Is the relationship between child abuse and suicide attempts mediated by nonsuicidal self‐injury and pain tolerance?

Abstract

Although there is evidence for an association of child abuse with lifetime suicidal behaviour, the underlying mechanisms remain unclear. In recent research, we found this relationship to be indirect and mediated by capability for suicide (CS). Emotional and sexual abuse were directly associated with CS. Based on the Interpersonal Psychological Theory of Suicide, the result for emotional abuse was surprising and raised the question for a missing link in this association. Consequently, this study examines nonsuicidal self‐injury (NSSI) as an additional mediator (M1) between child abuse (X), pain tolerance (M2), and suicide attempts (Y). We included 308 psychiatric inpatients (M = 36.9 years, 53% female) with either an acute suicidal crisis (n = 146) or a recent suicide attempt (n = 157). For the assessment, we used the Childhood Trauma Screener (CTS), the German version of the self‐injurious thoughts and behaviours interview (SITBI‐G), the German Capability for Suicide Questionnaire (GCSQ), and a pressure algometer for measuring pain tolerance objectively. Serial mediator analyses were applied. All types of abuse showed relationships with NSSI, which itself was connected to suicidal behaviour in almost all models, whereas pain tolerance did not show the expected relations. The results suggest that NSSI is an important predictor for suicide attempts and should be considered in suicide risk assessment. Future research should address this topic in prospective studies with a more comprehensive assessment of child abuse. In summary, this study once again highlights the serious effects of child abuse and in particular the mediating role of NSSI.

Child abuse and suicidality in the context of the Interpersonal Psychological Theory of Suicide: A network analysis

“…In contrast, Schönfelder et al. (2021) found no subtype of abuse to be associated with CS but NSSI showed correlations with both, child abuse and suicide attempts.…”

“…In addition to the immense impact it has on physical health (Afifi et al., 2008, 2016), child abuse also has substantial adverse lifelong effects on mental health (Afifi et al., 2008; Norman et al., 2012). Correspondingly, research has shown that experiences of abuse during childhood are related to various self‐destructive behaviours such as substance abuse (Jaffee, 2017), non‐suicidal self‐injury (NSSI; Brown et al., 2018; Schönfelder et al., 2021), suicidal ideation (Bruwer et al., 2014; Gibb et al., 2001), and suicidal behaviour (Liu et al., 2017; Norman et al., 2012; WHO, 2016; Zatti et al., 2017). As these results demonstrate, the relationship between child abuse and suicidality has been shown repeatedly.…”

“…As this list of emotional abuse types includes some potentially fear‐inducing behaviours, it may help illuminate the direct relationship between emotional abuse and CS via the sub‐dimension fearlessness about pain and death . Several studies also have investigated the relationship between child abuse, the components of the IPTS (Allbaugh et al., 2017; Schönfelder et al., 2019; Smith et al., 2017), and suicidality (Allbaugh et al., 2017; Schönfelder et al., 2019, 2021) in mediation models. Since these four studies are fundamental for the present study, a brief introduction is in order.…”

“…The second study by Schönfelder et al. (2021) focussed solely on the relationship between child abuse and suicide attempts and added a second mediator (NSSI) beyond CS to the analysis. The common finding of the first three studies was that neither physical nor sexual abuse was significantly related to PB or TB.…”

“…Since prior research has already shown that the IPTS can act as a suitable theoretical framework for understanding how child abuse is related to suicidality in adulthood (Schönfelder et al., 2019, 2021), the present study used this theory and its components, but differed in terms of the assessment of child abuse, the simultaneous analysis of all relevant variables in one network and the fact that it was measuring suicide attempts prospectively (six‐month follow‐up period). The network was constructed to consist of the three subtypes of child abuse (physical, sexual, and emotional), the three components of the IPTS (TB, PB, and CS), suicidal ideation, and suicide attempts, which were assessed via interviews (suicidal ideation and suicide attempts) and self‐report questionnaires (child abuse, TB, PB, and CS).…”