Child Psychiatry & Human Development

, Volume 42, Issue 2, pp 119–133

Suicidal Ideation, Parent–Child Relationships, and Adverse Childhood Experiences: A Cross-Validation Study Using a Graphical Markov Model

Original Article


Suicide is one of the leading causes of death in many Western countries. An exploration of factors associated with suicidality may help to understand the mechanisms that lead to suicide. Two samples in Germany (n = 500 and n = 477) were examined via Internet regarding suicidality, depression, alcohol abuse, adverse childhood experiences, and parent–child relationships. A Graphical Markov Model was constructed from the first subsample, testing for main, quadratic and interaction effects. All effects in the model were cross-validated using the second subsample. Depression was found to be a strong predictor of suicidality; alcohol abuse was not a predictor. Both maternal and paternal love also predicted suicidality; the former had an indirect effect via depression and the latter a direct effect. Early experiences with violence showed both a direct and indirect association with suicidality. In addition to depression being a predictor for suicidality, various pathways connect suicidality with early childhood experiences.


Suicidality Childhood adversities Family atmosphere International survey 


  1. 1.
    Hardt J, Johnson JG, Courtney EA, Sareen J (2006) Childhood adversities associated with risk for suicidal behaviour. Psychiatr Times 23:32–36Google Scholar
  2. 2.
    World Health Organization (2002) World report on violence and health. In: Krug EG, et al. (eds) World Health Organization, GenevaGoogle Scholar
  3. 3.
    Mittendorfer-Rutz E, Rasmussen F, Wasserman D (2008) Familial clustering of suicidal behaviour and psychopathology in young suicide attempters. A register-based nested case control study. Soc Psychiatry Psychiatr Epidemiol 43:28–36PubMedCrossRefGoogle Scholar
  4. 4.
    Spijker J, de Graaf R, Ten Have M, Nolen WA, Speckens A (2009) Predictors of suicidality in depressive spectrum disorders in the general population: results of the Netherlands mental health survey and incidence study. Soc Psychiatry Psychiatr Epidemiol 45:513–521PubMedCrossRefGoogle Scholar
  5. 5.
    Beautrais AL, Joyce PR, Mulder RT, Fergusson DM, Deavoll BJ, Nightingale SK (1996) Prevalence and comorbidity of mental disorders in persons making serious suicide attempts: a case-control study. Am J Psychiatry 153:1009–1014PubMedGoogle Scholar
  6. 6.
    Hintikka J, Koivumaa-Honkanen H, Lehto SM, Tolmunen T, Honkalampi K, Haatainen K et al (2009) Are factors associated with suicidal ideation true risk factors? A 3-year prospective follow-up study in a general population. Soc Psychiatry Psychiatr Epidemiol 44:29–33PubMedCrossRefGoogle Scholar
  7. 7.
    Han MA, Kim KS, Ryu SY, Kang MG, Park J (2009) Associations between smoking and alcohol drinking and suicidal behavior in Korean adolescents: Korea youth behavioral risk factor surveillance, 2006. Prev Med 19:642–655Google Scholar
  8. 8.
    Cavanagh JT, Carson AJ, Sharpe M, Lawrie SM (2003) Psychological autopsy studies of suicide: a systematic review. Psychol Med 33:395–405PubMedCrossRefGoogle Scholar
  9. 9.
    Werner EE, Smith RS (1992) Overcoming the odds. High risk children from birth to adulthood. Cornell University Press, Ithaca, LondonGoogle Scholar
  10. 10.
    Kuhlberg JA, Pena JB, Zayas LH (2010) Familism, parent–adolescent conflict, self-esteem, internalizing behaviors and suicide attempts among adolescent latinas. Child Psychiatry Hum Dev 41:425–430PubMedCrossRefGoogle Scholar
  11. 11.
    Rutter M (1980) Attachment and the development of social relationships. In: Rutter M (ed) Scientific foundations of developmental psychiatry. Heinemann, LondonGoogle Scholar
  12. 12.
    Johnson JG, Cohen P, Gould MS, Kasen S, Brown J, Brook JS (2002) Childhood adversities, interpersonal difficulties, and risk for suicide attempts during late adolescence and early adulthood. Arch Gen Psychiatry 59:741–749PubMedCrossRefGoogle Scholar
  13. 13.
    Hardt J, Sidor A, Nickel R, Kappis B, Petrak F, Egle UT (2008) Childhood adversities and suicide attempts: a retrospective study. J Fam Violence 23:713–718CrossRefGoogle Scholar
  14. 14.
    Hardt J, Egle UT, Johnson JG (2007) Suicide attempts and retrospective reports about parent–child relationships: evidence for the affectionless control hypothesis. GMS—Psychosoc Med 2007-4:DOC12Google Scholar
  15. 15.
    Andrews G, Corry J, Issakidis C, Slade T, Swanston H (2002) Comparative risk assessment: child sexual abuse. Final report, in WHO Collaborating Centre on Evidence and Health Policy in Mental Health, St. Vincent’s Hospital, Sydney, AustraliaGoogle Scholar
  16. 16.
    Rutter M, Quinton D (1977) Psychiatric disorder—ecological factors and concepts of causation. In: McGurk H (ed) Ecological factors in human development. North-Holland Publishing Co, Amsterdam, pp 173–187Google Scholar
  17. 17.
    Fergusson DM, Horwood LJ (2001) The Christchurch health and development study: review of findings on child and adolescent mental health. Aust N Z J Psychiatry 35:287–296PubMedCrossRefGoogle Scholar
  18. 18.
    Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V et al (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study. Am J Prev Med 14:245–258PubMedCrossRefGoogle Scholar
  19. 19.
    Kempe CH, Silverman FN, Steele BF, Droegemueller W, Silver HK (1962) The battered-child syndrome. JAMA 181:17–24PubMedGoogle Scholar
  20. 20.
    Rovi S, Chen P-H, Johnson MS (2004) The economic burden of hospitalizations associated with child abuse and neglect. Am J Public Health 94:586–590PubMedCrossRefGoogle Scholar
  21. 21.
    Widom CS (1989) The cycle of violence. Science 244:160–166PubMedCrossRefGoogle Scholar
  22. 22.
    Fergusson DM, Lynskey MT (1995) Suicide attempts and suicidal ideation in a birth cohort of 16-year-old New Zealanders. J Am Acad Child Adolesc Psychiatry 34:1308–1317PubMedCrossRefGoogle Scholar
  23. 23.
    Afifi TO, Enns MW, Cox BJ, Asmundson GJ, Stein MB, Sareen J (2008) Population attributable fractions of psychiatric disorders and suicide ideation and attempts associated with adverse childhood experiences. Am J Public Health 98:946–952PubMedCrossRefGoogle Scholar
  24. 24.
    Cox DR, Wermuth N (1996) Multivariate dependencies: models, analysis and interpretation, vol 1. Chapman and Hall, LondonGoogle Scholar
  25. 25.
    Wermuth N, Cox DR (2001) Graphical models: an overview. In: Baltes PB, Smelser NJ (eds) International encyclopedia of the social and behavioural sciences. Elsevier, Amsterdam, pp 6379–6386Google Scholar
  26. 26.
    Hardt J (2008) The symptom-check-list-27-plus (SCL-27-plus): a modern conceptualization of a traditional screening instrument. German Medical Scienc—Psychosoc Med 5(doc08)Google Scholar
  27. 27.
    Bush B, Shaw S, Cleary P, Delbanco TL, Aronson MD (1987) Screening for alcohol abuse using the CAGE questionnaire. Am J Med 82:231–235PubMedCrossRefGoogle Scholar
  28. 28.
    George G, Kaplan N, Main M (1985) The adult attachment interview. Unpublished manuscript, University of California, BerkelyGoogle Scholar
  29. 29.
    Engfer A (1997) Entwicklung punitiver Mutter-Kind-Interaktionen im sozioökologischen Kontext. In Abschlußbericht für die Deutsche Forschungsgemeinschaft, PaderbornGoogle Scholar
  30. 30.
    Hardt J, Egle UT, Engfer A (2003) Der Kindheitsfragebogen, ein Instrument zur Beschreibung der erlebten Kindheitsbeziehungen zu den Eltern. Z Diff Diag Psychol 24:33–43Google Scholar
  31. 31.
    Hardt J (2004) Psychische Langzeitfolgen manifester Kindheitsbelastungen: Die Rolle von Eltern-Kind-Beziehungen. Pabst, LengerichGoogle Scholar
  32. 32.
    Wright S (1934) The method of path coefficients. Ann Math Stat 5:161–215CrossRefGoogle Scholar
  33. 33.
    Baron RM, Kenny DA (1986) The moderator- mediator variable distinction in social psychological research:conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51:1173–1182PubMedCrossRefGoogle Scholar
  34. 34.
    Hardt J, Petrak F, Filipas D, Egle UT (2004) Adaptation to life after surgical removal of the bladder—an application of Graphical Markov Models for analysing longitudinal data. Stat Med 23:649–666PubMedCrossRefGoogle Scholar
  35. 35.
    R Development Core Team (2007) R: a language and environment for statistical computing. R Foundation for Statistical Computing, ViennaGoogle Scholar
  36. 36.
    Kim HS, Kim HS (2008) Risk factors for suicide attempts among Korean adolescents. Child Psychiatry Hum Dev 39:221–235PubMedCrossRefGoogle Scholar
  37. 37.
    Bolton JM, Belik SL, Enns MW, Cox BJ, Sareen J (2008) Exploring the correlates of suicide attempts among individuals with major depressive disorder: findings from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 69:1139–1149PubMedCrossRefGoogle Scholar
  38. 38.
    Fonagy P, Gergely G, Jurist EL, Target M (2002) Affect regulation, mentalization and the developmement of the self. Other Press, New YorkGoogle Scholar
  39. 39.
    Schier K (2009) Piekne brzydactwo. Problematyka obrazu ciala I jego zaburzen. Wydawnictwo Naukowe Scholar, WarszawaGoogle Scholar
  40. 40.
    Jakel B (2008) Prenatal roots of attachment in psychotherapy. Int J Prenat Perinat Psychol Med 3(4):148–166Google Scholar
  41. 41.
    Boszormenyi-Nagy I, Spark GM (1981) Unsichtbare bindungen. Klett-Cotta, StuttgartGoogle Scholar
  42. 42.
    Chase ND (1999) Parentification. An overview of theory, research and social issues. In: Chase ND (ed) Burdened children theory, research and treatment of parentification. Sage, Thousand OaksGoogle Scholar
  43. 43.
    Joe S, Stein DJ, Seedat S, Herman A, Williams DR (2008) Non-fatal suicidal behavior among South Africans: results from the South Africa stress and health study. Soc Psychiatry Psychiatr Epidemiol 43:454–461PubMedCrossRefGoogle Scholar
  44. 44.
    Fazel S, Cartwright J, Norman-Nott A, Hawton K (2008) Suicide in prisoners: a systematic review of risk factors. J Clin Psychiatry 69:1721–1731PubMedCrossRefGoogle Scholar
  45. 45.
    Westheide J, Quednow BB, Kuhn KU, Hoppe C, Cooper-Mahkorn D, Hawellek B et al (2008) Executive performance of depressed suicide attempters: the role of suicidal ideation. Eur Arch Psychiatry Clin Neurosci 258:414–421PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Medical Psychology and Medical Sociology, Clinic for Psychosomatic Medicine and Psychotherapy, School of MedicineUniversitätsmedizin Mainz Johannes Gutenberg UniversityMainzGermany
  2. 2.Faculty of PsychologyUniversity of WarsawWarsawPoland

Personalised recommendations