Child Maltreatment and Adolescent Suicide Risk: Underlying Growth Patterns of Internalizing and Externalizing Symptomology

Introduction

Suicide is the second leading cause of death for adolescents (Centers for Disease Control and Prevention, 2016) and this risk is exacerbated by child maltreatment (CM; Miller, Esposito-Smythers, Weismoore, & Renshaw, 2013). CM has also been linked to internalizing (INT) and externalizing (EXT) problems in adolescence (Oshri, Rogosch, Burnette, & Cicchetti, 2011) and these problem behaviors are strongly associated with youth suicidal behaviors (Lewinsohn, Rohde, & Seeley, 1996). In order to develop targeted suicide prevention interventions for adolescents with CM histories, more research is needed on the developmental mechanism that underlies risk for suicidal behaviors. Thus, the present study aimed to identify and compare multiple trajectories of INT/EXT symptomology as underlying pathways to the association between CM and suicidal behaviors during adolescence.

Methods

A sample was obtained from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN; N = 1,241; 51.85% female). Data were obtained biannually at six time-points from age 6 to age 16. Type and severity of CM were coded by trained researchers based on Child Protective Services (CPS) records (MMCS; English & LONGSCAN Investigators). Caregivers reported on INT/EXT symptoms at child ages 6 to 14, with the Child Behavior Checklist (Achenbach, 1991). Adolescent suicide risk was assessed with three youth-reported items during the age-16 visit.

Patterns of change in INT/EXT symptomology over time were analyzed using parallel process growth mixture modeling, with Mplus 7.4 (Muthén & Muthén, 1998-2010). The appropriate class solution was chosen based on recommended fit indices (AIC, BIC, entropy; Muthén, 2003). Predictors and outcomes of growth trajectories were assessed using the 3-step approach (Lanza, Tan, & Bray, 2013)

Results

A four-class solution was deemed optimal based on statistical and conceptual criteria. Classes included a low INT/EXT class (82.25%), high EXT class (7.96%), high INT/EXT class (6.43%), and a declining INT moderate EXT class (3.37%). Compared to the low INT/EXT class, youth in the high INT/EXT class experienced more severe physical abuse (OR = 3.04, 95%CI [1.07, 8.58]) and sexual abuse (OR = 3.39, 95%CI [1.16, 9.94]), and youth in the high INT class experienced more severe neglect (OR = 2.45, 95%CI [1.24, 4.84]). The high INT/EXT class significantly predicted suicidal behaviors, as compared to the low INT/EXT and the high EXT classes.

Conclusions

Youth with growth in internalizing and externalizing symptomology throughout childhood and adolescence were at the greatest risk for suicidal behaviors in adolescence. Suicide prevention programs may be more effective by targeting maltreated youth with concurrent elevations in EXT/INT symptoms.