The association between child abuse and attempted suicide: A retrospective cohort study

Background: Child abuse and suicide among the young population is a serious and prevalent problem. Many studies have demonstrated that people with adverse childhood experiences, such as child abuse, are likely to develop suicidal behavior. This study evaluates the connection between child abuse and suicidal behavior in the Hong Kong community where incidents of child abuse have been on the rise over the past decade. Aims: To determine the association between child abuse and attempted suicide in the child population of Hong Kong using hospital electronic medical records system. Method: From January 1, 1995 to July 31, 2016, patients with admission age < 18 years with the diagnosis of child abuse or influenza infection (comparison group) were included in this study (n = 54,256). In secondary data analysis, an association was found between children who had experienced child abuse and the outcome measure of hospital admission for attempted suicide compared with influenza infection. Results: The adjusted hazard ratio of attempting suicide in children who experienced sexual abuse and physical abuse compared with the influenza-infected group was 6.48 (95% CI [4.56, 9.19]) and 4.83 (95% CI [3.67, 6.34]). The age at onset of adverse incidents was negatively associated with the attempted suicide timing. Female patients had a 1.64 higher risk of repeating attempted suicide. In addition, nearly 5% of children who had experienced child abuse attempted suicide in the 10 years after their admission, and more than 36% of patients had a record of repeated suicide attempt in the 20 years after the initial admission. Limitations: The accuracy of the diagnosis, selection bias, insufficiency of study period, Berkson’s bias, incomplete socioeconomic status, as well as the absence of psychiatric diagnosis are the limitations. Conclusion: Our results indicate that there is a significant association between child abuse and suicide attempts in Hong Kong. If confirmed, the study (a) demonstrates that hospital admission records are a critical source for identifying children with a high risk for suicidal behavior; (b) may inform policy makers that additional and long-term intervention programs should be provided to children so as to reduce subsequent suicide attempts.