To What Extent can Adolescent Suicide Attempts be Attributed to Violence Exposure? A Population-Based Study from Western Canada

Abstract

Suicide is the second leading cause of death among adolescents in Canada and globally. The purpose of our study was to calculate what proportion of adolescent suicide attempts could be prevented in the absence of verbal, physical and sexual violence. Using the province-wide 2008 British Columbia Adolescent Health Survey (N=29,315) we calculated population-attributable fractions for each type of violence, as well as exposure to any violence, separately by gender, among adolescents age 12-19. We found violence victimization is implicated in the majority of suicide attempts. Focusing on violence prevention may be an important strategy for reducing suicide among young people.Violence victimization in adolescents has been identified as a significant public health problem (Mrug, Loosier, & Windle, 2008; Ruchkin, Henrich, Jones, Vermeiren, & SchwabStone, 2007), not only because adolescents experience higher rates of violence victimization than do other age groups in the general population, but more importantly, such experience significantly contributes to physical injury and death, as well as psychological maladjustment and mental health problems for adolescents (Finkelhor, Turner, Ormrod, & Hamby, 2009;Ruchkin et al., 2007). Considerable evidence exists suggesting that any type of violence, whether verbal teasing, being threatened with weapons, sexual harassment or sexual exploitation, and physical assault by a family member, an intimate partner, or peers at school, all can have negative effects on young people's emotional, behavioral, and developmental well-being (Buka, Stichick, Birdthistle, & Earls, 2001;Hebert, Lavoie, Vitaro, McDuff, & Tremblay, 2008;Swahn et al, 2008).In spite of the strong relationship demonstrated between violence exposure and youth health and well-being, violence has rarely been identified as a key social determinant of health for adolescents or indeed, any age group. According to the World Health Organization's definition, social determinants of health "are the conditions in which people are born, grow, live, work and age" (WHO, 2011). These circumstances shape people's health and are mostly responsible for the existence of health inequities (Raphael, 2010). As Mikkonen and Raphael (2010) argue, "the primary factors that shape the health of Canadians are not medical treatment or lifestyles choices but rather the living conditions they experience" (p7). CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptThis is particularly true for adolescents, because they less frequently suffer from acute or chronic diseases, compared to other age groups. Instead, their health, including their mental health, is largely determined by the living conditions they experience, and the nature of their relationships with the people in these environments.After road traffic accidents, suicide is the next most common cause of death among adolescents, both in Canada and throughout the world (Patton et al., 2009; Public Health Agency of Canada, 2011). Among the various risk factors for suicid...

Child Sexual Abuse among a Representative Sample of Quebec High School Students: Prevalence and Association with Mental Health Problems and Health-Risk Behaviors

“…For example, in the BC Adolescent Health Survey, sexual violence was linked to a heightened risk of suicide attempts for both boys and girls. 30 Our results suggest few gender differences in the association between child sexual abuse and the correlates examined while controlling for other forms of maltreatment. Our findings thus concur with past studies conducted with clinical samples of minor victims of sexual abuse and failed to identify gender differences in the severity of internalized, externalized, and trauma symptoms.…”

“…For example, in the BC Adolescent Health Survey, sexual violence was linked to a heightened risk of suicide attempts for both boys and girls. 30…”

Youth self-report of child maltreatment in representative surveys: a systematic review

“…12 Verbal sexual abuse How many times have you had unwanted sexual comments or jokes directed at you? 22 Did anyone hurt your feelings by saying or writing something sexual about your body? 12 Online victimization Did anyone on the Internet ever ask you sexual questions about (himself/herself/yourself) or try to get you to talk online about sex when you did not want to talk about those things?…”

Segmenting or Summing the Parts? A Scoping Review of Male Suicide Research in Canada

“…59 A population study ( n = 29,315; 48% males) reported that adolescent males were more likely than females to report physical violence (46% vs. 30%), and such experiences increased their odds 5-fold for making a suicide attempt; boys who experienced sexual violence were 3 times more likely than girls to make a suicide attempt. 70 Boys who reported being bullied were 2 to 3.5 times more likely to report suicidal ideation, mental distress, and delinquency. 60 Deviant behaviors were also a significant predictor of boys making a suicide attempt, 64 and among high school students ( n = 712; 360 males), boys with suicidal ideation scored higher on negative attribution style, hopelessness, and depression.…”