suicide completer study to have included a measure of past abuse found very large odds ratios of 11.7–49.3 for suicide by adolescents (Brent et al., 1999). These odds ratios were derived from prevalences of 30–42 percent of suicides having an abuse history versus about 2.5 percent of matched controls without a history of abuse. Abuse history, obtained as part of a life events inventory, was collected from about half of subjects and all of controls (n=131). Thus, this study of suicide victims confirms studies of suicide attempters on the importance of abuse as a risk factor.

Daniel, an 18-year-old college freshman, was the eldest of three children. Throughout his childhood, Daniel was physically beaten by his alcoholic father…. At the age of 13, Daniel chose to live with his divorcing mother while his two siblings stayed with the father…. The family was bitterly divided and his father refused to pay his mother any alimony. [He] earned … an academic scholarship at a local university. In the summer prior to his freshman year, Daniel’s mother was diagnosed as having inoperable stomach cancer and she died one month prior to Daniel’s starting college…. His Thanksgiving visit to his father’s home was a disaster. Daniel returned to school a day early. On the night of his return, Daniel called his father and during an argument on the phone, shot himself in the head with a revolver he had apparently taken from his father’s home. Daniel’s last words to his father prior to the fatal gunshot were “I hate me and I hate you—it’s time for the big payback, Dad….” (Berman & Jobes, Adolescent Suicide: Assessment and Intervention, 1991:40-41).

CHILDHOOD SEXUAL ABUSE AND POPULATION ATTRIBUTABLE RISK FOR SUICIDE

Child sexual abuse carries the highest risk of a suicide attempt compared with other types of childhood maltreatment (Table 5-2). For example, Brown and colleagues (1999) found that sexual abuse carried higher odds ratios for a suicide attempt than did physical abuse or neglect, after controlling for other contextual factors. Child sexual abuse also carried the highest odds ratio for suicide attempts in a prospective, population-based study in New Zealand (Fergusson et al., 2000b). Sexual abuse also carried an extremely high risk (OR=30.3) for repeated suicide attempts in adolescents (Brown et al., 1999).

Based on the strength of childhood sexual abuse as a risk factor, several population-based studies calculated the percentage of suicide attempts that are attributable to child sexual abuse, i.e., the population



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