More than words: The association of childhood emotional abuse and suicidal behavior

All types of abuse and neglect have been associated with suicide attempts. However, the association between the level of each type of childhood trauma and suicidal behavior severity (including the progression from ideation to attempts), adjusting for their co-occurrence, is not yet clear.

We used a cross-sectional web-based survey collected from the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP) to investigate the isolated effects of each type of childhood trauma on suicidal behavior severity. The sample consisted of 71,429 self-selected volunteers assessed with the Childhood Trauma Questionnaire (CTQ) and the following key question: "Have you ever thought about or attempted to kill yourself?" (Suicidal Behavior Questionnaire, SBQ-17).

After adjusting for demographic variables, and childhood trauma subtypes, severe emotional abuse (EA) was associated with suicidal ideation and attempts, mainly for serious suicide attempts (OR, 22.71; 95% CI, 2.32-222.05). We found associations of smaller magnitude for severe emotional neglect (EN) with serious suicide attempts, and for severe physical neglect (PN) and sexual abuse (SA) with attempts without really meaning to die. No meaningful trend for physical abuse (PA) was found. Using as reference group ideators, EA was associated with serious suicide attempts, with a peak at the 95th percentile (OR, 4.39; 95% CI, 2.04-9.41). We found associations of smaller magnitude for PN and SA, and no meaningful trend for EN and PA.

Suicidal behavior was strongly associated with emotional abuse in childhood, even when compared with ideators, suggesting that it is a relevant factor for the progression from ideation to attempts.