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Reducing Suicide: A National Imperative
the most prominent programs is a home visitation program by nurses targeted to high risk mothers during pregnancy and infancy (almost 25 visits). A 15-year follow-up of a home visitation program with a randomized controlled design found lower incidence of verified reports of childhood abuse and neglect in comparison with families in comparison group (Olds et al., 1997). Since social supports significantly influence the intergenerational cycle of child abuse (Egeland et al., 1988), intervention programs that offer support to high-risk children and their families can be of great benefit in terms of providing protective functions and promoting positive outcomes (Berrueta-Clement, 1984; Consortium for Longitudinal Studies, 1983; Copple et al., 1987; Price et al., 1988).
Individuals with a history of child abuse may require alternative approaches to standard treatment. Holmes (1995) found that within a group of adults being treated for depression and anxiety, a history of child abuse was the main determinant of treatment effectiveness. However, while the various psychological treatments were very effective for patients without a history of abuse, they were ineffective for those with a history of abuse. Consequently, Stevenson (1999:92) points out that “the assumption that treatments found to be effective in general are also likely to be of greatest benefit to victims of maltreatment needs to be treated with caution.” Yet the controlled clinical trials conducted thus far have found that cognitive-behavioral therapy for child sexual abuse, in particular, is effective at reducing symptoms of anxiety and depression, both risk factors for suicide, in children. These trials included treatment of non-offending parents (Cohen and Mannarino, 1996; 1998; Deblinger and Heflin, 1996; King et al., 2000).
The American Academy of Pediatrics recommends universal screening of adolescents for sexual victimization (AAP, 2001). While there appears to be no formal study of pediatrician practices, it is believed that universal screening is not done as frequently or consistently as it should be (Personal communication, D.W. Kaplan, University of Colorado, October 11, 2001).
Childhood traumas are highly prevalent in the population and elevate suicide risk. While childhood abuse increases the risk for development of mental disorders, it also may be a risk factor for suicide independent of psychopathology. Of the many types of childhood trauma, childhood sexual abuse is the strongest and most independent risk factor for suicide attempts, accounting for 9–20 percent of suicide attempts.
Exposure to trauma can affect the developing brain with potentially lifelong alterations in the physiological stress response system and