Exposure to childhood sexual abuse (CSA) may increase the odds of later suicidal behavior, including suicide attempts, new research suggests.
A meta-analysis of 9 studies from 6 different countries, with a total of almost 9000 participants, showed that those who experienced CSA before the age of 16 to 18 years were more than twice as likely to attempt or complete suicides.
"CSA exposure is associated with suicide attempts when a range of different confounders are controlled for," the investigators, led by Karen M. Devries, PhD, from the London School of Hygiene and Tropical Medicine in the United Kingdom, write.
"But the temporality of the association is not well established, and the association is highly heterogeneous," add the researchers.
They note that more research that controls for baseline suicidal behavior and other factors is now needed, as well as more studies to determine whether CSA affects completed vs attempted suicides differently.
The study was published online April 14 in Pediatrics.
Major Cause of Global Death
"Self-inflicted injuries are one of the major causes of disease burden and death globally. Understanding the extent to which this is associated with…CSA exposure can help inform prevention strategies," write the investigators.
They examined 20 health and social science databases before selecting 7 longitudinal cohort and 2 twin studies for inclusion in this meta-analysis.
The cohort studies included 2 from Australia and 1 each from the United States, Canada, New Zealand, Switzerland, and the Netherlands. Both of the twin studies were from Australia.
The 9 studies included a total of 8733 participants (mean age, 18 years); follow-up periods ranged from 3 to 44 years.
CSA exposure was measured by self-reports and/or official records. Onset and range of suicidal behavior and age and circumstances surrounding suicide attempts were also examined.
Results showed that the overall pooled odds ratio (OR) between CSA and suicides or suicide attempts in the longitudinal studies was 2.43 (95% confidence interval [CI], 1.94 - 3.05; P < .0001). Estimates did not differ significantly between men and women.
For the twin studies, the pooled OR was 2.65 (95% CI, 0.82 - 4.49). However, because the sample sizes for both studies were relatively small, the pooled OR was not found to be statistically significant.
Sex Differences
Although all of the included studies adjusted for several confounders, including family environment, other traumatic childhood events, and/or comorbid mental illness, the investigators note that baseline suicidal behavior "was not well-controlled."
They add that there also were not enough data to extensively assess possible sources of heterogeneity.
Still, "assuming the relationship between CSA and suicidal behavior is causal and unconfounded, calculations suggest that between 20.1% and 22.3% of suicidal behavior in women could be attributed to CSA exposure," report the researchers.
In contrast, only between 9.6% and 10.8% of these behaviors in men could be attributed to exposure to CSA.
Overall, the investigators note that the findings are consistent with those shown in past reviews ― that there is an association between CSA and increased risk for suicidal ideation and/or attempts in both men and women.
"Prevention strategies that take into account who perpetrates violence against children are needed, and interventions for suicidal patients must be sensitive to histories of violence," the authors conclude.
The investigators report no relevant financial relationships.
Pediatrics. Published online April 14, 2014. Abstract
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Cite this: Child Sexual Abuse Linked to Suicidal Behavior - Medscape - Apr 23, 2014.
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