European Child & Adolescent Psychiatry

, Volume 28, Issue 10, pp 1311–1319 | Cite as

Psychopathological mechanisms of early neglect and abuse on suicidal ideation and self-harm in middle childhood

  • Elise PaulEmail author
  • Ana Ortin
Original Contribution


Informed by diathesis-stress models of suicide risk, this longitudinal study examines the psychopathological mechanisms through which early maltreatment increases the risk for suicidal ideation and self-harm in middle childhood. The sample included 2958 families from the Fragile Families and Child Wellbeing Study, who participated in interviews at child’s ages of 3 and/or 5, and 9. Via the Child Behavior Checklist, primary caregivers reported on the child’s suicidal ideation and self-harm at age 9 and on clinically elevated depressive/anxious symptoms, aggressive behaviors, attention problems, and comorbid aggression and depressive/anxious symptoms at age 5. Past year neglect and physical/psychological abuse were measured via the Parent–Child Conflict Tactics Scale at age 3. Multivariate structural equation models indicated that early neglect had a significant indirect effect on suicidal ideation via clinically elevated depressive/anxious symptoms (OR = 1.57, 95% CI 1.09–2.25) and comorbid symptomatology (OR = 1.28, 95% CI 1.02–1.62), and on self-harm also via clinically elevated depressive/anxious symptoms (OR = 1.39, 95% CI 1.04–1.84) and comorbid symptomatology (OR = 1.20, 95% CI 1.01–1.43). Early physical/psychological abuse had a significant indirect effect on self-harm via clinically elevated attention problems (OR = 1.09, 95% CI 1.01–1.21). Unique developmental pathways for suicidal ideation and self-harm emerged among children exposed to abuse or neglect. For those exposed to early neglect, interventions should target depressive/anxious symptoms, especially when comorbid with aggression, to prevent suicidal ideation and self-harm. For children exposed to early physical/psychological abuse, problems with attention and impulsivity may be targets for reducing the risk for self-harm.


Child abuse Child neglect Self-injurious behavior Suicidal ideation Longitudinal studies 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Internal Review Board of Cornell University and meets all ethical considerations according to the 1964 Declaration of Helsinki and its later amendments. Informed written consent was obtained by FFCWS researchers from all participants prior to inclusion in the study.


  1. 1.
    Curtin SC, Warner M, Hedegaard H (2016) Suicide rates for females and males by race and ethnicity: United States, 1999 and 2014 (NCHS E-Stats). Hyattsville, Md, Centers for Disease Control and Prevention, National Center for Health Statistics.
  2. 2.
    Adrian M, Miller AB, McCauley E, Vander Stoep A (2015) Suicidal ideation in early to middle adolescence: sex-specific trajectories and predictors. J Child Psychol Psychiatry 57:645–653CrossRefGoogle Scholar
  3. 3.
    Anderson HD (2011) Suicide ideation, depressive symptoms, and out-of-home placement among youth in the US child welfare system. J Clin Child Adolesc Psychol 40:790–796CrossRefGoogle Scholar
  4. 4.
    Herba CM, Ferdinand RF, van der Ende J, Verhulst F (2007) Long-term associations of childhood suicide ideation. J Am Acad Child Adolesc Psychiatry 46:1473–1481CrossRefGoogle Scholar
  5. 5.
    Musci RJ, Hart SR, Ballard ED et al (2016) Trajectories of suicidal ideation from sixth through tenth grades in predicting suicide attempts in young adulthood in an urban African American cohort. Suicide Life Threat Behav 46:255–265CrossRefGoogle Scholar
  6. 6.
    Lin F-G, Lin J-D, Hsieh Y-H, Chang C-Y (2014) Quarrelsome family environment as an enhanced factor on child suicidal ideation. Res Dev Disabil 35:3245–3253CrossRefGoogle Scholar
  7. 7.
    Pfeffer CR (1990) Preoccupations with death in “normal” children: the relationship to suicidal behavior. OMEGA-J Death Dying 20:205–212CrossRefGoogle Scholar
  8. 8.
    Hawton K, Hall S, Simkin S et al (2003) Deliberate self-harm in adolescents: a study of characteristics and trends in Oxford, 1990–2000. J Child Psychol Psychiatry 44:1191–1198. CrossRefPubMedGoogle Scholar
  9. 9.
    Hawton K, Bergen H, Waters K et al (2012) Epidemiology and nature of self-harm in children and adolescents: findings from the multicentre study of self-harm in England. Eur Child Adolesc Psychiatry 21:369–377CrossRefGoogle Scholar
  10. 10.
    Winsper C, Lereya T, Zanarini M, Wolke D (2012) Involvement in bullying and suicide-related behavior at 11 years: a prospective birth cohort study. J Am Acad Child Adolesc Psychiatry 51:271–282CrossRefGoogle Scholar
  11. 11.
    Simioni AR, Pan PM, Gadelha A et al (2018) Prevalence, clinical correlates and maternal psychopathology of deliberate self-harm in children and early adolescents: results from a large community study. Rev Bras Psiquiatr 40:48–55CrossRefGoogle Scholar
  12. 12.
    Paul E, Ortin A (2017) Correlates of suicidal ideation and self-harm in early childhood in a cohort at-risk for child abuse and neglect. Arch Suicide Res. CrossRefGoogle Scholar
  13. 13.
    Cicchetti D, Rogosch FA, Sturge-Apple M, Toth SL (2010) Interaction of child maltreatment and 5-HTT polymorphisms: suicidal ideation among children from low-SES backgrounds. J Pediatr Psychol 35:536–546CrossRefGoogle Scholar
  14. 14.
    Thompson R, Briggs E, English D et al (2005) Suicidal ideation among 8-year-olds who are maltreated and at risk: findings from the LONGSCAN studies. Child Maltreat 10:26–36CrossRefGoogle Scholar
  15. 15.
    U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau (2017) Child Maltreatment 2015.
  16. 16.
    Dunn EC, McLaughlin KA, Slopen N et al (2013) Developmental timing of child maltreatment and symptoms of depression and suicidal ideation in young adulthood: results from the national longitudinal study of adolescent health. Depress Anxiety 30:955–964PubMedGoogle Scholar
  17. 17.
    Bridge JA, Goldstein TR, Brent DA (2006) Adolescent suicide and suicidal behavior. J Child Psychol Psychiatry 47:372–394CrossRefGoogle Scholar
  18. 18.
    Brodsky BS (2016) Early childhood environment and genetic interactions: the diathesis for suicidal behavior. Curr Psychiatry Rep 18:86CrossRefGoogle Scholar
  19. 19.
    Brent DA, Mann JJ (2006) Familial pathways to suicidal behavior: understanding and preventing suicide among adolescents. N Engl J Med 355:2719–2721CrossRefGoogle Scholar
  20. 20.
    Dervic K, Brent DA, Oquendo MA (2008) Completed suicide in childhood. Psychiatr Clin N Am 31:271–291CrossRefGoogle Scholar
  21. 21.
    O’Leary CC, Frank DA, Grant-Knight W et al (2006) Suicidal ideation among urban nine and ten year olds. J Dev Behav Pediatr 27:33–39CrossRefGoogle Scholar
  22. 22.
    Vander Stoep A, Adrian M, Mc Cauley E et al (2011) Risk for suicidal ideation and suicide attempts associated with co-occurring depression and conduct problems in early adolescence. Suicide Life Threat Behav 41:316–329CrossRefGoogle Scholar
  23. 23.
    Wyman PA, Gaudieri PA, Schmeelk-Cone K et al (2009) Emotional triggers and psychopathology associated with suicidal ideation in urban children with elevated aggressive-disruptive behavior. J Abnorm Child Psychol 37:917–928CrossRefGoogle Scholar
  24. 24.
    Pfeffer CR, Klerman GL, Hurt SW et al (1993) Suicidal children grow up: rates and psychosocial risk factors for suicide attempts during follow-up. J Am Acad Child Adolesc Psychiatry 32:106–113CrossRefGoogle Scholar
  25. 25.
    Angelkovska A, Houghton S, Hopkins S (2012) Differential profiles of risk of self-harm among clinically referred primary school aged children. Sch Psychol Int 33:646–660CrossRefGoogle Scholar
  26. 26.
    Kovess-Masfety V, Pilowsky DJ, Goelitz D et al (2015) Suicidal ideation and mental health disorders in young school children across Europe. J Affect Disord 177:28–35CrossRefGoogle Scholar
  27. 27.
    Banny AM, Cicchetti D, Rogosch FA et al (2013) Vulnerability to depression: a moderated mediation model of the roles of child maltreatment, peer victimization, and serotonin transporter linked polymorphic region genetic variation among children from low socioeconomic status backgrounds. Dev Psychopathol 25:599–614CrossRefGoogle Scholar
  28. 28.
    Cicchetti D (2016) Socioemotional, personality, and biological development: illustrations from a multilevel developmental psychopathology perspective on child maltreatment. Annu Rev Psychol 67:187–211CrossRefGoogle Scholar
  29. 29.
    Finzi R, Har-Even D, Shnit D, Weizman A (2002) Psychosocial characterization of physically abused children from low socioeconomic households in comparison to neglected and nonmaltreated children. J Child Fam Stud 11:441–453CrossRefGoogle Scholar
  30. 30.
    Manly JT, Kim JE, Rogosch FA, Cicchetti D (2001) Dimensions of child maltreatment and children’s adjustment: contributions of developmental timing and subtype. Dev Psychopathol 13:759–782CrossRefGoogle Scholar
  31. 31.
    Miller AB, Esposito-Smythers C, Weismoore JT, Renshaw KD (2013) The relation between child maltreatment and adolescent suicidal behavior: a systematic review and critical examination of the literature. Clin Child Fam Psychol Rev 16:146–172CrossRefGoogle Scholar
  32. 32.
    Reichman NE, Teitler JO, Garfinkel I, McLanahan SS (2001) Fragile families: sample and design. Child Youth Serv Rev 23:303–326CrossRefGoogle Scholar
  33. 33.
    Achenbach T, Rescorla L (1991) Manual for the ASEBA school-age forms profiles. University of Vermont, Research Center for Children, Youth & Families, Burlington, VTGoogle Scholar
  34. 34.
    Achenbach TM (1991) Manual for the youth self-report and 1991 profile. Department of Psychiatry, University of Vermont, BurlingtonGoogle Scholar
  35. 35.
    Sourander A, Helstelä L, Haavisto A, Bergroth L (2001) Suicidal thoughts and attempts among adolescents: a longitudinal 8-year follow-up study. J Affect Disord 63:59–66CrossRefGoogle Scholar
  36. 36.
    Straus MA, Hamby SL, Finkelhor D et al (1998) Identification of child maltreatment with the Parent–Child Conflict Tactics Scales: development and psychometric data for a national sample of American parents. Child Abuse Negl 22:249–270CrossRefGoogle Scholar
  37. 37.
    Straus MA (2001) Scoring and norms for the CTS2 and CTSPC family research laboratory. University of New Hampshire, DurhamGoogle Scholar
  38. 38.
    Straus M, Hamby S (1997) Measuring physical and psychological maltreatment of children with the Conflict Tactics Scales. Out of the darkness: contemporary perspectives on family violence. SAGE Publications Inc, Thousand Oaks, pp 119–135CrossRefGoogle Scholar
  39. 39.
    Achenbach TM (1991) Child behavior checklist/4–18. Univ Vt, BurlingtonGoogle Scholar
  40. 40.
    Kessler RC, Andrews G, Mroczek D et al (1998) The World Health Organization composite international diagnostic interview short-form (CIDI-SF). Int J Methods Psychiatr Res 7:171–185CrossRefGoogle Scholar
  41. 41.
    Dickman SJ (1990) Functional and dysfunctional impulsivity: personality and cognitive correlates. J Pers Soc Psychol 58:95CrossRefGoogle Scholar
  42. 42.
    Straus MA, Hamby SL, Boney-McCoy S, Sugarman DB (1996) The revised conflict tactics scales (CTS2) development and preliminary psychometric data. J Fam Issues 17:283–316CrossRefGoogle Scholar
  43. 43.
    StataCorp. (2015) Stata statistical software: release 14. StataCorp LP, College StationGoogle Scholar
  44. 44.
    Gul H, Gurkan CK (2016) Child maltreatment and associated parental factors among children with ADHD: a comparative study. J Atten Disord 13:1278–1288Google Scholar
  45. 45.
    Pfeffer CR (1986) The suicidal child. Guilford Press, New YorkGoogle Scholar
  46. 46.
    Adam KS (1994) In: Sperling MB, Berman WH (eds) Suicidal behavior and attachment: a developmental model. Guilford Press, New York, pp 275–298Google Scholar
  47. 47.
    Pfeffer CR, Trad PV (1988) Sadness and suicidal tendencies in preschool children. J Dev Behav Pediatr 9:86–88CrossRefGoogle Scholar
  48. 48.
    Klaus NM, Mobilio A, King CA (2009) Parent–adolescent agreement concerning adolescents’ suicidal thoughts and behaviors. J Clin Child Adolesc Psychol 38:245–255CrossRefGoogle Scholar
  49. 49.
    Kashani JH, Goddard P, Reid JC (1989) Correlates of suicidal ideation in a community sample of children and adolescents. J Am Acad Child Adolesc Psychiatry 28:912–917CrossRefGoogle Scholar
  50. 50.
    Taylor CA, Guterman NB, Lee SJ, Rathouz PJ (2009) Intimate partner violence, maternal stress, nativity, and risk for maternal maltreatment of young children. Am J Public Health 99:175–183CrossRefGoogle Scholar
  51. 51.
    Guterman NB, Lee SJ, Taylor CA, Rathouz PJ (2009) Parental perceptions of neighborhood processes, stress, personal control, and risk for physical child abuse and neglect. Child Abuse Negl 33:897–906CrossRefGoogle Scholar
  52. 52.
    Thomas R, Zimmer-Gembeck MJ (2012) Parent–child interaction therapy: an evidence-based treatment for child maltreatment. Child Maltreat 17:253–266. CrossRefPubMedGoogle Scholar
  53. 53.
    Brotman LM, Calzada E, Huang K-Y et al (2011) Promoting effective parenting practices and preventing child behavior problems in school among ethnically diverse families from underserved, urban communities. Child Dev 82:258–276. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.G87 Martha van Rensselaer Hall, Cornell UniversityIthacaUSA
  2. 2.Department of Psychology, Hunter CollegeCity University of New YorkNew York CityUSA
  3. 3.Institute of Social Medicine, Occupational Health and Public Health, University of LeipzigLeipzigGermany

Personalised recommendations