Online citations, reference lists, and bibliographies.

Childhood Abuse, Household Dysfunction, And The Risk Of Attempted Suicide Throughout The Life Span: Findings From The Adverse Childhood Experiences Study.

S. Dube, R. Anda, V. Felitti, D. Chapman, D. Williamson, W. Giles
Published 2001 · Medicine

Cite This
Download PDF
Analyze on Scholarcy
Share
CONTEXT Suicide is a leading cause of death in the United States, but identifying persons at risk is difficult. Thus, the US surgeon general has made suicide prevention a national priority. An expanding body of research suggests that childhood trauma and adverse experiences can lead to a variety of negative health outcomes, including attempted suicide among adolescents and adults. OBJECTIVE To examine the relationship between the risk of suicide attempts and adverse childhood experiences and the number of such experiences (adverse childhood experiences [ACE] score). DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of 17 337 adult health maintenance organization members (54% female; mean [SD] age, 57 [15.3] years) who attended a primary care clinic in San Diego, Calif, within a 3-year period (1995-1997) and completed a survey about childhood abuse and household dysfunction, suicide attempts (including age at first attempt), and multiple other health-related issues. MAIN OUTCOME MEASURE Self-reported suicide attempts, compared by number of adverse childhood experiences, including emotional, physical, and sexual abuse; household substance abuse, mental illness, and incarceration; and parental domestic violence, separation, or divorce. RESULTS The lifetime prevalence of having at least 1 suicide attempt was 3.8%. Adverse childhood experiences in any category increased the risk of attempted suicide 2- to 5-fold. The ACE score had a strong, graded relationship to attempted suicide during childhood/adolescence and adulthood (P<.001). Compared with persons with no such experiences (prevalence of attempted suicide, 1.1%), the adjusted odds ratio of ever attempting suicide among persons with 7 or more experiences (35.2%) was 31.1 (95% confidence interval, 20.6-47.1). Adjustment for illicit drug use, depressed affect, and self-reported alcoholism reduced the strength of the relationship between the ACE score and suicide attempts, suggesting partial mediation of the adverse childhood experience-suicide attempt relationship by these factors. The population-attributable risk fractions for 1 or more experiences were 67%, 64%, and 80% for lifetime, adult, and childhood/adolescent suicide attempts, respectively. CONCLUSIONS A powerful graded relationship exists between adverse childhood experiences and risk of attempted suicide throughout the life span. Alcoholism, depressed affect, and illicit drug use, which are strongly associated with such experiences, appear to partially mediate this relationship. Because estimates of the attributable risk fraction caused by these experiences were large, prevention of these experiences and the treatment of persons affected by them may lead to progress in suicide prevention.
This paper references
cide among drug addicts in the U . K
A Oyefeso (1999)
10.1016/S1056-4993(18)30258-X
Homeostasis, stress, trauma, and adaptation. A neurodevelopmental view of childhood trauma.
B. D. Perry (1998)
Some comments on methods
W Clark (1997)
10.1097/00005650-198808000-00004
Development of a Brief Screening Instrument for Detecting Depressive Disorders
M. Burnam (1988)
Prevalence of depressive symptoms in primary care.
W. Zung (1993)
Gender differences in completed and attemptedsuicides.AnnEpidemiol.1994;152:152-158
EK Moscicki (1994)
cide among drug addicts in the U
A Oyefeso (1999)
10.1111/j.1600-0447.1997.tb09629.x
Down‐rating lifetime suicide risk in major depression
G. Blair-West (1997)
dictive patterns of suicidal behavior
JW Sentell (1995)
10.1097/00004583-199609000-00015
Risk factors for serious suicide attempts among youths aged 13 through 24 years.
A. Beautrais (1996)
Exposure to alcoholism in the family: United States, 1988.
Schoenborn Ca (1991)
10.1001/JAMA.280.21.1864
Improving research, policy, and practice to understand child sexual abuse.
D. Finkelhor (1998)
10.1111/j.1600-0447.1987.tb02856.x
Suicides in close connection with psychiatric care: An analysis of 57 cases in a Swedish county
U. B. Sundqvist-Stensman (1987)
10.1037/e583772012-001
Age adjustment using the 2000 projected U.S. population.
R. J. Klein (2001)
Devel - opmentofabrief screening instrument fordetectingde - pressive disorders
WellsKB BurnamMA (1988)
10.1016/S0306-4603(01)00204-0
Adverse childhood experiences and personal alcohol abuse as an adult.
S. Dube (2002)
10.1017/S0033291798006916
Suicidal behaviour: an epidemiological and genetic study.
D. Statham (1998)
Validity of the medical outcomes study depression screener in family practice training centers and community settings.
R. Nagel (1998)
[Modern epidemiology].
M. Graffar (1971)
Psychiatric emergencies . In : Kaplan HI , Sadock BJ , eds
D Harwitz (1996)
10.1017/S0033291799001373
Early sexual abuse and lifetime psychopathology: a co-twin-control study.
S. Dinwiddie (2000)
Psychiatric emergencies.
S. Schorr (1995)
10.1097/00006254-200003000-00012
Unintended Pregnancy Among Adult Women Exposed to Abuse or Household Dysfunction During Their Childhood
P. Dietz (2000)
10.1016/0145-2134(85)90060-2
The sexual abuse of Afro-American and white-American women in childhood.
G. E. Wyatt (1985)
10.1542/peds.106.1.e11
Adverse Childhood Experiences and Sexually Transmitted Diseases in Men and Women: A Retrospective Study
S. Hillis (2000)
10.4088/JCP.V58N1109
Determinants of suicidal ideation: the role of substance use disorders.
K. P. Pages (1997)
10.1176/ajp.148.12.1665
Childhood origins of self-destructive behavior.
B. A. van der Kolk (1991)
10.1007/978-1-4757-4002-8_107
Alcohol Abuse and Dependence
A. J. Mooney (1983)
10.1001/ARCHPSYC.56.11.1048
Clinical determinants of suicidal ideation and behavior in geriatric depression.
G. Alexopoulos (1999)
10.1016/0145-2134(90)90033-P
Child abuse: adolescent records vs. adult recall.
D. Della Femina (1990)
Suicidal behaviours in vulnerable adolescents
E. Fombonne (1998)
10.1016/1047-2797(94)90062-0
Gender differences in completed and attempted suicides.
E. Mościcki (1994)
10.1097/00005053-199901000-00006
Perceived abuse and neglect as risk factors for suicidal behavior in adolescent inpatients.
D. Lipschitz (1999)
10.1016/S0193-953X(05)70327-0
Identification of suicide risk factors using epidemiologic studies.
E. Mościcki (1997)
10.1176/ps.44.12.1193
Childhood abuse and neglect.
A. M. Fuchs (1993)
cide in twins
A Roy (1991)
Prevention Effectiveness
AC Haddix (1996)
10.1093/MILMED/162.3.168
Predictive patterns of suicidal behavior: the United States armed services versus the civilian population.
J. W. Sentell (1997)
Determinants of suicidal ideation
KP Pages (1997)
Suicidal ideation among the United States drinking population
BF Grant (1999)
10.1097/00004583-199907000-00014
Suicide in adolescents with disruptive disorders.
J. Renaud (1999)
10.1176/AJP.156.9.1456
Prediction of level of serotonin 2A receptor binding by serotonin receptor 2A genetic variation in postmortem brain samples from subjects who did or did not commit suicide.
G. Turecki (1999)
10.1001/JAMA.282.17.1652
Adverse childhood experiences and smoking during adolescence and adulthood.
R. Anda (1999)
Associationsofsub - stanceuse , abuse , anddependencewithsubsequent suicidal behavior
WaltersEE BorgesG (2000)
10.1542/PEDS.107.2.E19
Abused boys, battered mothers, and male involvement in teen pregnancy.
R. Anda (2001)
Age adjustment using the 2000 projected U.S. population.
Klein Rj (2001)
10.1001/archpsyc.1991.01810250031003
Suicide in twins.
A. Roy (1991)
Devel - opmentofabrief screening instrument fordetectingdepressive disorders
WellsKB BurnamMA
10.1177/088626099014009005
Adolescent Physical Abuse and Risk for Suicidal Behaviors
S. Kaplan (1999)
10.1001/jama.1987.03390240075026
Alcohol, firearms, and suicide among youth. Temporal trends in Allegheny County, Pennsylvania, 1960 to 1983.
D. Brent (1987)
10.1001/JAMA.1997.03550020063039
Prevalence of child physical and sexual abuse in the community. Results from the Ontario Health Supplement.
H. Macmillan (1997)
10.15288/jsa.1993.54.246
Alcohol in America: Drinking Practices and Problems
T. Beresford (1993)
10.1046/J.1360-0443.2001.9622275.X
Shattered childhood: a key issue in suicidal behavior among drug addicts?
I. Rossow (2001)
Suicide and Occupation
B. Brenner (1958)
Predictive patterns of suicidal behavior
JW Sentell (1997)
10.2105/AJPH.83.2.179
Aggression, substance use, and suicidal behaviors in high school students.
C. Garrison (1993)
10.1097/00004583-199605000-00017
Depression, family environment, and adolescent suicidal behavior.
C. Hollis (1996)
10.1016/S0165-0327(99)00004-X
Lifetime suicide risk in major depression: sex and age determinants.
G. Blair-West (1999)
10.1192/BJP.175.3.277
Suicide among drug addicts in the UK.
A. Oyefeso (1999)
10.15288/JSA.1999.60.422
Suicidal ideation among the United States drinking population: results from the National Longitudinal Alcohol Epidemiologic Survey.
B. Grant (1999)
10.1038/2221005b0
Suicide and Depression
D. Kay (1969)
10.1016/S0145-2134(00)00238-6
Bias assessment for child abuse survey: factors affecting probability of response to a survey about childhood abuse.
V. Edwards (2001)
10.7748/phc.13.9.6.s3
Child abuse.
A. D. Jackson (1987)
10.1093/OXFORDJOURNALS.AJE.A010278
Associations of substance use, abuse, and dependence with subsequent suicidal behavior.
G. Borges (2000)
10.1192/BJP.173.2.154
Suicidal behaviours in vulnerable adolescents. Time trends and their correlates.
E. Fombonne (1998)
10.1023/A:1021801927353
Healthy People 2010
S. Yu (2004)
10.1016/S0163-8343(96)00037-0
Suicide and violence assessment in psychiatry.
D. H. Hughes (1996)
10.1111/j.1532-5415.1996.tb01370.x
Suicidal Ideation Among Older Primary Care Patients
C. Callahan (1996)
10.1001/JAMA.282.14.1359
Unintended pregnancy among adult women exposed to abuse or household dysfunction during their childhood.
P. Dietz (1999)
10.1016/0163-8343(95)00098-4
Childhood abuse and suicidality in obstetrics patients in a hospital-based urban prenatal clinic.
E. W. Farber (1996)
10.1007/BF02102893
Recovered memories of abuse in women with documented child sexual victimization histories
L. M. Williams (1995)
10.1001/ARCHPSYC.56.7.617
Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey.
R. Kessler (1999)
10.1097/00004583-199602000-00006
Violent methods associated with high suicide mortality among the young.
A. Ohberg (1996)
10.2105/AJPH.79.10.1396
Homicide, suicide, motor vehicle crash, and fall mortality: United States' experience in comparative perspective.
I. Rockett (1989)
10.4324/9781315760841
Suicidal behaviour.
C. Mclaughlin (1993)
10.1097/00004583-199301000-00004
Childhood depression and risk of suicide: a preliminary report of a longitudinal study.
U. M. Rao (1993)
10.3109/10673229709034728
Late‐Life Suicide: A Review
A. Bharucha (1997)
10.1037/0033-2909.121.2.246
Family risk factors for child and adolescent suicidal behavior.
B. Wagner (1997)
10.1016/S0306-4603(98)00109-9
Risk factors for suicide attempts among low-income women with a history of alcohol problems.
J. Kingree (1999)
10.1111/J.1943-278X.1999.TB00760.X
Comparing suicide attempters, suicide ideators, and nonsuicidal homeless and runaway adolescents.
K. Yoder (1999)
10.1001/JAMA.1997.03550070061039
Alcohol and illicit drug abuse and the risk of violent death in the home.
F. Rivara (1997)
10.1037/e608822007-001
Exposure to alcoholism in the family: United States, 1988.
C. Schoenborn (1991)
10.1016/0145-2134(90)90077-7
Sexual abuse in a national survey of adult men and women: prevalence, characteristics, and risk factors.
D. Finkelhor (1990)
10.1017/S0033291797005357
Tolerance of suicide, religion and suicide rates: an ecological and individual study in 19 Western countries.
J. Neeleman (1997)
10.1176/AJP.154.12.1715
Characteristics of borderline personality disorder associated with suicidal behavior.
B. Brodsky (1997)



This paper is referenced by
Witnessing parental domestic violence and symptoms of depression and anxiety in Filipino adolescents.
Hindin Mj (2005)
10.13109/prkk.2009.58.8.572
Entwicklungstrauma-Störung: Auf dem Weg zu einer sinnvollen Diagnostik für chronisch traumatisierte Kinder
B. Kolk (2009)
10.7202/037872AR
Les facteurs associés au risque suicidaire chez les adolescents délinquants
Catherine Laurier (2009)
10.1016/j.chiabu.2009.09.004
ISPCAN Child Abuse Screening Tool Children's Version (ICAST-C): Instrument development and multi-national pilot testing.
A. Zolotor (2009)
10.1007/978-1-4419-1526-9_15
Organizational Stress and Trauma-Informed Services
Sandra L. Bloom (2010)
10.1007/978-3-540-28266-2_44
Breast Cancer: the Impact of Depression and its Treatment
E. J. Betan (2006)
ARTICLE IN PRESS Association of Suicide Attempts with Childhood Traumatic Experiences in Patients with Major Depression 2
Almila Erol (2012)
10.1080/13607863.2012.758236
Early childhood abuse and late-life suicidal ideation
Natalie J. Sachs-Ericsson (2013)
10.1521/psyc.2013.76.2.97
Suicide Among Soldiers: A Review of Psychosocial Risk and Protective Factors
M. Nock (2013)
10.1177/0272431612468505
Finnish Sixth Graders as Victims of Adult, Peer, and Co-Occurring Adult and Peer Violence
Lotta Uusitalo-Malmivaara (2013)
10.3389/fpsyt.2013.00080
Epigenetic Risk Factors in PTSD and Depression
Florian J. Raabe (2013)
10.1007/S40653-017-0161-0
Adverse Childhood Experiences from Ages 0–2 and Young Adult Health: Implications for Preventive Screening and Early Intervention
Alysse Melville (2017)
10.1017/S0033291717001684
Abortion and subsequent depressive symptoms: an analysis of the National Longitudinal Study of Adolescent Health.
Anu Manchikanti Gomez (2018)
10.1007/s10995-017-2367-z
Relationship of Adverse Family Experiences to Resilience and School Engagement Among Vermont Youth
Laurin Kasehagen (2017)
10.1016/j.jaac.2018.07.911
Characteristics and Precipitating Circumstances of Suicide Among Incarcerated Youth.
Donna A Ruch (2019)
The impact of intimate partner violence against women in Peru: estimates using matching techniques.
A. Morrison (2007)
PREVENTION OF DEPRESSION AND SUICIDE
S. Platt (2008)
Investigating the Interrelationships between Adverse Developmental Experience, Emotion Regulation Strategies, and Mental Health
Gráinne McGinty (2018)
10.3390/ijerph9051908
Childhood and Adult Trauma Experiences of Incarcerated Persons and Their Relationship to Adult Behavioral Health Problems and Treatment
N. Wolff (2012)
Relations Between Adverse Childhood Experiences and Current Maladaptive Beliefs in a College Sample
Ilana S Berman (2017)
Early maladaptive schemas and suicidal ideation in depressed patients
N. Flinka (2017)
10.1353/hpu.2011.0139
Addressing Depression and Accumulated Trauma in Urban Primary Care: Challenges and Opportunities
Monique M. Parrish (2011)
The social determinants of elevated rates of suicide among Inuit youth
J. Hicks (2007)
10.1027/0227-5910/a000426
Suicidal Behaviors Among Adolescents – The Role of School and Home Environment: Findings From a Cross-Sectional National-Based Survey
Hanan El-Sayed Badr (2017)
10.1080/10511482.2018.1553057
“I Would Say It’s Almost Like a Crime Against, You Know, the Soul”: Building a Culture of Health in Low-Income Housing Communities Through Addressing Childhood Trauma
Irán Barrera (2019)
10.1016/j.ypmed.2020.106011
Rates of suicidal ideation among HIV-infected patients in care in the HIV Outpatient Study 2000-2017, USA.
Marcus D. Durham (2020)
10.1080/13607863.2019.1652245
A life-span approach to examining older vulnerable population's subjective well-being: the role of adversity and trauma.
Mai S Yang (2019)
10.1002/wps.20039
Early childhood sexual abuse increases suicidal intent.
J. López-Castroman (2013)
10.1016/j.pmrj.2014.01.013
Adverse childhood experiences and disability in U.S. adults.
S. M. Schüssler-Fiorenza Rose (2014)
10.1017/CBO9780511777042.010
The Impact of Early Life Trauma on Health and Disease: The relationship of adverse childhood experiences to adult medical disease, psychiatric disorders and sexual behavior: implications for healthcare
V. Felitti (2010)
10.1016/j.ogc.2009.10.011
Intimate partner violence.
A. Zolotor (2009)
Papel da adaptabilidade familiar na adopção de comportamentos de saúde em filhos de veteranos de guerra com sintomatologia traumática
Susana Pedras (2010)
See more
Semantic Scholar Logo Some data provided by SemanticScholar