1. Childhood sexual abuse is associated with an increased risk of suicide attempts.
2. The magnitude of the association between suicide attempt and childhood sexual abuse is heterogenous, and the temporality of the association is difficult to establish.
Evidence Rating Level: 2 (Good)
Study Rundown: Self-inflicted harm is common and can be attributed to both environmental and hereditary factors. Understanding and controlling for these factors may decrease the burden of disease. This study sought to better understand the relationship between childhood sexual abuse (CSA) and suicide attempts. To that end, this study reviewed the consistency of the relationship between CSA and suicide or suicidal behavior and whether the relationship persisted after controlling for known confounding factors. Based on their systematic review and meta-analysis, the authors concluded that a positive relationship between CSA and suicide attempts exists, though size effect varies considerably. In addition, only 2 studies included the temporal relationship between attempted suicide and exposure to CSA, making this relationship difficult to establish. Though this analysis covers an international population, the heterogeneity in the measurement of CSA and suicide attempts throughout the included studies made it difficult to reach all but the broadest conclusions.
In-Depth [meta-analysis]: This meta-analysis supports the established relationship between childhood sexual abuse (CSA) and suicide attempts in adults. Of the 22,235 studies culled in the original search, 7 longitudinal prospective studies and 2 twin prospective studies met inclusion criteria for analysis. The studies ranged widely, from 102 to 4848 subjects, plus a 12 810 754 participant study from Australia. Additionally, cohorts from Europe, New Zealand, and the USA were included. Length of follow up ranged between 3 and 36 years, with 3 to 5 waves of data collection within this period. The degrees of CSA and suicide attempts were defined differently among studies. For example, some studies include self-reported single incidents, others considered incidents over a period of time, and still others excluded abuse by perpetrators of the same age. Two studies used death records to establish suicide, while the rest used reported attempts, and some included measures of multiple attempts. Two studies attempted to control for baseline suicide behavior though no studies controlled for major depressive disorder, a known risk factor for suicide. Despite the extensive heterogeneity revealed by this analysis (I2*= 87.5%, p<.0001), there was an overall positive odds ratio of 2.43 (CI= 95%) with no significant differences between men and women.
*I2 is a measurement of heterogeneity described as a percentage of total variation across studies due to heterogeneity rather than chance. Values range from 0 to100%. A larger percentage indicates increased levels of heterogeneity.
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