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Original Investigation |

Association of Child Abuse Exposure With Suicidal Ideation, Suicide Plans, and Suicide Attempts in Military Personnel and the General Population in Canada

Tracie O. Afifi, PhD1,2; Tamara Taillieu, MSc3; Mark A. Zamorski, MD4,5; Sarah Turner, BHSc1; Kristene Cheung, MA6; Jitender Sareen, MD, FRCPC1,2,6
[+] Author Affiliations
1Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
2Department of Psychiatry, University of Manitoba, Winnipeg, Canada
3Department of Applied Health Sciences, University of Manitoba, Winnipeg, Canada
4Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada
5Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
6Department of Psychology, University of Manitoba, Winnipeg, Canada
JAMA Psychiatry. 2016;73(3):229-238. doi:10.1001/jamapsychiatry.2015.2732.
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Importance  Recent evidence indicates a high prevalence of child abuse exposure in modern US veterans, which may explain in part their higher likelihood of suicide relative to civilians. However, the relationship between child abuse exposure and suicide-related outcomes in military personnel relative to civilians is unknown. Furthermore, the associations among deployment-related trauma, child abuse exposure, and suicide-related outcomes in military personnel have not been examined.

Objectives  To determine whether child abuse exposure is more prevalent in Canadian Armed Forces (CAF) personnel compared with the Canadian general population (CGP); to compare the association between child abuse exposure and suicidal ideation, suicide plans, and suicide attempts among the CAF and CGP; and to determine whether child abuse exposure has an additive or interaction effect on the association of deployment-related trauma and past-year suicidal ideation and suicide plans among Regular Forces personnel.

Data, Setting, and Participants  Data were collected from the following 2 nationally representative data sets: the 2013 Canadian Forces Mental Health Survey (CFMHS) for the CAF (8161 respondents; response rate, 79.8%) and the 2012 Canadian Community Health Survey–Mental Health (CCHS-MH) for the CGP (23 395 respondents; response rate, 68.9% [of these, 15 981 age-matched participants were drawn]). Data were collected from April 15 to August 31, 2013, for the CFMHS and January 2 to December 31, 2012, for the CCHS-MH. Data were analyzed from October 2014 to October 22, 2015. Statistical weights were applied to both data sets.

Main Outcomes and Measures  Child abuse exposure, including physical abuse, sexual abuse, and exposure to intimate partner violence, and deployment-related trauma were assessed in relation to suicide-related outcomes.

Results  Data were analyzed from 24 142 respondents aged 18 to 60 years (Regular Forces, 86.1% male and 13.9% female; Reserve Forces, 90.6% male and 8.9% female; and CGP, 49.9% male and 50.1% female). Any child abuse exposure was higher in the Regular Forces (47.7%; 95% CI, 46.4%-49.1%) and Afghanistan mission–deployed Reserve Forces (49.4%; 95% CI, 46.3%-51.5%) compared with the CGP (33.1%; 95% CI, 31.8%-34.4%). All types of child abuse exposures were associated with increased odds of suicidal ideation, suicide plans, and suicide attempts in the CGP (range of adjusted odds ratios [AORs], 3.0 [95% CI, 2.3-3.9] to 7.7 [95% CI, 5.7-10.3]; P < .05) and CAF (range of AORs, 1.7 [95% CI, 1.0-2.9] to 6.3 [95% CI, 4.2-9.5]; P < .05), with many associations significantly weaker in military personnel relative to civilians. Additive effects for past-year suicide ideation (AOR, 2.7; 95% CI, 1.8-4.2) and past-year suicide plans (AOR, 4.6; 95% CI, 2.3-9.2) but not interactive effects for past-year suicide ideation (AOR, 1.2; 95% CI, 0.7-2.2) and past-year suicide plans (AOR, 0.8; 95% CI, 0.3-2.2) were noted between deployment-related trauma and child abuse exposure among Regular Forces personnel.

Conclusions and Relevance  Individuals with a child abuse history may be more likely to enter the military, and child abuse exposure may increase the likelihood of suicide-related outcomes. Prevention efforts targeting child abuse may reduce suicide-related outcomes.

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Questions for Future Research
Posted on January 29, 2016
Williams, W. Sherod, PhD
Department of Defense
Conflict of Interest: None Declared
I am a psychologist who formerly worked in the Department of Veterans Affairs following the \"Tail Hook\" incident in the early 1990s. I developed training for trauma counselors who were being readied to provide counseling services to victims of military sexual trauma and assault. During the course of preparing the training, we reviewed the research literature on the topic, we found that researchers were reporting that about 16% of males and 33% of females reported some kind of abuse or neglect prior to entering the military.

After reading your article, I wondered if any of the data collected or to be collected could shed light on the following questions:

-With the elimination of the draft and the transition to an all volunteer military, have the rates of reported pre-military abuse and neglect increased?

-Given the different rates of suicide by Canadian and US military personnel that you report, what recommendations do you have for reducing the difference?
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