More recent research has extended these findings. Cumulative risks from both physical and sexual abuse for suicide attempts have been found in studies of high school girls (Silverman et al., 2001) and African American women (Kaslow et al., 2000). A nationally representative study found that suicide attempts were more prevalent in adults with five or more childhood adversities, including child sexual abuse, physical abuse, psychological abuse, and parental suicide or psychopathology (Molnar et al., 2001a).

The most ambitious study of cumulative effects of childhood trauma was performed by Felitti and colleagues (1998). A survey asking about major types of childhood trauma was sent to 13,494 adults who also completed a standardized primary care evaluation at a San Diego HMO. Childhood traumas referred to physical and sexual abuse, neglect, as well as most other traumas listed in Table 5-1. The number of childhood traumas was found to have a dose–response relationship with suicide attempts (Table 5-3). With four or more traumas, for example, adults had 12 times the likelihood of a suicide attempt, a likelihood that was far greater than that associated with fewer traumas. Moreover, the number of traumas had a dose–response relationship with several disease conditions, including ischemic heart disease, cancer, and chronic bronchitis or emphysema.


Childhood trauma induces immediate biological, psychological, and behavioral effects, some of which can be persist for long periods. This section, while not exhaustive, offers a portrait of these effects. How they relate to later suicidality is discussed in a later section.

TABLE 5-3 Childhood Traumas and Adjusted Odds of a Suicide Attempt

Number of Traumasa

Adjustedb Odds Ratio of Ever Attempting Suicide









4 or more


aListed in Table 5-1.

bAdjusted for age, gender, race, and educational attainment.

SOURCE: Felitti et al., 1998.

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