TOPLINE:

Among 1391 youth aged 10-17 years evaluated for sexual abuse, more than 11% experienced suicidality within 90 days, with nearly 22% of those attempting suicide. Sexual and gender diverse (SGD) youth showed higher rates of suicidality than non-SGD youth.

METHODOLOGY:

• Researchers conducted a retrospective chart review using electronic health records (EHRs) from a medically based child advocacy center (CAC) within a large Midwestern children’s hospital in the US between January 1, 2018, and December 31, 2022.
• A total of 1391 youth aged 10-17 years who received forensic interviews and medical assessments for child sexual abuse (CSA) were included, with exclusions for those without CSA disclosures, follow-up-only visits, or residence outside the county and six adjacent counties.
• Suicide risk screening was performed during CAC evaluations for all patients older than 11 years and for 10- or 11-year-olds if caregivers expressed concerns regarding dysphoric mood, suicidal ideation, or self-harm.
• Researchers reviewed each adolescent’s healthcare encounters across the institution during the 90 days following CAC evaluation to identify reports of suicidality, including suicidal ideation, suicide attempts, or deaths by suicide.
• Demographic data including age, sex, race, ethnicity, and SGD status were retrieved from the EHR, and the relationship between the alleged perpetrator and child was coded as relative or nonrelative based on forensic interview information.

TAKEAWAY:

• Among youth evaluated at the CAC, 11.1% were presented with suicidality within 90 days, and of those, 21.9% attempted suicide during that period.
• Youth reporting current depressive symptoms or suicidal ideation at CAC evaluation had significantly higher rates of suicidality within 90 days than those who did not (16.3% vs 4.7%; P < .001 and 29.6% vs 10.4%; P < .001, respectively).
• Youth with a history of suicidal ideation or prior suicide attempts at CAC evaluation showed significantly higher rates of suicidality within 90 days than those without such history (17.1% vs 2.6%; P < .001 and 25.1% vs 7.4%; P < .001, respectively).
• Among youth whose relationship with the alleged perpetrator was known, a significantly greater proportion of suicide attempts occurred when the perpetrator was a nonrelative rather than a relative (3.2% vs 1.4%; P = .03).

IN PRACTICE:

“This study supports the need for suicidality screening for youth both at the time of child sexual abuse evaluation as well as in the weeks and months following disclosure. Prompt, trauma-informed mental health care is critical for preventing further harm, especially for high-risk youth, including individuals with current depressive symptoms, prior suicidal ideation, and those who identify as sexual and gender diverse,” the authors of the study wrote.

SOURCE:

This study was led by Daisy Sornabala, Meharry Medical College School of Medicine in Nashville, Tennessee, and Nichole L. Michaels, PhD, Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital in Columbus, Ohio. It was published online in Pediatrics.

LIMITATIONS:

The study cannot demonstrate that cases of suicidality reported were a direct result of CSA. Data were collected from one CAC in the US with robust mental health resources and may not be representative of the general US population or all CACs. If an adolescent presented with suicidality within the 90-day period to a healthcare provider not accessible via the hospital’s EHR, that encounter was not included, and patients experiencing suicidality who did not seek healthcare were also not captured, potentially underrepresenting suicidality and suicide attempts. Cases of nonsuicidal self-injury may have been inadvertently coded as suicidality based on EHR information. Cases in which youth presented with suicidality outside the 90-day window were excluded. Researchers were unable to obtain a complete accounting of each patient’s mental health encounters pre- and post-CAC evaluation, which could provide valuable context for understanding patterns of behavior.

DISCLOSURES:

Sornabala’s work on this study received support from the National Student Injury Research Training Program of the Center for Injury Research and Policy at Nationwide Children’s Hospital, which was funded by the Child Injury Prevention Alliance. The authors disclosed having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.