History of Child Maltreatment and Suicide Attempts Among Street Youth

Katherine Bakes, MD reviewing Hadland SE et al. Pediatrics 2015 Aug 3.

In a longitudinal cohort of street youth, 5% reported a suicide attempt; attempted suicide was most strongly associated with a history of physical abuse.

Mortality is very high among street youth, with suicide a leading cause of death. Understanding the elevated suicide risk in this population is important for developing prevention strategies. Using a longitudinal cohort of community-recruited street youth in Vancouver, Canada, investigators prospectively evaluated the risk for attempted suicide in relation to childhood maltreatment.

Eligibility requirements included age between 14 and 26, use of illicit drugs (other than marijuana) during the preceding month, and street involvement (i.e., homelessness or use of services for street-involved youth). At baseline, participants completed the Childhood Trauma Questionnaire to detect maltreatment in five categories: sexual abuse, physical abuse, emotional abuse, physical neglect, and emotional neglect. They also completed a questionnaire including the Center for Epidemiologic Studies Depression (CES-D) scale, with scores >21 indicating high levels of depressive symptoms.

A total of 660 participants (68% male; 25% Aboriginal; 16% lesbian, gay, bisexual, or transgender; median age at baseline, 22) were enrolled over 7 years; median follow-up duration was 26 months. Thirty-five participants (5%) reported 44 suicide attempts; 259 (39%) reported lifetime suicidal ideation. Suicide attempts were more likely among individuals with CES-D scores >21. A history of childhood maltreatment was strongly associated with risk for attempted suicide, with increased risk among youth who reported previous physical abuse (adjusted hazard ratio, 4.5), emotional abuse (AHR, 4.9), or emotional neglect (AHR, 3.1). In multivariable analysis, only physical abuse was independently associated with elevated risk for attempted suicide (AHR, 2.7).

Citation(s):

Hadland SE et al. Suicide attempts and childhood maltreatment among street youth: A prospective cohort study. Pediatrics 2015 Aug 3; [e-pub].