Research Papers

Contributing Factors for the Onset of Suicidal Tendencies in Survivors of Childhood Physical Abuse

Introduction

In 2009, Canada had a rate of 11.5 suicides per 100 000 individuals, which reached a total of 3 890 deaths by suicide just in that year alone (Stats Canada, 2012). In the same year it was discovered that “nearly one quarter (23%) of all deaths among 15- to 19-year-olds were due to suicide, more than double the proportion of 9% in 1974” (Stats Canada, 2012). Evidence has been attributed to the link between suicide related behaviour and childhood physical abuse (CPA), (Mironova et al., 2011). Because of this connection, it is important to provide a greater understanding of the ways in which CPA presents this risk so that interventions can be set in place to prevent suicide and suicide attempts among this population (Swogger, You, Cashman-Brown, & Conner, 2011). When considering the connection between childhood physical abuse and the development of suicidal tendencies, it can be seen that there are a variety of factors that can contribute to the development of such tendencies. Through research it was discovered that these factors can be located in certain areas in a person’s life. These areas’ include: their behaviour, their psychological stability, and their environment. These subdivisions will be discussed in further detail under the “supporting research” heading later in the paper.

Other sections that will be covered in this paper include: a background, a summary, implications for child and youth care (CYC) work, and of course, a concluding paragraph to round it off. The background portion of the paper will provide the reader with insight as to why the writer chose this topic, definitions important to the thesis, and a brief history of the main topics being discussed. The summary section will directly follow the supporting research portion of the assignment, and will give a brief recap of all the areas discussed under the supporting research heading. The area headed as implications for future CYC work will highlight the ways in which both victims of physical abuse and suicidal thoughts can be treated when they are brought into care, and ways that a CYC can help to promote resiliency within this population. Finally, a conclusion will be provided to tie all of the information in this paper together. By discussing these factors and how they affect the survivors of CPA, we can begin to understand the ways in which suicidal tendencies develop within this demographic, which could ultimately help in the creation of therapeutic interventions.

Background

On a more personal side of things, and through careful reflection, I have discovered that this topic may mean more to me than I had initially believed. In my father’s past he had some issues with substance abuse and would sometimes physically abuse my younger brothers and me- although in minor ways compared to a lot of cases. However, sooner or later he gave up these behaviours, and I was approximately 10 or 11 years old when we had “forgiven” him and continued on with our lives. Learning now that these behaviours could have sparked an onset of suicidal tendencies within survivors of physical abuse, it is important for me to discover the factors that can lead to these tendencies so I have an understanding of what me and my brothers managed to avoid, and must continue to avoid in order to beat the odds.

The term physical abuse is used to explain all acts of physical harm by a caregiver that may result in different levels of injury; minor injuries (bruising), and major injuries (genital mutilation, or death), (Rimer, 2012). Physical abuse may also incorporate acts that are in no way intended to harm the child, such as inappropriate or excessive punishment (Rimer, 2012). Suicidal tendency is being used as a blanket term to cover the susceptibility behind the areas of suicide attempts (efforts behind killing themselves), and suicidal ideation (the thoughts that drive these behaviours), (Barlow, Durand, & Stewart, 2012).

As stated in the introduction, the increase in successful suicide attempts in youth between the ages of 15-19 years-of-age has skyrocketed in the last few decades and has increased from 9% of the total deaths of this age group in 1974, to 23% percent of the total deaths in 2009 (Stats Canada, 2012). In 2009 it was speculated that 702 000 children were at one time in their lives exposed to maltreatment (Sugaya, 2012). In the same year it was thought that 1 out of every 10 children in the world experienced a form of violent maltreatment, and CPA was reported as “the second most common form of maltreatment being recounted by 8% of the U.S adult population” in the year 2010 (Sugaya, 2012, p. 384). It is likely that these numbers have been increasing over the years and it can be speculated that with such high numbers in both areas- and with an apparent correlation between the two- that this is an important area for future research to take place in.

Supporting Research

Behavioural Impacts

Behaviorally, research found that things like aggression and declines in self-esteem, and the behaviours attributed to these declines, have contributed to the eventual breeding of suicidal tendencies (Swogger et al., 2011; Cero & Sifers, 2013). In a study done by Swogger et al. (2011) examining the correlation between CPA, aggression, and suicidal tendencies in criminal offenders, this team found that aggressive behaviours and CPA could in fact be attributed to suicide attempts within this population. For example, aggression is regulated by a certain hormone that also controls impulsivity and emotional responses, and, when produced in small quantities, has been known to result in suicidal tendencies (Swogger et al., 2011). Therefore, because of the prevalence of aggression in individuals with a history of CPA, along with the correlation between aggression and suicide attempts, it can be seen that CPA can affect suicidal tendencies indirectly through the development of aggressive behaviours in criminal offenders (Swogger et al., 2011).

To add further clarification to this point, it can be speculated through research that CPA alone can work to promote suicidal tendencies, but can also do it indirectly through the development of aggressive behaviours; which has a variety of other risk factors associated to it as well. During the course of this cross-sectional study they examined 266 individuals between the ages of 18-62; 199 males and 67 females (Swogger et al., 2011). To do this they surveyed all 266 individuals in 3 key areas: 1) childhood physical abuse (before the age of 18), 2) aggression, and 3) suicide attempts (Swogger, 2011). As a result of this study, Swogger et al. (2011) found that “the experience of CPA leads to a vulnerability to aggression that confers a risk for a suicide attempt” (p. 365), and added that by treating aggressive behaviour it may also be possible to reduce suicidal tendencies as a result.

Low levels of self-esteem have been connected to suicidal tendencies as well, and may also be indirectly affected by CPA as an end result (Cero & Sifers, 2013). In this study Cero and Sifers (2013) look at the effects CPA can have on self-esteem and suicidal ideation using The Interpersonal–Psychological Theory (IPTS), which inquires that perceived burdensomeness (feeling that they are a burden) and thwarted belongingness (feeling that they don’t belong) can result in suicidal tendencies. These two areas highlighted above are triggered by negative parental attitudes (such as CPA) and can lead to lower levels of self-esteem as a result (Cero & Sifers, 2013). To bring this concept together: perceived burdensomeness and thwarted belongingness can lead to suicidal ideation, which can be triggered by negative events such as CPA, and ultimately results in the lower levels of self-esteem that are attributed to these suicidal tendencies (Cero & Sifers, 2013).

So, how does this affect individuals behaviourally? The behaviours adopted from CPA, such as thwarted belongingness, can lower levels of self-esteem which may result in certain behaviours similar to suicide attempts and/or social isolation (Cero & Sifers, 2013). Throughout this study the duo surveyed 200 individuals in public schools in the areas of suicide attempts, physical abuse, and their services to others (Cero & Sifers, 2013). By doing this Cero and Sifers (2013) came to the conclusion that CPA can indirectly affect suicidal tendencies because of the impact it can have on the levels of self-esteem and the behaviours attributed to it.

Psychological Impacts

Mentally, research found that CPA has had a direct correlation in the development of psychiatric disorders (Sugaya et al., 2012), whose symptoms may spark suicidal tendencies in individuals as well. A study conducted by Sugaya et al. (2012) works to prove that CPA can be linked to compromised psychological stability throughout the course of one’s life. This study also discusses the connection between CPA and suicidal tendencies, but goes even further to explain that CPA may present a heightened risk of developing severe psychiatric disorders such as: major depression, post-traumatic stress disorder (PTSD), bi-polar disorder, substance abuse disorders (Sugaya et al., 2012), and many other disorders that have the potential to promote suicidal tendencies in adults with a history of CPA.

For example major depression can cause feelings of worthlessness, the inability to express pleasure, and many other symptoms that could potentially spark suicidal ideation in individuals with this disorder (Barlow et al., 2012). Major depression can also be a symptom for a lot of other psychiatric disorders as well, making suicide attempts with these disorders much more likely. The research was collected in two waves which used face-to-face interviews to assess approximately 43 093 individuals that were 18 years of age or older in the United States (Sugaya et al., 2012). The outcome of this research indicated that the prevalence of psychiatric disorders and suicidal tendencies in victims of CPA, greatly out-weighed that of the individuals who had not admitted to having experienced CPA in their lifetime (Sugaya et al., 2012).

Another psychological aspect that must be overcome for individuals to even consider suicide is the fear and pain that the suicide attempts might entail (Cero & Sifers, 2013). In this respect, CPA can act as a type of exposure therapy (Cero & Sifers, 2013). The individual being abused has a greater chance of becoming accustomed to these feelings of fear and pain because of the level of exposure they may have to face on a daily basis. Because of this, these emotions may start to become easier to deal with over time, which could increase the likelihood of them attempting suicide (Cero & Sifers, 2013). More severe cases of physical abuse have been proven to speed up this process because the individual will develop a tolerance to these feelings and emotions at a much quicker rate, and he or she will have a much easier time deciding to attempt suicide in the future (Cero & Sifers, 2013). Therefore, “preventing child physical abuse is an essential step to reduce childhood suffering and improve adult mental health” (Sugaya et al., 2012).

Environmental Impacts

Finally, environmental impacts such as living in a shared-environment with the abuser have also been shown to lead to suicidal tendencies in people that have experienced childhood physical abuse as well (Mironova et al., 2011). Because the individuals in these shared social environments have become accustomed to being punished as a disciplinary tactic, they make take on these behaviours toward themselves in the form of self-harm in order to punish their own mistakes (Mironova et al., 2011). An individual can also be considered to have a shared biological environment when they inherit genes that relate directly to characteristics of the abusive caregiver (epigenetics); which ultimately put’s them more at risk for developing both suicidal tendencies and aggressive behaviour in the future (Mironova et al., 2011). Mironova (2011) found that the majority of the articles being discussed in the paper were consistent with the idea that sharing an environment with a perpetrator of CPA will increase the likelihood of a youth developing suicidal tendencies.

Summary

In summary, it can be seen that there are a variety of factors that can contribute to the development of suicidal tendencies in victims of CPA, and that they can be seen in specific areas throughout a person’s life span. The three areas highlighted in the supporting research portion of this paper included: behavioural impacts, psychological impacts, and environmental impacts. The behavioural impacts section discussed how the development of aggressive behaviours was a common characteristic in survivors of CPA, and how this aggression was able to develop into suicidal tendencies (Swogger et al., 2011). Also under the subheading of behavioural impacts we talked about self-esteem, and how perceived burdensomeness and thwarted belongingness could lead to suicidal ideation, which are triggered by negative events such as CPA (Cero & Sifers, 2013). Once CPA had triggered these vulnerabilities, they would ultimately result in the lower levels of self-esteem that were attributed to suicidal tendencies (Cero & Sifers, 2013).

The next subheading covered was psychological impacts. In this portion of the paper we discussed the link between CPA and suicidal tendencies, and talked about how CPA could lead to the development of severe mental dysfunctions that may also produce symptoms that promote suicidal ideation (Sugaya et al., 2012). Also covered in this section was the area that talked about the need to overcome fear and pain in order to even consider suicidal ideations, and how exposure to physical abuse could speed up this process (Cero & Sifers, 2013). Last but not least, we discussed the environmental impacts of living in a shared space with the abuser and how suicidal tendencies were more likely to develop among this population than those who did not share an environmental space with the perpetrator (Mironova et al., 2011).

Implications for Future CYC Work

Prevention of Abuse

In an ideal world a thing such as CPA would cease to exist. However, this planet is no utopia and despite all the wonderful things that earth has to offer, things like loss, suffering, poverty, and abuse have pushed their way into everyday events, and whether we like it or not, these things are undoubtedly here to stay. That being said we are not completely at a loss, and although things like abuse happen, there are ways that they can be managed or avoided in some cases. Sugaya et al. (2012) says that the prevention of childhood physical abuse is essential for providing children with a better way of life which would, in due course, lead to a healthier adulthood.

Rimer (2012) in his manual Making a Difference, The Community Responds to Child Abuse, found that the prevention of child abuse and family violence can fall into three categories: (1) primary prevention, (2) secondary prevention, and (3) tertiary prevention. Primary prevention takes on more of an educational role and utilizes the creation of policies and procedures in order to create a safer environment for youth in their community (Rimer, 2012). This could include things such as: prenatal care centers, education, drop in centres, or any other services offered to the public that help to inform parents and children about healthy relationships (Rimer, 2012). Secondary prevention specializes in early identification and timely interventions aimed at the individuals susceptible to abuse, or that are in danger of abusing themselves, with the expectations that it will help to prevent any increases in violence (e.g. regular home visits, subsidized school programs, etc.), (Rimer, 2012). Finally, tertiary prevention targets youth who have already had experiences with abuse or family violence, and works to treat the individual for the abuse that has already taken place- while at the same time- attempting to prevent any further abuse from occurring (e.g. foster care, therapy, etc.), (Rimer, 2012). The overall goal of prevention is to advocate for abuse and family violence, and to educate/teach people in the community about the risks associated by means of abuse, with the ultimate goal of eliminating it for good (Rimer, 2012).

Building Resiliency and Preventing Risk of Suicide

When the three areas of prevention laid out above are not enough to impede abuse or family violence, it is important that people aspiring to enter this field understand the strategies that can be used to help promote resilience in the youth who have had abusive experiences. By building resilience in survivors of CPA, the youth may be able to avoid acquiring some of the traits listed above (e.g. aggression), that have been shown to increase the susceptibility for developing suicidal tendencies. Self-esteem in children who have been abused is often times diminished (Rimer, 2012), which, as we seen earlier can be a cause for concern when considering the development of suicidal tendencies. By planning activities in which success is inevitable, or by consistently demonstrating the child’s successes, a CYC could work to build this child’s self-esteem (Rimer, 2012), and not only promote resilience, but may also prevent the negative occurrences of abuse such as suicide.

Oftentimes survivors of CPA have difficulty understanding their own emotions because they may have been taught that it’s bad to react or feel a certain way, and may have been punished for it in the past (Rimer, 2012). By having them name their emotions or by providing them with examples of how to express emotions appropriately, it will help to build resilience in these youth as well (Rimer, 2012). This would be important for therapeutic interventions with the youth in the study done by Swogger et al. (2011) who demonstrated displaced aggression as a result of CPA which, for a large number of them, lead to the eventual development of suicidal tendencies; behaviours that, with the proper care, may have been easily avoided.

There will be times in a CYCs career where the youth in their care may still live in a violent home or with a violent perpetrator. In these instances- if you are not able to remove them from the home- it would be ideal to create a plan that would help them to feel safer at home, and that would be easy for them to follow if things start to break down at home (e.g. learning to dial 911, finding a trusted adult that lives nearby, etc.), (Rimer, 2012). It can be speculated that by doing this, it will build resiliency in a sense that you have allowed them to take control over, or at least have a say in, their own safety measures; which builds autonomy and gives them control over a situation they may have felt helpless in previously.

For the youth in the studies analysed by Mironova et al. (2011) that are at risk of developing suicidal tendencies because of their shared environment with the abuser, it is likely that by building a plan of action such as this, it will help to eliminate that risk by providing the youth with a feeling of safety; which might also reduce stress levels as well. The last one we will talk about in detail is linking families to community supports. Both the victims and the abusers need some sort of support after a traumatic event, and they may need someone, or something, to help them cope with life stressors. It is likely that this would be rather beneficial for youth who have had experiences with CPA, because it could provide the youth and their families with the counselling they may need to deal with psychiatric disorders that have been proven to develop in some cases (Sugaya, 2012).

Some of the remaining areas for helping to build resilience in individuals that have ties to family violence or abuse include: building trust, teaching proper communication skills, teaching with problem solving skills, and to help children resume developmental progress (Rimer, 2012). Building resilience in youth is very important as it may help to prevent a variety of negative consequences from developing in the future, and the methods you use will vary depending on the unique situation of the youth in your care. Interventions are very important for youth with a history of CPA. However, Barker (1991) encourages CYCs to remember that “changing the behaviour of an abused child requires active intervention, but interventions of a nature that does not further traumatize the youngster or further diminish the child’s self-esteem” (as cited in Rimer, 2012, p. 107).

Conclusion

In conclusion, it can be seen that there are a variety of ways in which suicidal tendencies can develop in survivors of CPA. Oftentimes these tendencies progress in victims of CPA when there is an emergence of a secondary characteristic that follows the abuse (aggression, psychiatric disorders, etc.), and helps to drive the manifestations of suicidal ideations (Cero & Sifers, 2013; Sugaya et al., 2012; Swogger et al., 2011). This has been shown throughout the course of this paper in a variety of different areas across the lifespan. One of these areas would include behaviour. As a result of CPA, behaviours such as increased aggression and lowered levels of self-esteem have proven to be instrumental to the development of suicidal tendencies in this population (Cero & Sifers, 2013; Swogger et al., 2011).

Another area would include psychological stability. In survivors of CPA, there is a good possibility that these individuals will develop psychiatric disorders whose symptoms have a chance to go hand-in-hand with the progression of suicidal tendencies (Sugaya et al, 2012). As an addition to this section we discussed how the effects of abuse can work to normalize the fear and pain attributed to suicide attempts which would increase the likelihood of this occurring (Cero & Sifers, 2013). The final area that was discussed was their environment and how sharing a space with the abuser could help to trigger suicidal tendencies in survivors of CPA (Mironova, 2011).

Because child abuse and suicidal tendencies have been around for some time, and seem to be increasing in recent years, it looks as if this topic will be on a steady incline in importance, and it is likely that new studies will be appearing on this subject in the years to come. It is also important to consider that when attempting to create effective therapeutic interventions, to take into account the multifaceted needs of the youth in your care in order to provide them with the most effective level of help possible. However, finding the right method is not always easy, and Dr. Joseph Marshall (1996) says that “there is no easy cookie cutter solutions, there is only you and me and whatever we can do” (p. 304). By discussing these factors and how they affect the survivors of CPA, we can begin to understand the ways in which suicidal tendencies develop within this population, which could ultimately help in the creation of therapeutic interventions for youth specific to this demographic.

References

Barlow, David H., Durand, V. Mark, Stewart, Sherry H. (2012) Abnormal psychology: An integrative approach. (3rd Canadian Edition) Nelson Publishing. ISBN-13: 978-0-17-650219-5 ISBN-10: 0-17-650219-X

Cero, I., & Sifers, S. (2013). Moderating factors in the path from physical abuse to attempted suicide in adolescents: Application of the interpersonal-psychological theory of suicide. Suicide and Life-Threatening Behavior, 43(3), 296-304.

Marshall, J., & Wheeler, L. (1996). Street soldier: One man’s struggle to save a generation, one life at a time. New York: Delacorte Press.

Mironova, P., Rhodes, A. E., Bethell, J. M., Tonmyr, L., Boyle, M. H., Wekerle, C., et al. (2011). Childhood physical abuse and suicide-related behavior: A systematic review. Vulnerable Children and Youth Studies, 6(1), 1-7.

Rimer P. (2012). Making a difference, the community responds to child abuse. Resource Manual. 6th edition. Boost- Child Abuse Prevention & Intervention.

Stats Canada. (2012, July 25). Study: Suicide rates, an overview, 1950 to 2009. Retrieved from http://www.statcan.gc.ca/daily-quotidien/120725/dq120725a-eng.pdf

Sugaya, L., Hasin, D. S., Olfson, M., Lin, K., Grant, B. F., & Blanco, C. (2012). Childhood physical abuse and adult mental health: A national study. Journal of Traumatic Stress, 25(4), 384-392.

Swogger, M. T., You, S., Cashman-Brown, S., & Conner, K. R. (2011). Childhood physical abuse, aggression, and suicide attempts among criminal offenders. Psychiatry Research, 185(3), 363-367.

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