distress -- namely, that most trauma doesn't lead to violence against the self.

"The majority of people are not suicidal, so it's not a one-to-one correspondence" between adverse life events and suicide attempts, says Keith, author of an editorial accompanying the journal article.

Keith says the CDC study has important limitations. The researchers had to rely on their subjects' truthfulness, not only about their history of childhood adversity but their emotional stability. And he says the fact that researchers didn't address the means of suicide attempts also is a large gap.

Still, even with these flaws, he says the results show that the subjects had been thinking strongly about suicide at some point in their lives and may still be. "They're people in psychological distress. We don't know if they really did attempt suicide, but in a way it's not as important as their state of mind," Keith says.

What To Do

For more on suicide, check the American Foundation for Suicide Prevention or the National Strategy for Suicide Prevention.

To learn more about the impact of adverse childhood events on health, try this Emory University Web site or this ACE-Network site.

SOURCES: Interviews with Shanta R. Dube, M.P.H., epidemiologist, CDC, Atlanta; Charles R. Keith, M.D., associate professor emeritus, child and adolescent psychiatry, Duke University Medical Center, Durham, N.C.; Dec. 26, 2001, Journal of the American Medical Association
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