Child abuse and suicide

A study of 3,338 children in Quebec looked into the prevalence of child abuse - both sexual and physical - and its links to suicidal behaviour later in life. Sexual abuse was reported by 9.9% of the children (men 2.7%, women 18%) physical abuse by 20.6% (men 26.3%, women 12.8%) and both types of abuse by 8.2% (men 4%, women 12.8%). In a third of the sexual abuse cases the abuser was a family member and in about two-thirds of cases the abuse occured on multiple occasions. Overall participants with no history of childhood abuse were less likely to demonstrate suicidal behaviour than those who had been abused. Children who had not been abused had the lowest prevalence of suicidal behaviour (6%) followed by those who had been physically abused (11.7%), those who had been sexually abused (14.8%) and those who had suffered both types of abuse (32.2%). Repeated abuse was more strongly associated with suicide attempts than a single incidence of abuse and abuse by immediate family members was linked to a higher level of risk than abuse by other family members or by strangers.

You can read more about this research at

http://psychcentral.com/news/2008/08/04/suicide-risk-among-abused-children/2685.html

Depression, abuse and hospital use

A small proportion of patients account for the majority of healthcare usage with 5-15% of patients responsible for 45-70% of costs. Heavy users often suffer from mental and physical illness, particularly an increased level of depression. Physical and sexual abuse, in either childhood or adulthood, is known to be linked to increased levels of depression and a U.S. study of 96 frequent users of health services examined the links between abuse, depression and frequent usage of health services. The researchers found that compared to people who had not been abused people who had suffered abuse over the past year were significantly more likely to be re-admitted to hospital. However, re-admissions were related to chronic disease management and were not the result of the physical effects of abuse. Major depression and abuse interacted with each other to increase rates of re-admission.

Levine, Jeffrey M. ... [et al] - Major depression and recent physical or sexual abuse increase readmissions among high-utilising primary care patients Mental Health in Family Medicine 2008, 5(1), 23-28

Child abuse and obesity

Past research has found a reasonably consistent association between various forms of childhood abuse and the development of eating pathology and a number of studies indicate a relationship between childhood abuse and obesity. A study of 121 people in the U.S. seeking surgical treatment for obesity found that 43% of them reported emotional abuse, 39% had witnessed violence, 19% had suffered sexual abuse, 17.4% physical abuse and 9.1% physical neglect.

Sansone, Randy A. ... [et al] - The prevalence of childhood trauma and parental caretaking quality among gastric surgery candidates Eating Disorders March-April 2008, 16(2), 117-127

Childhood sexual abuse and self-harm - is there a link?

Self-injurious behaviour can be defined as the causing of intentional, direct damage to one's body without suicidal intent. Common examples include cutting oneself and burning one's skin. Because such behaviour is associated with suicide and psychiatric disorders and because its treatment can be challenging it has attracted substantial attention in both the clinical and research literature. Little is known about its causes but some people have suggested that childhood sexual abuse is one of them. A number of studies have shown a link between childhood sexual abuse and later self-harm but other studies have found little or no association. Researchers have now got powerful and sophisticated tools which allow them to combine the results from a number of different studies - a process called meta-analysis. A meta-analysis of 45 different studies into the link between childhood sexual abuse and self-harm found that the significance of the relationship was very small and that in studies that take into account other psychiatric risk factors childhood sexual abuse explained little or no unique variance in self-injurious behaviour.

Klonsky, E. David and Moyer, Anne - Childhood sexual abuse and non-suicidal self-injury: meta-analysis British Journal of Psychiatry March 2008, 192(3), 166-170

Children taken into care and their mental health problems

Children who have been removed from their parents' care by social services because of abuse or neglect and placed into protective care are known to have a high incidence of mental-health problems. An Australian project in Melbourne aimed to assess and help children far earlier in the process. Of 161 children assessed as part of the scheme more than 60% met criteria for a major psychiatric diagnosis with post-traumatic stress disorder and adjustment disorders being the most common diagnoses. Nearly three-quarters of participants over the age of five scored in the borderline or abnormal range on the Strengths and Difficulties Questionnaire. There were more children under 1 and in adolescence in the group being taken into care.

Milburn, Nicole L., Lynch, Marell and Jackson, Jennifer - Early identification of mental health needs for children in care: a therapeutic assessment programme for statutory clients of child protection Clinical Child Psychology and Psychiatry January 2008, 13(1), 31-47

Childhood abuse, genes and depression

Childhood abuse and early life stress are among the strongest contributors to adult depression. However, a U.S. study of 470 people has found that those people who suffered from adverse childhoods but who carry a gene called corticotropin-releasing hormone receptor one (CRHR1) had markedly lower measures of depression, compared with people with less protective forms of the gene. The study supports previous evidence that corticotropin-releasing hormone and related hormones play a role in depression.

You can find out more about this research at

http://psychcentral.com/news/2008/02/06/gene-protects-from-depression-after-childhood-abuse/1880.html

Child abuse, depression, PTSD and risk-taking behaviour

A study of 113 women who injected drugs in Philadelphia looked into the links between childhood physical and sexual abuse, post-traumatic stress disorder (PTSD) and depression and high-risk sex and drug taking. 56% of the sample reported childhood sexual abuse and 68% childhood physical abuse. Out of the whole sample 23% suffered from depression while 53% suffered from both PTSD and depression (co-morbid). Childhood sexual abuse was associated with an increase in risk-taking behaviour but childhood physical abuse was not. Childhood sexual abuse was also associated with developing co-morbid PTSD and depression and co-morbid depression and PTSD was associated with increased risk-taking. Once co-morbid depression and PTSD were taken into account childhood sexual abuse was no longer associated with riskier behaviour suggesting that it was the increased risk of co-morbid PTSD and depression that led to higher levels of risk taking not childhood sexual abuse per se.

Plotzker, Rosalyn E., Metzger, David S. and Holmes, William C. - Childhood sexual and physical abuse histories, PTSD, depression, and HIV risk outcomes in women injection drug users : a potential mediating pathway. The American Journal on Addictions 2007, 16: 431-438

PTSD and mental health problems

People suffering from mental health problems are much more likely to have experienced traumatic stress during their lives. More than 40% of adults receiving psychiatric care have suffered from post-traumatic stress disorder (PTSD) compared to only 7% of the rest of the population. PTSD can increase the severity of severe mental illnesses such as schizophrenia and bipolar disorder and cause an increased likelihood of problems with agitation, impulse control, social isolation and substance misuse. A study of 35 women receiving community mental health services for severe and chronic mental illness in the U.S. found that 98% of them had suffered exposure to multiple traumatic stressors and more than half had suffered from PTSD at some point during their lives with 44% of the sample suffering from PTSD at the time of the study. Current PTSD prevalence was highest when traumatic loss, sexual abuse, physical abuse, traumatic assault or community violence were reported. A history of childhood sexual abuse, or PTSD, or both was associated with use of multiple substances and complex psychosocial problems.

Ford, Julian D. and Fournier, Debra - Psychological trauma and post-traumatic stress disorder among women in community mental health aftercare following psychiatric intensive care Journal of Psychiatric Intensive Care June 2007 3(1), 27-34