A Retrospective Case Control Study of Youth Suicide and Child Welfare Involvement

Objectives.This is the first population-based study to use linked administrative data to examine the significance of child welfare exposure on the risk of suicide. The study seeks to determine if there are differences in child protective service experiences that are associated with increased risk of suicide.

Methods.This is a population based, retrospective, case control study of suicide victims. Cases include all individuals between the ages of 15 and 19 years whose manner of death was coded as suicide in California between 2010 and 2017, and who had at least one referral of alleged abuse or neglect prior to the date of death. Each case was matched on sex, race/ethnicity, year of birth (age), and age of first maltreatment referral to four living controls. Information on child protection involvement for both cases and control came from administrative child protection records from California. A conditional logistic regression model was conducted, and adjusted odds ratios and 95% confidence intervals were reported.

Results.Overall, 505 California youth between 15 and 19 years, who had a history of child protective service involvement, committed suicide between 2010 and 2017. Results from a conditional logistic regression analysis demonstrated that youth who had ever received a referral for severe neglect [OR=6.2, 95%CI(4.26,8.97)] or physical abuse [OR=1.44, 95%CI(1.14,1.81)] were more likely to commit suicide. Female youth who had experienced sexual abuse were 2.14 times as likely to commit suicide (p<.001). Youth who had ever been removed and placed in relative care were 0.37 times as likely to commit suicide compared to youth who had never entered foster care (p<.001). Cases were also more likely to have received a greater number of lifetime referrals. Youth whose referral had ever been substantiated for any type of abuse were not significantly different from youth who had never experienced a substantiated referral.

Conclusions:This study supports previous research that has found physical and sexual abuse to be significant risk factors for suicidality. However, results from this study showed four unique findings; 1) there may be differential risk of suicide by sex for those who have experienced sexual abuse, 2) there is a dose-response relationship between the number of referrals and suicide risk,  3) having been removed from home and placed with a relative may act as a buffer for suicide risk, and 4) severe neglect was the greatest indicator of suicide risk. These findings underscore the importance of providing mental health services to all kids who are alleged to have experienced child maltreatment. Future research should examine the definition and role of general and severe neglect and its importance in child and adolescent psychopathology.