Suicide Attempts and Childhood Maltreatment Among Street Youth: A Prospective Cohort Study

Abstract

Background: Although suicide is a known leading cause of death among street youth, few prospective studies have explored childhood experiences as risk factors for future suicide attempt in this population. We examined the risk of attempted suicide in relation to childhood maltreatment among street youth.

Methods: From September 2005 to November 2013, data were collected from the At Risk Youth Study (ARYS), a prospective cohort of street youth in Vancouver, Canada. Inclusion criteria were age 14 to 26 years, past-month illicit drug use, and street involvement. Participants completed the Childhood Trauma Questionnaire, an instrument measuring self-reported sexual, physical, and emotional abuse and physical and emotional neglect. Suicide attempts were assessed semiannually. Using Cox regression, we examined the association between the 5 types of maltreatment and suicide attempts.

Results: Of 660 participants, 68.2% were male and 24.6% were Aboriginal. Median age was 21.5 years. The prevalence of moderate to extreme childhood maltreatment ranged from 16.8% (sexual abuse) to 45.2% (emotional abuse). Participants contributed 1841 person-years, with suicide attempts reported by 35 (5.3%) individuals (crude incidence density: 1.9 per 100 person-years; 95% confidence interval [CI]: 1.4-2.6 per 100 person-years). In adjusted analyses, types of maltreatment associated with suicide attempts included physical abuse (adjusted hazard ratio [HR]: 4.47; 95% CI: 2.12-9.42), emotional abuse (adjusted HR: 4.92; 95% CI: 2.11-11.5), and emotional neglect (adjusted HR: 3.08; 95% CI: 1.05-9.03).

Conclusions: Childhood maltreatment is associated with subsequent risk of suicidal behavior among street youth. Suicide prevention efforts should be targeted toward this marginalized population and delivered from a trauma-informed perspective.

FIGURE 1

Cumulative incidence of attempting suicide according to severity of sexual abuse (A), physical abuse (B), emotional abuse (C), physical neglect (D), emotional neglect (E), and any type of abuse/neglect (F): ARYS (Vancouver, British Columbia; 2005–2013). N = 660. Although both groupings listed (“moderate to severe abuse,” “none to moderate abuse”) include “moderate” levels of abuse, categories used standardized cutoffs of the CTQ and score ranges were mutually exclusive.^, Categories were collapsed with “none to moderate” (score of 5–12) incorporating “none to minimal” (score of 5–8) combined with “low to moderate” (score of 9–12), and “moderate to severe” (score >12) incorporating “moderate to severe” (score of 13–15) combined with “severe to extreme” (score >15). Where totals do not add to 660 at time zero, values are missing because the participant elected not to complete the CTQ at the baseline visit.