Diana Zuckerman, PhD and Sarah Pedersen
More than 34,000 Americans commit suicide every year, and suicide is among the top five causes of death for Americans aged 10-54, and is the second leading cause of death for adults 25-34. Research by Kaiser Permanente and the Centers for Disease Control and Prevention (CDC) shows that a child who has many very negative experiences can be 30 to 50 times as likely to attempt suicide when they are teens or adults.
The Adverse Childhood Experiences (ACE) Study is based on more than 17,000 adults who were patients at a primary care clinic in San Diego between 1995 and 1998 and who completed detailed questionnaires about negative experiences during their first 18 years of life, including abuse, neglect, domestic violence and family substance abuse. The average age was 56. Over half of the patients were women (54%) and three-quarters were white. Most had at least some college education, while one in four had only a high school diploma or less. Almost two out of three (64%) reported having suffered at least one of the eight “adverse” childhood experience (ACE) categories: emotional abuse, physical abuse, sexual abuse, battered mother, household alcohol or drug abuse, mental illness in household, parental separation or divorce, or having an incarcerated household member.
The more categories a participant had experienced, the higher their ACE “score.” According to the CDC, experiencing even one ACE increased the risk of attempted suicide up to five times. More than 5% of the women and 2% of the men reported having attempted suicide. The type of ACE significantly affected the likelihood of a suicide attempt. Attempts increased by 100% for those whose parents had divorced or separated, or where there was substance abuse in the home; increased by approximately 150% for those with an incarcerated family member or battered mother; tripled for those who had a mentally ill relative in the house, or who experienced physical or sexual abuse; and were five times as high for those reporting emotional abuse.
One type of major childhood stress tends to cause other types of major stress, and the impact of these experiences on suicide attempts increased dramatically when there were several stresses. For example, reporting at least seven of these stresses increased the chances of a youth suicide attempt 51-fold and adult suicide attempts 30-fold.
A 2009 study by Tracie Afifi and colleagues at the University of Manitoba in Canada on the relationship between child abuse, parental divorce, and long-term mental health and suicide outcomes came up with similar results. The authors concluded that either abuse or divorce significantly increase the likelihood of future mental health problems, including thinking about and attempting suicide. Having experienced both parental divorce and child abuse resulted in significantly increased chances of lifetime post-traumatic stress disorder, conduct disorder, and suicide attempts compared to having experienced either parental divorce or child abuse alone.
These studies highlight the devastating effect of stressful experiences over a long period of time on children and youth. One explanation is that when a child’s stress response system gets activated for a prolonged amount of time, this can lead to permanent changes in the development of the brain, causing long-term psychological and even physical consequences. Appropriate support and intervention can help youth and adults cope with distressing childhood experiences.
Centers for Disease Control and Prevention. The Effects of Childhood Stress on Health Across the Lifespan. 2008. http://www.cdc.gov/ncipc/pub-res/pdf/Childhood_Stress.pdf.
Dube SR, Anda RF, Felitti VJ, Chapman DP, Williamson DF, Giles WH. Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span. Journal of the American Medical Association. 2001;286(24):3089-3095.
Afifi TO, Boman J, Fleisher W, Sareen J. The relationship between child abuse, parental divorce, and lifetime mental disorders and suicidality in a nationally representative adult sample. Child Abuse & Neglect. 2009;33(3):139-147.
Meaney MJ, Szyf M. Environmental programming of stress responses through DNA methylation : life at the interface between a dynamic environment and a fixed genome. Dialogues in Clinical Neuroscience. 2005;7(2):103-123.