September 25, 2017
From Terry Ellis, LCSW, Executive Director and Clinical Director, Wolf Pack Consulting and Therapeutic Services, LLC
National Suicide Prevention Week was September 10th to the 16th. As a child and family therapist, supervisor, and person who works on planning, designing, implementing, and administering child and family service programs, I thought a lot this year about the role trauma plays in relation to suicidal behavior in children, adolescents, and adults.
Impact of Childhood Trauma
It has been determined events that impact development, such as childhood trauma, can sharply increase suicidal risk. The idea that the primary factor of impulsivity as a factor in suicidal behavior in adolescents and adults has been discounted. Although impulsivity may be a factor, the impulsivity in suicidal behavior is more likely related to brain wiring as related to coping with childhood trauma, stress, and neglect. It is also well documented that childhood trauma has a strong relationship with mental disorders and substance abuse, which also increase the risk for suicide. There is increased research focusing on determining the neuropsychosocial relationship between childhood trauma and suicidal behavior. Trauma can have significant impact on the brain’s ability to process stress responses and can lead to increased vulnerability around other developmental challenges and life events. Childhood trauma affects the ability to manage negative emotions and to stay optimistic (Cohen, 2016). There is a field called developmental traumatology, which combines knowledge from developmental neuroscience, developmental psychopathology, biology, stress, and trauma research. Much of this research is presented through the National Child Traumatic Stress Network (NCTSN).
Types of Childhood Trauma associated with Suicidality:
- Attachment challenges
- Loss or separation from parents
- Physical abuse by adults or peers
- Sexual abuse by adults or peers (strongest relationship to suicidality)
- Psychological maltreatment
- Family members with mental disorders, substance abuse disorders
- Parents or family members with suicidal behavior, or completion
- Family members who are engaged in criminal behavior
- Chronic childhood poverty or socioeconomic disadvantage
- Witnessing family violence
- Peer abuse and bullying
Other factors such as interpersonal conflict, school failure and challenges, and legal difficulties have not been clearly correlated with suicidality, but may be some of the stressful life events coupled with trauma, that may increase the risk of suicidality.
Multigenerational and Historical Trauma
There is also increased suicidal risk with the presence of multigenerational and historical trauma. The highest rate of suicidality of all racial and ethnic groups is found in the American Indian and Alaskan Native population. For example, American Indian and Alaskan Native adolescent and young adults have a rate of 34.3 suicides for males and 9.3 per females per 100,000 (2017 estimates by the Center for Disease and Prevention’s Center for Health Statistics). Males in the American Indian and Alaskan Native population have higher rates of suicide than any other gender or racial group.
Prevention Related to Trauma
Looking at this information it seems that the role of prevention related to trauma would be a major intervention in the prevention of suicidal behavior and completions. Integrative services are called for when addressing trauma and suicide. To date, family-oriented programs have had the greatest effectiveness related to prevention. Home visiting programs related to child abuse prevention are also correlated with a reduction of suicidal behavior in parents. Standard approaches for working with anxiety and depression, with individuals with histories of child abuse have not been found to be tremendously effective. Cognitive-behavioral therapy focused on the child abuse itself, instead of depression and anxiety, was effective in reducing the survivor’s anxiety and depression. Work with the non-offending parents greatly improved outcomes (King 2000-2001). Universal screening for child abuse, trauma, and suicidality also has special importance for predicting the possibility of incidence and relationship to suicidal risk. Integrative neuroscience research is needed and may produce more effective strategies for intervention.