Sexual abuse and suicidality: gender differences in a large community sample of adolescents

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Abstract

Objective: A cross-sectional study of gender specific relationships between self-reported child sexual abuse and suicidality in a community sample of adolescents.

Method: Students aged 14 years on average (N=2,485) from 27 schools in South Australia completed a questionnaire including items on sexual abuse and suicidality, and measures of depression (Centre for Epidemiological Studies Depression Scale), hopelessness (Beck Hopelessness Scale), and family functioning (McMaster Family Assessment Device General Functioning Subscale). Data analysis included logistic regression.

Results: In boys, self-report sexual abuse is strongly and independently associated with suicidal thoughts, plans, threats, deliberate self-injury, and suicide attempts, after controlling for current levels of depression, hopelessness, and family dysfunction. In girls, the relationship between sexual abuse and suicidality is mediated fully by depression, hopelessness, and family dysfunction. Girls who report current high distress about sexual abuse, however, have a threefold increased risk of suicidal thoughts and plans, compared to non-abused girls. Boys who report current high distress about sexual abuse have 10-fold increased risk for suicidal plans and threats, and 15-fold increased risk for suicide attempts, compared to non-abused boys. Fifty-five percent (n=15) of sexually abused boys attempted suicide versus 29% (n=17) girls.

Conclusions: A history of sexual abuse should alert clinicians, professionals and carers in contact with adolescents, to greatly increased risks of suicidal behavior and attempts in boys, even in the absence of depression and hopelessness. Distress following sexual abuse, along with depression and hopelessness indicate increased risk of suicidal behavior in girls, as well as boys.

Résumé

Objectif: Une étude selon le genre sur un échantillon d’adolescents représentatif d’une population d’une communauté sur les relations entre les abus sexuels subis dans l’enfance spontanément révélés et la problématique concernant le suicide.

Méthode: Les étudiants âgés en moyenne de 14 ans (N=2,485) de 27 écoles du Sud de l’Australie ont rempli un questionnaire comportant des items sur les abus sexuels et la tendance au suicide, avec des mesures de la dépression (Centre for Epidemiological Studies Depression Scale), le désespoir (Beck Hopelessness Scale), et le fonctionnement de la famille (McMaster Family Assessment Device general Functioning Subscale). L’analyse des données a comporté une régression logistique.

Résultats: Chez les garçons les abus sexuels spontanément révélés sont fortement et indépendamment associés à des idées de suicide, des projets, des menaces, des blessures volontaires et des tentatives de suicide, après contrôle d’un niveau actuel de dépression, du désespoir et du disfonctionnement familial. Chez les filles, la relation entre abus sexuels et tendance au suicide est influencée entièrement par la dépression, le désespoir et le disfonctionnement familial. Les filles qui rapportent une grande détresse actuelle concernant un abus sexuel courent toutefois 3 fois plus de risques de faire des projets et des menaces de suicide que les filles non-abusées. Les garçons qui rapportent un haut niveau de détresse actuelle concernant un abus sexuel courent un risque 10 fois plus grand de faire des projets et des menaces de suicide que les garçons non-abusés. 55% (n=15) des garçons abusés ont fait une tentive de suicide contre 29% (n=17) des filles.

Conclusions: La mention d’abus sexuels subis devrait alerter les cliniciens, les professionnels ainsi que ceux qui dispensent des soins à des adolescents:les garçons, même s’ils ne semblent pas déprimés ou découragés peuvent courir de grands risques de présenter des comportements suicidaires ou de faire des tentatives de suicide. La détresse suivant un abus sexuel, jointe à la dépression et au découragement signale un risque accru de comportement suicidaire autant chez les filles que chez les garçons.

Resumen

Spanish language abstract not available at time of publication.

Introduction

Child sexual abuse (CSA) is known to have serious adverse effects on the psychosocial development of children and young adolescents, effects extending into adulthood (Beitchman, Zucker, Hood, daCosta, & Akman, 1991; Mullen, King, & Tonge, 2000; Tyler, 2002). Recent research argues for a multifaceted model of traumatisation rather than a specific sexual abuse syndrome (Paolucci, Genuis, & Violato, 2001), and CSA may be best conceptualized as a non-specific risk factor for adverse adult outcomes (Romans, Martin, & Mullen, 1997). Although abuse of all forms is more frequent in those from disturbed and disrupted family backgrounds, not all apparent associations between abuse and adult problems are accounted for by childhood disadvantage (Mullen, Martin, Anderson, Romans, & Herbison, 1996). Stevenson (1999) suggests abused children are at risk of long-term psychological sequelae related to the abuse itself, not merely as a consequence of other associated background factors. Prospective studies of abused children (Calam, Horne, Glasgow, & Cox, 1998), longitudinal studies of adolescents and young adults (Brown, Cohen, Johnson, & Smailes, 1999; Silverman, Reinherz, & Giaconia, 1996), retrospective studies of adults (Barker Collo, 2001) and adult twins (Nelson et al., 2002) all indicate significant disturbance in the psychological functioning of survivors of abuse.

One particular outcome of CSA is increased suicidality (Beckinsale, Martin, & Clark, 1999; Bensley, Van Eenwyk, Spieker, & Schoder, 1999; Martin, 1996). Beautrais (2000) reviewed risk factors for youth suicide and found mental disorders and adverse childhood experiences to be strong risk factors, with odds ratios for suicide attempt ranging from 1.5 to 11.8 for sexually abused youth, compared to non-abused. In a large US-based survey (n=5,877, 15–54 years old), Molnar, Berkman, and Buka (2001) found a strong association between CSA and suicidal behavior mediated by psychopathology, with the odds of suicide attempt in sexually abused women 2–4 times that of non-abused women, and in men 4–11 times, controlling for other adversities.

The nature of CSA is an important factor in determining outcomes, with more extreme forms of abuse involving force or penetration associated with more harmful long-lasting effects (Tyler, 2002) and increased distress (Pillay & Schoubben Hesk, 2001). Worse CSA and increased distress also increase severity of suicidal behavior (Fergusson, Lynskey, & Horwood, 1996; Lipschitz et al., 1999).

Gender differences may also be important. The incidence of sexual abuse is lower in boys than girls, and the community believes that sexual abuse of boys is less serious and less harmful (Broussard, Wagner, & Kazelskis, 1991; Smith, Fromuth, & Morris, 1997). Of importance, this may adversely influence decision-making with regard to their care and protection. In fact, the experience carries more consequences for boys than for girls in regard to alcohol/drug use, aggressive behavior, and truancy as well as suicidality (Garnefski & Arends, 1998). Gender differences in the interplay between psychological functioning and suicidality of young adolescents have been found by others (Allison, Roeger, Martin, & Keeves, 2001; Lewinsohn, Rohde, Seeley, & Baldwin, 2001; Rich, Kirkpatrick Smith, Bonner, & Jans, 1992), and further work to clarify the area has been recommended (Mazza & Reynolds, 1998).

Many existing studies in the area of sexual abuse are retrospective reports from adults, providing insight long after the event (abuse generally in the pre-pubertal period, 8–12 years) (Goldman & Padayachi, 1997). Much valuable contextual and perceptual data is missing or forgotten. Greater knowledge is required at a stage where early intervention with depression and suicidal behavior can provide the opportunity for effective prevention of the possible outcome of suicide. Reviews of CSA studies suggest that future work should use appropriate contrast groups (i.e., normal populations) at identified chronological and developmental age periods (Paolucci et al., 2001). This also makes sense given that some youth suicides occur outside “psychiatric populations,” suggesting studies of community samples are needed to provide information about risk factors beyond the boundaries of psychopathology.

Measures of suicidality in children and adolescents can be influenced by the instrument, retrospection, and who does the reporting (Klimes Dougan, 1998), and multiple method assessments including clinical judgment and self-report are most likely to indicate actual risk (Prinstein, Nock, Spirito, & Grapentine, 2001). Despite this, self-report measures are valuable tools, in that they tap current and contextually relevant emotional states of the respondent in a non-judgmental and non-threatening manner.

This paper contributes to the literature in a number of important ways. First we attempt to clarify gender differences in response to CSA, to address community perceptions that it is less serious for boys. Second, we use a large community sample of young adolescents rather than a clinical or adult population. Third, we highlight the association between CSA and suicidality. Specifically, gender differences in associations between sexual abuse and suicidal behavior (comprising suicidal ideation, plans, threats, and deliberate self-injury [DSI], and suicide attempts) are the prime focus of the study. Depression, hopelessness, and family functioning, also known to be associated with sexual abuse and suicidality (Bergen, Martin, Richardson, Allison, & Roeger, 2003), are controlled for in logistic regression analyses.

Section snippets

Participants

This work derives from the Early Detection of Emotional Disorders program, a 3-year repeated measures longitudinal study of young adolescents, focusing on early detection of suicidal behaviors, and risk and protective factors implicated in later suicide. Following approval from the South Australian Department of Education and Children’s Services, and the Flinders Medical Centre Ethics Committee on Clinical Investigations, 25 government schools in the mental health service catchment area

Results

Approximately 85–87% of the 2,485 students fully completed each section of the questionnaire relevant to this study. Descriptive statistics are reported in Table 1.

Reported experience of sexual abuse was more prevalent amongst girls (girls 5.4% vs. boys 2.0%). Current distress from past sexual abuse was not associated with the identity of the abuser, but was related to depressive symptomatology [χ2(1)=8.50, p<.05] with 86.2% of those reporting high distress levels (scores 3–6) following abuse

Discussion

The findings of this cross-sectional study of a large community sample of adolescents indicate that the experience of sexual abuse is strongly associated with suicidal ideation and suicidal behavior comprising plans, threats, deliberate self-injury and attempts. Striking gender differences are apparent. In girls, although an association between sexual abuse and suicidality is evident initially, depressive symptomatology, hopelessness, and family functioning appear to mediate the relationship.

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    Financial support was provided by the South Australian Health Commission.

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