Miller, A. B., Jenness, J. L., Oppenheimer, C. W., Gottleib, A. L. B., Young, J. F., & Hankin, B. L. (2016). Childhood emotional maltreatment as a robust predictor of suicidal ideation: A 3-year multi-wave, prospective investigation. Journal of Abnormal Child Psychology, 45(1), 105-116.
Emotional maltreatment (i.e., verbal assaults directed to a child’s sense of well-being or self-worth) has been found to be a strong predictor of later internalizing problems even after accounting for other forms of child maltreatment. Children who have experienced emotional maltreatment are found to have poor cognitive flexibility, poor emotional regulation abilities, reduced prosocial behaviour, increased levels of aggression, and are at a greater risk of depression and anxiety. The experience of child maltreatment is a powerful predictor of suicidal ideation, with both cross-sectional and longitudinal studies finding this association. Current evidence indicates that there is an association between emotional maltreatment and suicidal ideation; however, due to methodological weaknesses in past studies (e.g., cross-sectional designs, single indicators of suicidal thoughts) additional longitudinal studies are required to expand our understanding of this relationship. The authors argue that little research has examined the impact of emotional maltreatment on suicidal ideation longitudinally and this type of research is necessary in order to better understand the associated consequences of emotional maltreatment over time.
The current study examines the relationship between emotional maltreatment and suicidal ideation through a 3-year longitudinal multi-wave path analysis model. This study examines the potential mediating effects that depression may have on this relationship as well as assessing biological sex as a potential moderator. Data included 682 youth aged 7-18 years who were recruited as part of a larger study addressing the development of depression in youth.
Descriptive statistics were used to describe levels of emotional maltreatment, depression, and suicidal ideation at Time 1, 2, and 3. Path analysis models were used to examine the relationship between emotional maltreatment and suicidal ideation across time points. Previous emotional maltreatment, suicidal ideation, depressive symptoms and age were controlled for across all time points. A multi-group analysis was later conducted to examine the effects of biological sex on the relationship between emotional maltreatment and suicidal ideation.
Overall, these results suggest that over time emotional maltreatment “contributes to the prospective prediction of suicidal ideation, even after controlling for age, suicidal ideation, biological sex, and depression. The relationship between Time 2 emotional maltreatment and Time 3 depressive differed by sex. This relationship was more significant for girls compared to boys (β = 0.29, SE = 0.05, p < .001; β = 0.13, SE = 0.06, p = .05 respectively).
Data were obtained from three measures: the Self-Injurious Thoughts and Behaviours Interview (SITBI; Nock et al., 2007), the Children’s Depression Inventory (CDI; Kovacs, 2003), and the Childhood Trauma Questionnaire (CTQ-EA; Bernstein et al., 2003; Bernstein & Fink, 1998).
Given that the study was longitudinal, authors note that there was some missing data. Authors report that of the total 682 participants, 30% had missing suicidal ideation data at Time 2 and 34% at Time 3. Participants with complete suicidal ideation data at both Time 2 and Time 3 were noted to not differ significantly across demographic variables (e.g., sex, age, race/ethnicity) or all independent variables of interest. No other information was provided on missing data or attrition rates.
The authors noted a number of strengths in this study. First, the study was conducted over three years as opposed to a single point in time. Authors noted that this longitudinal analysis of the relationship between emotional maltreatment and suicidal ideation was the first time it was assessed in this manner, thereby providing a better understanding of emotional maltreatment and its consequences across time. Second, depressive symptoms were included at each time point allowing researchers to better understand its influence on the relationship between emotional maltreatment and suicidal ideation. Third, researchers used repeated valid measures at each time point. Fourth, given the ages included in the sample size, researchers were able to examine risk of suicidal ideation across different developmental stages and follow these children and youth longitudinally as they continued to develop. Last, the study had a large sample size which will lead to greater external validity.
Despite these strengths there are also a number of limitations. First, authors specifically looked at emotional maltreatment and did not take into account other forms of abuse (i.e., physical, sexual) that may be better predictors of suicidal ideation. Second, the study primarily focused on suicidal ideation and did not take into account suicide attempts, therefore it is still unknown if emotional maltreatment lead to suicide attempts. Third, despite being a longitudinal study the emotional maltreatment measure used in the study was self-report and retrospective. Last, the current study did not address childhood resilience and why some children do not display the negative consequences associated with emotional maltreatment, while other children continue to be impacted by their experiences.