Direct and indirect effects of maltreatment typologies on suicidality in a representative Northern Irish sample: Psychopathology only partially mediates the relationship

doi:10.1016/j.jpsychires.2015.11.001

Journal of Psychiatric Research

Volume 72, January 2016, Pages 82-90

https://doi.org/10.1016/j.jpsychires.2015.11.001 Get rights and content

Highlights

•
Predictors of suicidal behaviours in NI were investigated.
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Speculation abounds over the association between the conflict and suicidality.
•
The moderating role of childhood maltreatment was examined in this study.
•
Two maltreatment subgroups encompassing 11.6% of the population were identified.
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Subgroup membership but not conflict exposures predicted suicidal behaviours.

Abstract

There has been a rise in suicide rates among men who grew up during the 1970's in Northern Ireland (NI). Conflict exposures (CEs) have been linked with suicide ideation but not attempts. Civil conflict has also been linked with aggressive parenting which is associated with the development of aggressive drives, psychopathology and suicidality. This study investigated (1) cohort specific associations between latent classes (LCs) of maltreatment and (2) associations between LCs, CEs, psychopathology and suicidality. Data were from NI Study of Health and Stress (N = 1986). Maltreatment and suicidality were queried using validated measures. Psychiatric assessments were based on DSM-IV criteria. Logistic regression, latent class analysis, chi square tests and mediation analyses were conducted. Two at risk LCs were identified, entitled “family violence exposure” (FVE, 10.4%; Male, 55.4%) and “family violence and sexual abuse exposure” (FVSAE, 1.2%; Female, 90.5%). Both were more likely to have experienced CEs (FVE = 71%; FVSAE = 77.5%) than the low risk class. The FVE were more likely to be male; aged 35–49 and to suffer from a mental disorder. The FVSAE class all endorsed rape, were more likely to be separated and to suffer from a mental disorder. CEs uniquely predicted ideation but not enactment. Psychopathology partially mediated the relationship between LCs and suicidality. FVE and FVSAE directly increased the odds of enactment. These findings are original and highly pertinent and they should be used to inform any strategy for addressing the cohort specific and trauma related rise in suicide rates in NI.

Graphical abstract

Section snippets

Materials and methods

The survey was conducted in accordance with the latest version of the Declaration of Helsinki and the study design was approved by the ethical committee at Ulster University. Informed consent of the survey participants was obtained after the nature of the procedures had been fully outlined.

Associations between exposures to maltreatment, parental maladjustment, civil conflict, psychiatric diagnoses and suicidality

The results of the regression analyses are detailed in Table 1. To begin with, the strong association between suicidality and sexual molestation was mainly consistent with previous reports (McHolm et al., 2003, Molnar et al., 2001, Ogata et al., 1990). The non-significant association between suicidality and exposures to rape and physical abuse are dissonant with the findings of Joiner and colleagues (2007), where rape and physical abuse were reported to be the strongest risk factors for suicide

Role of funding source

The survey was carried out in conjunction with the World Health Organization WMH Survey Initiative, which is supported by the National Institute of Mental Health (NIMH; R01 MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, GlaxoSmithKline,

Conflicts of interest

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Author contributions

Both authors devised the theoretical rationale and conducted the literature review for this study. Dr McKenna conducted the analysis, wrote the first draft of the manuscript and revised the manuscript after the initial peer review process. Dr Gillen edited and revised the manuscript and completed the reference section.

Acknowledgements

I would like to thank (1) the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation and fieldwork; (2) Professor Brendan Bunting (PI on NISHS), Professor Siobhan O′ Neill and Dr Samuel Murphy (co-ordinators of NISHS based at Ulster University) for providing the data for this research project; (3) Dr. Finola Ferry who coded the conflict trauma variable; (4) Dr. Liam Mahedy from Cardiff University who was involved in the initial coding of the

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Second, internalizing and externalizing paths from childhood maltreatment to suicidal thoughts via adolescent psychopathology (i.e., anxiety, mood and conduct disorder symptoms) are modeled simultaneously to evaluate the specificity of these pathways. In some studies (e.g., Miller et al., 2016) a specific emotional maltreatment-depressive symptom pathway has been described while in other studies the presence of any psychopathology has been identified as a partial mediator of relations between childhood maltreatment and suicidal thoughts (McKenna & Gillen, 2016). Third, the present study assessed differences in the direct and indirect paths between childhood maltreatment and suicidal thoughts across gender groups, in order to document if gender differences noted previously (Rhodes et al., 2014) could be replicated in a sample of adolescents receiving substance use treatment services.
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In particular, going unsupervised was associated with all forms of suicidal behavior while lacking medical care was linked to both suicidal ideation and suicide attempts. Although some previous studies have found that childhood neglect or some of its forms are not associated with suicidal behavior (Brown et al., 1999; McKenna & Gillen, 2016; Ramiro, Madrid, & Brown, 2010), that the association may vary across settings (Borges et al., 2010), or that neglect has an indirect effect on suicidal behavior (Bahk, Jang, Choi, & Lee, 2017), our finding that any/greater neglect was associated with all forms of suicidal behavior accords with the results of an earlier systematic review and meta-analysis, which stated that there was robust evidence that childhood neglect was associated with suicidal behavior (attempts) (Norman et al., 2012). It is also in line with the findings from a recent study by Vanderminden et al. (2019) where all forms of lifetime and past year neglect were associated with youth suicidal ideation in a model that was adjusted for demographic covariates.
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Data were analyzed from 5665 adults that were drawn from the National Comorbidity Survey Replication (NCS-R). Information was obtained on ‘care’, ‘supervisory’ and ‘medical’ neglect in childhood and lifetime suicidal behavior (ideation, plan, attempt). Lifetime psychiatric disorders were based on the World Mental Health - Composite International Diagnostic Interview. Logistic regression analysis was used to examine the associations.
In fully adjusted models, any neglect was associated with significantly increased odds for all forms of suicidal behavior (suicidal ideation, odds ratio [OR]: 1.80, 95 % confidence interval [CI]: 1.42–2.29; plan, OR: 2.27, 95 % CI: 1.78–2.91; attempt, OR: 2.05, 95 % CI: 1.63–2.59, all p < 0.001). In unadjusted analyses all individual forms of neglect were significantly associated with all forms of suicidal behavior. However, when all forms of neglect were included together in the fully adjusted models, care neglect was no longer significantly associated with any form of suicidal behavior.
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The clinical status of a child´s psychological problems more severely affects the individual's behavior on a psychological, social or emotional level. Moreover, the presence of a clinical condition is associated with greater psychological discomfort and a poorer quality of life for the child that suffers from it (Kandemir et al., 2014; McKenna and Gillen, 2016). Accordingly, it is important to explore the effects of any clinical condition when examining such psychopathologies (i.e.: internalizing and externalizing problems) in children and adolescents (Ciciolla et al., 2014; De Bolle et al., 2010).
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Direct and indirect effects of maltreatment typologies on suicidality in a representative Northern Irish sample: Psychopathology only partially mediates the relationship

Highlights

Abstract

Graphical abstract

Section snippets

Materials and methods

Associations between exposures to maltreatment, parental maladjustment, civil conflict, psychiatric diagnoses and suicidality

Role of funding source

Conflicts of interest

Author contributions

Acknowledgements

Child Abuse Negl.

Behav. Res. Ther.

J. Affect. Disord.

Child Abuse Negl.

Factor analysis and the AIC

Psychometrika

Additive impact of childhood emotional, physical, and sexual abuse on suicide attempts among low-income African American women

Suicide Life-Threat. Behav.

The family history method using diagnostic criteria: reliability and validity

Arch. Gen. Psychiatry

Diagnostic and Statistical Manual of Mental Disorders

Multigenerational perspectives on coping with the Holocaust experience: an attachment perspective for understanding the developmental sequalae of trauma across generations

Int. J. Behav. Dev.

Variations in risk and treatment factors among adolescents engaging in different types of deliberate self-harm in an inpatient sample

J. Clin. Child Adolesc. Psychol.

Risk factors for suicide in psychiatric outpatients: a 20-year prospective study

J. Consult. Clin. Psychol.

Childhood adversities as risk factors for onset and persistence of suicidal behaviour

Br. J. Psychiatry

Trauma associated with civil conflict and posttraumatic stress disorder: evidence from the Northern Ireland Study of Health and Stress

J. Trauma. Stress

Lifetime prevalence of health disorders and delay in treatment following initial onset: evidence from the Northern Ireland Study of Health and Stress

Psychol. Med.

Children and Political Violence Children and Political Violence

Suicide attempts versus nonsuicidal self-injury among individuals with anxiety disorders in a nationally representative sample

Depress. Anxiety

Annual research review: resilient functioning in maltreated children – past, present, and future perspectives

J. Child Psychol. Psychiatry

The ISTSS expert consensus treatment guidelines for complex PTSD in adults

Longitudinal pathways between political violence and child adjustment: the role of emotional security about the community in Northern Ireland

J. Abnorm. Child Psychol.

Suicide and deliberate self harm in older Irish adults

Int. Psychogeriatrics

Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span. Findings from the Adverse Childhood Experiences Study

J. Am. Med. Assoc.

Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study

Pediatrics

Childhood adversities and risk for suicidal ideation and attempts: a longitudinal population-based study

Psychol. Med.

Childhood adversities and adult psychopathology in the National Comorbidity Survey Replication (NCS-R) I: associations with first onset of DSM-IV disorders

Arch. Gen. Psychiatry

Childhood adversities and suicide attempts: a retrospective study

J. Fam. Violence

Transgenerational transmission of war-related trauma

Repetition of deliberate self-harm: a study of the characteristics and subsequent deaths in patients presenting to a general hospital according to extent of repetition

Suicide & Life-Threatening Behav.

How often does deliberate self-harm occur relative to each suicide? A study of variations by gender and age

Suicide & Life-Threatening Behav.

IBM SPSS Statistics for Windows, Version 22.0

Why People Die by Suicide

Four studies on how past and current suicidality relate even when “everything but the kitchen sink” is covaried

J. Abnorm. Psychol.

Mental disorders and war in Lebanon