Thursday, 20 June 2013
Childhood Abuse, Depression and Suicide
Making the Connection Between Childhood Abuse, Depression and Suicide
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It is naive of us to believe that all children enjoy a happy childhood and family life; abuse remains the unspoken family secret and scientists are actively involved in research to help understand the long-term effects, and to prevent child abuse. The fact is that physical, emotional and sexual abuse, and to some degree neglect, in childhood leaves victims vulnerable to all manner of psychiatric disorders and a propensity toward committing suicide, usually in their young adulthood. Scientists and psychiatrists have made a firm connection between childhood abuse, depression and suicide.
Of course, not all victims of abuse in childhood attempt suicide. In a 2008 report published in the British Journal of Psychiatry, Dr. Gustavo Turecki and his colleagues at McGill University in Montréal, Canada, found that the incidence of suicide attempts bears a correlation to the type of abuse and the identity of the abuser; generally, a first-line relative, such as a father or brother, will have far greater impact on an individual. Neglect appears to be the least traumatic of the forms of abuse in terms of predicting the likelihood of depression and/or suicide later in life. Sexual abuse appears to carry the highest risk, and then emotional and physical abuse; the combination of two or more can be especially lethal.
The purpose of these studies is to identify adults who might be at greater risk for depression (and other psychiatric problems) and, ultimately, suicide by opening up conversation and recognizing the propensity of abused children to have mental illness leading to self-inflicted death as adults. There is also a factor that plays a role in the odds of a childhood abuse victim suffering from depression: memory.
There is a school of thought among psychiatric professionals that the brain of a child who suffers abuse finds a default mechanism to either switch off their ability to remember, and therefore dwell upon, abusive incidents, or to repress memories sufficiently that they are able to function in the aftermath of abuse. In both cases, the result is almost invariably depression. It is worthy to note that, statistically, 83.3% of childhood abuse occurs in the family home and between family members, not strangers. In a home where there is spousal abuse (more than just a typical argument between a couple), odds are close to 60% that there is also child abuse going on. In-home child abuse is seldom reported; the children involved usually live in fear and do not understand that they have options for recourse. As a result, episodes of depression frequently begin at a very young age, and are too often written off as childhood “moodiness”.
Dr. Thomas Verny, a practicing psychiatrist and author with a specialty in pre-natal psychology, knows that abuse can and sometimes does start before a child is even born, but the burden of it occurs once a child is functioning within the family unit. He has studied and counseled many childhood abuse victims, and says, “Repressed memories are a defense mechanism; it is an automatic process, not one that the victim thinks through.” He also believes that there is a distinct correlation between childhood abuse and depression, among other disorders, the worst of which, in his opinion, is borderline personality disorder, an incredibly complex mental illness. “Schizophrenia is actually easier to treat,” he says.
Joan is an only child, and now, in mid-life, an orphan; this is a fact in which she finds relief. Joan’s father was a patriarch with an iron fist, a bully. She was the couple’s only child and when her father’s day went poorly, Joan’s evening was hell. Her mother, also abused emotionally and physically, was paralyzed and did nothing to stop her husband’s tirades exacted upon their daughter. Joan could do no right by her father. If she brought home a near-perfect report card, he would pick holes in it until there was an excuse for battery. If she dressed in blue, she looked ugly; if she dressed in red she looked like a tart. Joan quit school at 17 and moved out; it probably saved her life, but the damage was done.
Joan has suffered from episodes of depression all her life, and there is nothing to suggest that because her father is dead now that these bouts will stop; they haven’t and he has been gone five years. Fortunately, when Joan attempted suicide for the second time when she was 21, she received excellent psychiatric care and knows how to cope with depression when it hits, to recognize the triggers and to nurture herself when the “darkness descends”, as she puts it. But Joan’s depression has a distinguishing feature to it: she instantly defaults to thoughts of suicide when the wall of depression consumes her. Because Joan knows this, she also understands that she is not truly suicidal any more, but this is how her brain copes, just as it chose repression of memory to withstand her childhood abuse.
Part of Joan’s strategy is to let the people who love her know as soon as she finds herself sliding into depression; that way, they do not bear the burden of guilt, and they know it’s nothing they have done. Thanks to this openness, Joan’s family does not have to fear she will take her own life. There is no way for Joan to make the abuse go away; it is part of her past and cannot be changed, so coping with its legacy is all she can do. Joan is able to rationalize her depression and three attempts at suicide, now that she is a mature adult and has received proper care, but she is 100% certain that the abuse she suffered as a child resulted in her depression and was the causative factor in her desire to end her life.
Scientists like Dr. Turecki and his team are engaged in their studies with the intention of predicting those at risk for suicide and preventing them from taking their own lives. In some instances, that’s harder than it sounds because a physical, biological shift occurs, not just mental trauma, in many cases of childhood abuse. Dr. Turecki, in examining 60 brains of mostly adult males who committed suicide, 40% of whom had been abused in some form during their childhoods, saw something startling: “There was a change to certain critical genes that then lead to the development of certain behaviors, that in turn increased the risk of suicide.” What Dr. Turecki witnessed was the result of a change in DNA; this is very different from depression as an outcome of childhood abuse. Like Joan’s experience with her brain taking what is tantamount to “separate” action to protect her from the abuse and its terrible memories, Dr. Turecki has found that traumas suffered due to abuse in childhood may actually cause the brain to undergo physical alterations, some of which may lead to suicide.
Some may argue that the sheer embarrassment, terror and shame brought on by childhood abuse is sufficient to warrant suicidal thoughts, and they’d be correct. But there is an established link between childhood abuse, depression and ensuing suicide. The rate of clinical depression and major depressive disorder in people who were abused as children is significantly higher than the general population.
Initially, Dr. Turecki’s team was searching for one specific gene that formed the connection, but much to their surprise, they have, thus far, uncovered more than 100 such genes. “It is more complex than we thought at the beginning,” says Benoit Labonte, a member of the McGill Group for Suicide Studies and part of Dr. Turecki’s research crew. With the aim of developing a test that will single out those at risk for suicide, and to find treatments (not just for the mental aspects, but for the physical alterations in the brain) -Dr. Turecki adds, “We know already that we can modify these changes in cell models.” There is hope for what victims would see as hopeless.
Another study conducted at the Department of Epidemiology, Mailman School of Public Health, Columbia University in New York City, took a slightly different approach to the same problem and revealed similar results. The 34,653 subjects of the study were a mixture of males and females all with a history of childhood abuse, to varying degrees. The study, reported in the February 20102 issue of the British Journal of Psychiatry, and entitled, “Childhood maltreatment and the structure of common psychiatric disorders”, looked more at the link between childhood abuse and depression as opposed to, ultimately, suicide. It found that men showed “externalizing liability”, where women experienced “internalizing liability”. In simple terms, this is how they burdened the guilt from their youthful experiences.
The Columbia study concluded: “The association between childhood maltreatment and common psychiatric disorders operates through latent liabilities to experience internalising and externalising psychopathology, indicating that the prevention of maltreatment may have a wide range of benefits in reducing the prevalence of many common mental disorders. Different forms of abuse have gender-specific consequences…”
What both of these studies, among many others, suggest is that by identifying childhood abuse, even if we are failing to prevent it (which we, as a society, are), we can take action to grapple with the psycho-social outcome, to help victims manage the ensuing depression, and prevent a vital person from ending his or her life.