by University of Barcelona

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An article published in the Journal of Clinical Medicine reveals child maltreatment increases some determining risk factors in adolescents' suicidal behaviors. According to this research, people who have suffered child maltreatment are more likely to show personality traits that are related to intense anger, impulsivity and emotion dysregulation. Also, they tend to undergo more stressful situations over their life. These new stressors and emotion dysregulation would be the factors that could lead to suicidal behaviors in adolescents.

The study is led by Professor Lourdes Fañanás, from the Faculty of Biology of the University of Barcelona, the Institute of Biomedicine of the UB (IBUB) and the Mental Health Networking Biomedical Research Centre (CIBERSAM). Researcher Laia Marques-Feixa, also member of these institutions, is the first author of the article. Carried out together with the CIBERSAM EPI-Young Stress Group, the study counts on the participation of teams from the University of Lleida, the Benito Menni Mental Health Care Complex (Sant Boi de Llobregat), Hospital Clínic de Barcelona, the University Hospital Gregorio Marañón (Madrid), the University Hospital Puerta de Hierro (Madrid), the University Hospital Araba—Santiago Apóstol (Vitoria) and the Adolescent Day-Hospital in Gavà, from the Orienta Foundation.

Suicide in young adults: A global health problem

In Spain, suicide is now the first cause of death among young people. Although death by suicide in adults has a higher prevalence in men than women, women show more suicidal and non-suicidal attempts (self-harming, for instance) than men. As a worrying figure, during the pandemic caused by COVID-19, the number of hospitalizations of women aged between twelve and eighteen with self-harming behaviors has skyrocketed.

The new study focuses on the analysis of 187 children and adolescents aged from seven to seventeen, with and without mental disorders. The researchers have analyzed their experiences of child abuse, recent stressful life episodes, and some personality traits and the risk of suicidal behaviors.

"Adolescence is a period of high emotional vulnerability and 70% of mental disorders are estimated to come up during this time", notes Professor Lourdes Fañanás, member of the Department of Evolutionary Biology, Ecology and Environmental Sciences of the UB and principal researcher at the CIBERSAM group. "The brain of an adolescent —she continues— undergoes a process of maturation and this process might involve difficulties in self-control and a higher impulsivity and emotional instability, which are decisive elements for developing some risky behaviors".

"It is also a period full of changes (family dynamics, new groups with classmates, new challenges and activities, etc.) that can involve an increase of stressful situations for young people", adds Fañanás.

Moreover, according to the researcher Laia Marques-Feixa (UB-IBUB-CIBERSAM), "when there is a relational trauma during childhood —for instance, psychological, physical or sexual abuse or negligence—, three primary developmental capacities can be altered: emotional regulation, identity and interpersonal relatedness". "If one reaches adolescence without having consolidated good bases in these skills, this person can have more difficulties due to the lack of solid psychological resources to deal with challenges, conflicts and daily difficulties that come up over the course of our life", concludes the expert.

Young psychopathology: The journey to adolescence

Life experiences, apart from genetic predisposition, are decisive elements to define our personality. In psychology, experts talk about personality disorders when the way in which someone understands, thinks and relates to the environment and him or herself is inflexible and maladaptive, so that it all creates a psychological discomfort and deterioration of the quality of life.

The study does not establish a direct link between child maltreatment and the possibility of expressing a suicidal behavior in youngsters. However, the conclusions indicate that suffering from child maltreatment increases risk factors that can lead to suicidal behaviors in adolescents.

"Our research shows that, in order to reduce suicidal behaviors in adolescents, we need to work on the regulation strategies of emotions, as well as to reduce the potential exposure to new stressful events (changing homes, fights, suspension from school, etc.), especially regarding those people with records of child abuse", notes Laia Marques-Feixa.

Since adolescence is the period when the foundations of our personality are being built, it is hard to make a diagnosis of these disorders among youngsters. "Moreover, there are some common traits between the different personality disorders, and this condition makes it harder for us to make a specific diagnostic", highlights expert Jorgue Moya-Higueras, from the University of Lleida and CIBERSAM.

"This is why —he continues—, approaching this issue from a more dimensional perspective —with transdiagnostic personality traits over a continuous period of time, such as emotional dysregulation— can be a more useful strategy than the categorical classification (present disorder or not present)".

More investment in public healthcare to improve prevention

At the moment, the SURVIVE consortium —an initiative promoted by the European Regional Development Fund (ERDF) from the European Union, the Carlos III Health Institute, and the Ministry of Science, Innovation and Universities— gathers several institutions and hospitals to study the suicide incidence, assess the risk factors, and design intervention and prevention strategies.

Promoting more complex and longitudinal studies —with more to consider— will be an essential element for defining factors of prediction of suicide in adolescents and improving the prevention strategies with all the health and social involved stakeholders.

In this context, the first step to prevent suicidal behaviors "would be to invest more money in prevention, specially regarding the young population. This means we need to support the families so that these children can grow up in a healthy and safe atmosphere", notes the team.

Secondly, we need a good detection and early intervention in children and adolescents who show emotional or behavioral difficulties, as warned by the experts. Although there is a code for suicidal risk, public healthcare should offer a wide network of professionals, services and resources to aid as soon as possible. "Since most people who present suidical behaviors have an associated mental disorder, the most important thing to start with should be this", note the experts.

Despite the population's high demand of these services over the last years, the ratio of public professionals of mental health in Spain is only 6 per every 100,000 people. These figures are tripling in Europe. "Therefore, to solve this shameful deficit we should start by investing in mental health, specially in children and adolescents, from the different health services, education, justice, etc.", concludes the research team.

More information: Laia Marques-Feixa et al, Risk of Suicidal Behavior in Children and Adolescents Exposed to Maltreatment: The Mediating Role of Borderline Personality Traits and Recent Stressful Life Events, Journal of Clinical Medicine (2021). DOI: 10.3390/jcm10225293

Provided by University of Barcelona