a past history of abuse were up to 25 times more likely than adults without a past history to attempt suicide.

Child sexual abuse, in particular, was examined in a meta-analysis of 37 studies published between 1981 and 1995 (Paolucci et al., 2001). The total number of subjects was more than 25,000. The unweighted and weighted effect sizes of child sexual abuse on suicide were 0.64 and 0.44,7 confirming a substantial link between child sexual abuse and suicide (defined as suicidal ideation or a suicide attempt).

A spate of recent, well-designed studies, including prospective studies, add to this body of evidence (Table 5-2). Virtually all studies found a significant relationship, with odds ratios ranging from about 2 to 10. These odds ratios were derived from prevalences of about 21–34 percent of participants having a past history of abuse or neglect and making a suicide attempt versus about 4–9 percent of participants without a history of abuse or neglect making an attempt (Brown et al., 1999; Fergusson et al., 2000b; Molnar et al., 2001a). The only negative study in Table 5-2 was restricted to physical abuse in children ages 9–17 (Flisher et al., 1997). The difference may be explained by study subjects being younger and by suicide attempts being ascertained only for the previous 6 months. Most other studies record any past suicide attempt.

Beyond maltreatment, other childhood adversities have been studied in relation to suicide attempts, but the associations are generally not as strong. Significant associations from large, population-based studies have been found for parental psychopathology (especially depression) or substance use disorders, parental suicide, and family socioeconomic adversity (Fergusson et al., 2000b; Molnar et al., 2001a). Other family factors, while also significantly associated with suicide attempts, were not found by Fergusson and colleagues (2000b) to be independent predictors: parental history of alcoholism/alcohol problems; parental changes due to separation/divorce, death, remarriage and reconciliation; parental history of illicit drug use; and parental history of criminal offending. Nevertheless, these other types of family traumas have a cumulative effect on suicide attempts and independent associations with psychopathology, as explained in later sections.

It is important to point out that the studies in Table 5-2 measure suicide attempts as opposed to suicide completion. The psychological autopsy method used for studying suicide victims cannot readily ascertain physical or sexual abuse because family members and friends are generally reluctant to disclose, or lack knowledge of, the abuse. The sole


Weighting based on study sample size.

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