Childhood Adversities Predict Suicidal Behaviours…

Bruffaerts R, Demyttenaere K, Borges G, Haro JM, Chiu WT, Hwang I, Karam EG, Kessler RC, Sampson N, Alonso J, Andrade LH, Angermeyer M, Benjet C, Bromet E, de Girolamo G, de Graaf R, Florescu S, Gureje O, Horiguchi I, Hu C, Kovess V, Levinson D, Posada-Villa J, Sagar R, Scott K, Tsang A, Vassilev SM, Williams DR, & Nock MK (2010). Childhood adversities as risk factors for onset and persistence of suicidal behaviour. The British journal of psychiatry : the journal of mental science, 197 (1), 20-7 PMID: 20592429

I recently glanced upon a draft document by those total bend-over, in the-tent experts, Suicide Prevention Australia (SPA), in which they argue that suicide stigma can be overcome by promoting that old hoary nut that suicide stems from poor mental health. You know, mental disorders are diseases like any other and suicide is thus a product of disease, as tumours are a product of cancer. Does this line of thinking (sic, marketing) have any evidence to back up its public health credentials? The answer is, absolutely not. Promoting suicide as a subset of a purported disease state only adds to misunderstanding, apprehension and distancing. It invokes clinical pessimism and religious fatalism to construct the suicidal individual as perpetually at risk. Scary, scary stuff…

If you talk with suicidal people, or more politely put, people who have survived one or more suicide attempts, you start to understand just how far off the mark SPA and those other gutless arseholes who merely read the ideological script given to them by governments and big pharma, really are. I have worked, therapeutically, with hundreds of survivors, men and women whose suicide attempts did not just come upon them like a bad cold but rather, which came about as a direct consequence of compounded, traumatic life events. That trauma remains, in terms of suicide prevention in Australia, the lumbering great elephant in the tent that no one dares to ever name. Until such time as we muster the courage to utter the big ‘T’(rauma) word, suicide prevention will stay seriously off target.

In this article by Bruffaerts (2010) and more co-authors than there are dud apologies from BP for the Gulf of Mexico oil disaster, they make the point that although ‘childhood adversities’ (their terminology) are a known risk factor for suicidal behaviours, that causal pathway receives ‘much less scientific attention than mental disorders or genetics’ (p.20). Still, based on a globally representative sample of 55,299 subjects, the authors (2010, pp.20-21) were able to confirm that childhood adversity does indeed play a significant contributing role in suicidal behaviours. Their main findings included:

1. That ‘exposure to multiple adversities (in childhood and adolescence) consistently predicted suicidal behaviours’;

2. That ‘there was at least a threefold increase in lifetime suicide attempt and lifetime suicidal ideation among individuals with a history of sexual or physical abuse’;

3. Adversities (including ‘sexual and physical abuse’) ‘were most predictive of suicidal behaviour’ amongst adolescents and young adults; and

4. That ‘[s]exual and physical abuse were strong risk factors for both onset and persistence of suicidal behaviours’ (2010, p.25).

What Bruffaerts et al. (2010) suggest is what is increasingly accepted as the most valid hypothesis for suicidal behaviours, that is, that these behaviours emerge from cumulative, traumatic life events (p.25) and that their confluence with critical stages or points, particularly in childhood and adolescence, seems to increase their likelihood of occurring. In effect, the person at risk of suicide is not a random subject befallen by some mysterious disorder but instead, is a subject afflicted by the ‘allostatic load’ of ‘early-life stress’ (2010, p.25). Finding our way out of the suicide maze will not be furthered by handing out more scripts for anti-depressants. It can only start, as I always say, when we learn to take care of children from birth to adulthood and across the life span (2010, p.25)…