From Childhood Adversity to Suicidal Ideation in Adolescents: The Path through Internalizing and Externalizing Behaviors

Background and Purpose: Children who have been exposed to maltreatment and other childhood adversities are at increased risk for various negative health outcomes in adolescence and early adulthood, including internalizing behaviors and externalizing behaviors. However, the proximal path from adversity experiences and behavioral outcomes to suicidal ideation in adolescents is less clear. While there is an extant research base on the associations between internalizing and externalizing behaviors and suicidality, the link between childhood adversity and the behavioral problems that can lead to suicidality in adolescents is unclear. The present study aims to investigate the pathway between childhood adversity and suicidal ideation in adolescents, through internalizing and externalizing behaviors.  

Methods:  We analyzed data from 947 youth from the five sites of the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) study. Recruitment at all sites included children with exposure to maltreatment, ranging from those with a maltreatment reports, to those with substantiated early history of maltreatment. Data on suicidal ideation was collected at ages 16 and 18; discrete reports at both time points were combined resulting in ideation being reported by 22.2% of adolescents. Data on 7 childhood adversities experienced before age of 16 was collected from participants (yes vs. no); these  were separated into two categories: ‘maltreatment’ (4 items; physical, sexual, emotional abuse, and neglect) and ‘family dysfunction’(3 items; parental history of substance use, intimate partner violence, and incarceration). Youth Self-Report (YSR) reports at age 16 of adolescent’s internalizing and externalizing behaviors were included to examine the path between childhood adversity and adolescent suicidal ideation. Internalizing behaviors consist of withdrawn, somatic complaints, and anxious/depressed scores. Externalizing behaviors consist of delinquent and aggressive behavior scores. Covariates included child’s gender, race, and baseline depression. Path analysis were conducted using Mplus version 8. Missing data were managed with full information estimation.

Results: The mean score for maltreatment was 0.98 (range 0 to 4) and 1.69 for family dysfunction (range 0 to 3). Results of the path models showed that ‘maltreatment’ (0.13, p<.05), but not family dysfunction was directly associated with suicidal ideation. Maltreatment was also positively associated with both internalizing  (0.16, p<.05) and externalizing (0.12, p<.05) behaviors. Internalizing (0.15, p<.05) and externalizing (0.12, p<.05) behaviors were both significantly associated with suicidal ideation. There were no significant paths for family dysfunction.

Conclusions and Implications: This study highlights the ways in which childhood adversity impacts adolescent suicidal ideation through internalizing and externalizing behaviors. Our findings support recent literature that suggests that type of childhood adversity may be more important to understand than number of adversities experienced. Specifically, by examining childhood maltreatment and family dysfunction separately, our findings suggested that adolescents with history of childhood maltreatment are at increased need for prevention strategies that increase coping skills and social support that can reduce suicidality.