Teens who were harassed by a caretaker or by peers or who were sexually assaulted were more than twice as likely to consider suicide as those who were not victimized, researchers found.

In a study assessing the effects of multiple forms of victimization on teens’ suicidal ideation, being the target of parental maltreatment (OR 4.35, 95% CI 2.14 to 8.32), sexual assault (OR 3.35, 95% CI 1.34 to 7.53), and peer victimization (OR 2.35, 95% CI 1.19 to 4.47) were significantly associated with suicidal ideation, according to Heather Turner, PhD, of the University of New Hampshire in Durham, and colleagues.

Teens who had been polyvictimized - those exposed to seven or more types of harassment—in the past year were nearly six times as likely to think about suicide (OR 5.81, 95% CI 3.09 to 10.15), they wrote online in the Archives of Pediatrics and Adolescent Medicine.

“These findings emphasize the need to include comprehensive victimization assessment in adolescent suicide prevention and intervention efforts,” Turner and co-authors noted, adding that teenage patients who experienced harassment from peers or a caretaker, or who were the victims of sexual assault, should have suicide risk assessment included in treatment.

Youth suicide is the third leading cause of death among adolescents in the U.S., behind auto accidents and homicide, the authors wrote. They analyzed the effects of a number of victimizing exposures on suicidal ideation across two points in time among 1,186 students, ages 10 to 17, who participated in the National Survey of Children’s Exposure to Violence—a nationally representative survey that obtains data on incidence and prevalence rates “of a wide range of childhood victimizations.” Participants’ demographic characteristics were collected, and they were asked if they had been victimized in any of a number of different ways in the past year, including peer victimization, sexual assault, witnessing family violence, exposure to community violence, and maltreatment by a parent or caregiver. They also were asked about ever being diagnosed with an internalizing disorder, such as posttraumatic stress or anxiety disorder. Participants were contacted by phone initially in the first half of 2008 and followed-up with in 2010. Data were used to determine whether there were significant differences in suicidal ideation by demographic and victimization exposure types, to measure the effects of each victimization category independently, and to assess the effect of polyvictimization as noted at the first contact on suicidal ideation reported in the follow-up calls. The researchers found:   Although only 4.3% of respondents reported experiencing suicidal ideation, nearly twice as many females as males reported suicidal ideation (5.6% versus 2.9%, P<0.05). Nearly 11% of students in parent-stepparent families reported having suicidal ideation compared with two biological- or adoptive-parent families (3.1%), single-parent families (4.3%), and other adult caregivers (2%, P<0.001 for all). At follow-up, participants who had been subject to polyvictimization had almost six-fold increased odds of contemplating suicide compared with participants who hadn't been victimized (OR 5.81, 95% CI 3.09 to 10.15). Teens who had ever been diagnosed with an internalizing disorder had more than fourfold increased odds of suicidal ideation (OR 4.05, 95% CI 1.78 to 8.26) compared with those who had never had such a diagnosis. Witnessing community or familial violence was not significantly associated with suicidal ideation. The researchers noted that they could not explain the “particularly strong influence of maltreatment” by a caregiver on suicidal thoughts, but hypothesized that mistreatment by “those on whom youth typically depend for safety, stability, and nurturance” may increase feelings of hopelessness. The authors said the study was limited by lower numbers of suicidal affect, which also decreased statistical power to measure associations and perform subgroup analyses.