Psychopathological mechanisms of early neglect and abuse on suicidal ideation and self-harm in middle childhood.

Informed by diathesis-stress models of suicide risk, this longitudinal study examines the psychopathological mechanisms through which early maltreatment increases the risk for suicidal ideation and self-harm in middle childhood. The sample included 2958 families from the Fragile Families and Child Wellbeing Study, who participated in interviews at child's ages of 3 and/or 5, and 9. Via the Child Behavior Checklist, primary caregivers reported on the child's suicidal ideation and self-harm at age 9 and on clinically elevated depressive/anxious symptoms, aggressive behaviors, attention problems, and comorbid aggression and depressive/anxious symptoms at age 5. Past year neglect and physical/psychological abuse were measured via the Parent-Child Conflict Tactics Scale at age 3. Multivariate structural equation models indicated that early neglect had a significant indirect effect on suicidal ideation via clinically elevated depressive/anxious symptoms (OR = 1.57, 95% CI 1.09-2.25) and comorbid symptomatology (OR = 1.28, 95% CI 1.02-1.62), and on self-harm also via clinically elevated depressive/anxious symptoms (OR = 1.39, 95% CI 1.04-1.84) and comorbid symptomatology (OR = 1.20, 95% CI 1.01-1.43). Early physical/psychological abuse had a significant indirect effect on self-harm via clinically elevated attention problems (OR = 1.09, 95% CI 1.01-1.21). Unique developmental pathways for suicidal ideation and self-harm emerged among children exposed to abuse or neglect. For those exposed to early neglect, interventions should target depressive/anxious symptoms, especially when comorbid with aggression, to prevent suicidal ideation and self-harm. For children exposed to early physical/psychological abuse, problems with attention and impulsivity may be targets for reducing the risk for self-harm.