Elsevier

Child Abuse & Neglect

Volume 37, Issue 11, November 2013, Pages 986-996
Child Abuse & Neglect

Child abuse and suicidal ideation among adolescents in China

https://doi.org/10.1016/j.chiabu.2013.06.006Get rights and content

Abstract

The present study examined the relationship among physical abuse, psychological abuse, perceived family functioning and adolescent suicidal ideation in Shanghai, China. Perceived family functioning was investigated as a possible moderator between physical abuse, psychological abuse and suicidal ideation. A cross sectional survey using convenience sampling was conducted. A total of 560 valid self-administered questionnaires were completed by the students aged from 12 to 17 in Shanghai. Descriptive statistical analyses, Pearson correlations analyses, and hierarchical regression analyses were adopted as methods of data analyses. Results indicated that physical abuse was significantly associated with greater adolescent suicidal ideation, while a higher level of perceived family functioning was significantly associated with lower suicidal ideation. However, psychological abuse was not associated with suicidal ideation. Perceived family functioning was shown to be a moderator between physical abuse and suicidal ideation. Specifically, mutuality and family communication moderated the relationship between physical abuse and suicidal ideation. To decrease adolescent suicidal ideation, measures are suggested to prevent physical abuse and enhance family functioning. First, it is important to increase the parents’ awareness of the meaning and boundaries of physical abuse, as well as the role it plays in contributing to adolescent suicidal ideation. Second, parents should be taught appropriate parenting skills and knowledge and be guided to treat the children as individuals with their unique personality, rights and privileges. Third, it is important to promote family harmony, effective communication as well as mutual trust, concern and understanding among family members.

Introduction

China is a country with one of the highest suicide rates in the world with 23 per 100,000, or 287,000 people killing themselves each year (Phillips, Li, & Zhang, 2002). Suicide is also the fifth leading cause of death in China and is the leading cause of death among young Chinese adults aged between 15 and 34 (Phillips et al., 2002). Suicidal ideation is an important predictor of suicide. According to one study on the lifetime prevalence of suicidal ideation, suicidal plans and suicide attempts among 5,201 people in Beijing and Shanghai, 3.1% reported suicidal ideation, and 1.0% reported suicide attempts (Lee et al., 2007). Among those who had suicidal ideation, 29.5% had made a plan, and 32.3% attempted suicide. Existing studies have identified different personal and family risk factors and predictors of suicidal ideation among Chinese adolescents.

Child abuse has been a severe phenomenon in Chinese society. The China Law Society conducted a national survey of 3,543 people. Up to 71.9% of the interviewees reported they had been beaten by their parents once or more in their lives (Liu & Zhang, 2002). Another survey of 300 primary school students in Xi’an city showed that 60.14% of students experienced being beaten, scolded, or forced to stand at the corner as punishment, or being deprived of food or rest by their parents. Many cases of child abuse occurred in unstable or dysfunctional families, such as families with a single parent, families of the mobile population, families with violent members, or families with members having personality disorders (Yang and Feng, 2011, Sunday et al., 2008). Prior studies also showed that child abuse was highly related to suicidal ideation and attempts among adolescents (Baldry and Winkel, 2003, Sfoggia et al., 2008). Poor family functioning was found to be positively associated with suicidal ideation (Spirito, Valeri, Boergers, & Donaldson, 2003). Based on the above data and general trends, an understanding of the relationship between child abuse, family functioning, and suicidal ideation among Chinese adolescents can help in developing better suicide prevention measures.

Previous studies have reported that child abuse was associated with suicidal ideation. Specifically, physical abuse, a major form of child abuse, was identified to be a strong predictor of suicidal ideation and attempts. Physical abuse includes mild to severe physical maltreatment, but excludes corporal punishment that is regarded as expected responses of parents to persistent child misbehavior (Straus, Hamby, Finkelhor, Moore, & Runyan, 1998). A number of studies have identified the high association between child physical abuse and suicidal ideation in adulthood (Afifi et al., 2009, Calder et al., 2010, Hardt et al., 2011). Furthermore, some Western studies specifically identified that childhood physical abuse was a strong predictor of adolescent suicidal ideation (Duke et al., 2010, Nilsen and Conner, 2002, Salzinger et al., 2007, Thompson et al., 2012).

Prior studies likewise identified childhood psychological abuse, another major form of child abuse, as a predictor of suicidal ideation. Psychological abuse was defined as the verbal and symbolic acts used by the parent to cause psychological pain or fear on the part of the child (Straus et al., 1998). Psychological abuse was shown to be associated with adolescent and adult suicidal ideation and attempts (Enns et al., 2006, Locke and Newcomb, 2005). A specific form of child psychological abuse, maternal verbal assault involving verbal threats and hostility, was identified to be associated with increased risk for suicide attempts during late adolescence (Johnson et al., 2002). Parental criticism with critical or sarcastic comments was found to be strongly associated with adolescent suicidal ideation, plans, and attempts (Wedig & Nock, 2007). However, Ystgaard, Hestetun, Loeb, and Mehlum (2004) found that parent antipathy to their children was not associated with the later suicidal behavior in their offspring. The results of previous studies are equivocal. Hence, further research needs to be conducted.

Family functioning refers to the quality of family life at the systemic level, and is related to parental concern, family communication, harmony, and mutuality (Shek, 2002). Previous studies showed that family functioning was a significant predictor of suicidal ideation. Poor family functioning was highly related to adolescent suicidal ideation both in population-based and clinical samples (Algorta et al., 2011, Maras et al., 2011). Family cohesion (Donnell et al., 2004, Eshun, 2003) and family support (Harris and Molock, 2000, Perkins and Hartless, 2002) were found to be significant negative predictors of suicidal ideation in both adults and adolescents. A high level of perceived family functioning was found to be a significant negative predictor of suicidal ideation, whereas family conflict and negative family climate were significant positive predictors of suicidal ideation in a community sample of Hong Kong adolescents (Kwok and Shek, 2011, Lee et al., 2006, Sun, 2005). However, previous studies mainly focused on a single aspect of family functioning such as family cohesion, family conflict, or family climate. Some studies even used a single item to measure the variable of family functioning. Hence, a more comprehensive and locally developed measure of family functioning is needed to obtain a clearer picture of the relationship between perceived family functioning and suicidal ideation.

Although child abuse may escalate suicidal ideation, the picture may be different in families with perceived healthy functioning. Previous findings suggest that perceived family functioning may moderate the relationship between child abuse and suicidal ideation. Family cohesion was found to buffer the negative impacts of life stress and protect adolescents from developing suicidal behaviors (Rubenstein, Halton, Kasten, Rubin, & Stechler, 1998). It was also shown that family functioning moderated the relationship between hopelessness and suicidal ideation, between social problem solving and suicidal ideation among Chinese adolescents in Hong Kong (Kwok and Shek, 2008, Kwok and Shek, 2009). However, moderating effect of family functioning was not found between parenting style and child social competence (Xu, 2008), and between life stress and quality of life in adolescents with a mobility disability (Alriksson-Schmidt, Wallander, & Biasini, 2007). Hence, the moderating role of perceived family functioning on suicidal ideation remains to be explored.

Chinese culture is characterized by familism, and the family, rather than the individual, is the “basic structural and functional unit” (Yang, 1995). Influenced by Confucian ethics, Chinese culture puts a high value on filial piety (xiaodao). A Chinese saying states that “Filial piety is the foundation of all virtues.” The parents are regarded as household heads (jiazhang) with the power and authority to govern and discipline their children. Authoritarian parenting is typical in a Chinese family. The parents believe that “Severe beating is caring and scolding is loving” (Qiao & Chan, 2005). Chinese parents tend to use physical and emotional punishment to solve parent–child problems and conflicts, which may easily lead to child abuse (Qiao & Chan, 2008). However, a study on parents’ attitudes toward child abuse in Beijing showed that most parents did not regard child battering by biological parents as child abuse, and many children had similar views and agreed that they must accept their parents’ discipline due to filial piety (Qiao, 2007). Hence, the association between child abuse and adolescent suicidal ideation in Chinese societies may not be as strong as that in the Western societies. Further exploration in this area is needed.

Furthermore, in the past three decades, China experienced rapid modernization and industrialization. The Chinese traditional stable big family structure has been gradually substituted with the nuclear family structure. The great social change, such as the elevated ratio of divorce and the migrant population, created unstable and dysfunctional families (Liu et al., 2006, Yang, 2010), and those factors were found to be associated with adolescent suicidal ideation. It is thus worth studying how child abuse and perceived low family functioning interact to predict suicidal ideation in a Chinese society that heavily emphasizes the harmony, solidarity, and cohesion of the family (Rosenthal and Feldman, 1996, Yang, 1995). Thus, the present study aims to examine the relationship among child abuse, perceived family functioning, and adolescent suicidal ideation.

Based on the previous literature, two research questions and five hypotheses are formulated. The research questions are as follows: (1) What is the relationship between physical abuse, psychological abuse, family functioning, and adolescent suicidal ideation? and (2) What is the role played by family functioning in the relationship between physical abuse, psychological abuse and adolescent suicidal ideation? Based on the research questions, the following research hypotheses are formulated:

H1

A higher level of physical abuse is significantly associated with greater suicidal ideation.

H2

A higher level of psychological abuse is significantly associated with greater suicidal ideation.

H3

A high level of perceived family functioning is significantly associated with lower suicidal ideation.

H4

Perceived family functioning is a significant moderator between physical abuse and suicide ideation.

H5

Perceived family functioning is a significant moderator between psychological abuse and suicide ideation.

Section snippets

Procedure and participants

A cross-sectional survey using convenience sampling was conducted. The study was approved by the City University Research Ethics Committee. Consent was obtained from the principals of three government-run schools in Shanghai, China. A total of 590 questionnaires were completed by students ranging from pre-secondary to junior secondary school year three (Grades 6–9). Among the returned questionnaires, 560 questionnaires were regarded as valid. The purpose of the study was clearly explained to

Results

As shown in Table 2, physical abuse was found to be significantly and negatively correlated with perceived family functioning, r (560) = −.35, p < .001. A higher level of perceived family functioning showed a significant correlation with lower suicidal ideation, r (560) = −.47, p < .001. A higher level of physical abuse was significantly correlated with greater suicidal ideation, r (560) = .22, p < .001. Analyses showed that the level of multicollinearity within different variables was acceptable in the

Physical abuse and suicidal ideation

Regression analysis supported Hypothesis 1, indicating that physical abuse was significantly and positively associated with suicidal ideation among Chinese adolescents. This result coincides with previous findings on physical abuse and suicidal ideation (Duke et al., 2010, Nilsen and Conner, 2002, Salzinger et al., 2007, Thompson et al., 2012).

Adolescence is a vulnerable period in life. Many important concepts on the world, self-identity, and the meaning of life are formed during this period.

Implications and limitations

Practically speaking, measures can be taken to prevent the occurrence of physical abuse in families to prevent adolescent suicidal ideation. First, a significant number of families in China have low awareness of the meaning and boundaries of physical abuse, and many Chinese parents do not regard the physical punishment of their children as physical abuse. Thus, helping these parents understand the meaning of physical abuse and the role it might play in the development of suicidal ideation among

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    This research is partly funded by East China University of Science & Technology and CityU CLASS Research Grant.

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