Child abuse and suicidal ideation among adolescents in China☆
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
References (74)
- et al.
The relationship between child abuse, parental divorce and lifetime mental disorders and suicidality in a nationally representative adult sample
Child Abuse and Neglect
(2009) - et al.
Direct and vicarious victimization at school and at home as risk factors for suicidal cognition among Italian adolescents
Journal of Adolescence
(2003) - et al.
The effects of school, family, self-concept and deviant behaviour on adolescent suicide ideation
Journal of Adolescence
(1989) - et al.
Parent-reported suicidal behavior and correlates among adolescents in China
Journal of Affective Disorders
(2008) - et al.
Suicide rates in China, 1995–99
Lancet
(2002) - et al.
Adolescent suicidal behavior: Associations with preadolescent physical abuse and selected risk and protective factors
Journal of the American Academy of Child and Adolescent Psychiatry
(2007) - et al.
Identification of child maltreatment with the Parent–Child Conflict Tactics Scales: Development and psychometric data for a national sample of American parents
Child Abuse and Neglect
(1998) - et al.
Physical abuse during adolescence: Gender differences in the adolescents’ perceptions of family functioning and parenting
Child Abuse and Neglect
(2008) - et al.
Suicidal ideation in adolescence: Examining the role of recent adverse experiences
Journal of Adolescence
(2012) - et al.
Parental expressed emotion and adolescent self-injury
Journal of the American Academy of Child and Adolescent Psychiatry
(2007)
To unfold a hidden epidemic: Prevalence of child maltreatment and its health implications among high school students in Guangzhou, China
Child Abuse and Neglect
Is there a specific relationship between childhood sexual and physical abuse and repeated suicidal behavior?
Child Abuse and Neglect
Multiple regression: Testing and interpreting interactions
Suicidality in pediatric bipolar disorder: Predictor or outcome of family processes and mixed mood presentation?
Bipolar Disorders
Quality of life and resilience in adolescents with a mobility disability
Journal of Pediatric Psychology
Adolescent suicide attempts: Risks and protectors
Pediatrics
Deliberate self-harm in children and adolescents: A qualitative study exploring the needs of parents and carers
Clinical Child Psychology and Psychiatry
History of abuse and current suicidal ideation: Results from a population based survey
Journal of Family Violence
Co-occurrence of intimate partner violence and child abuse in Hong Kong Chinese families
Journal of Interpersonal Violence
Childhood physical and emotional maltreatment and its psychological effects in 391 university students in China
Chinese Journal of School Doctor
Multiple pathways from stress to suicidality and the protective effect of social support in Hong Kong adolescents
Suicide and Life-Threatening Behavior
Risk and resiliency factors influencing suicidality among urban African American and Latino youth
American Journal of Community Psychology
Adolescent violence perpetration: Associations with multiple types of adverse childhood experiences
Pediatrics
Childhood adversities and risk for suicidal ideation and attempts: A longitudinal population-based study
Psychological Medicine
Sociocultural determinants of suicide ideation: A comparison between American and Ghanaian college samples
Suicide and Life-Threatening Behavior
Becoming a moral child: The socialization of shame among young Chinese children
Ethos
Punitive discipline and child behavior problems in Chinese–American immigrant families: The moderating effects of indigenous child-rearing ideologies
International Journal of Behavioral Development
Family, peer and individual correlates of depressive symptomatology among U.S. and Chinese adolescents
Journal of Consulting and Clinical Psychology
Comparison of childhood adversities and their possible consequences in Poland and Germany
Journal of Public Health
Cultural orientation, family cohesion and family support in suicide ideation and depression among African American college students
Suicide and Life-Threatening Behavior
Introduction to mediation, moderation, and conditional process analysis
Childhood adversities, interpersonal difficulties and risk for suicide attempts during late adolescence and early adulthood
Archives of General Psychiatry
Testing the moderating effect of parent-adolescent communication on the acculturation gap-distress relation in Korean American families
Journal of Youth and Adolescence
Hopelessness family functioning and suicidal ideation among Chinese adolescents in Hong Kong
Open Family Studies Jounral
Social problem solving, family functioning and suicidal ideation among Chinese adolescents in Hong Kong
Adolescence
Family processes and suicidal ideation among Chinese adolescents in Hong Kong
Scientific World Journal
Lifetime prevalence of suicide ideation, plan and attempt in metropolitan China
Acta Psychiatrica Scandinavica
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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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