Home > Public Resources > Trauma Blog > 2020 - September > Understanding Predictors of Suicidal Ideation Among Sexually Abused Adolescent Girls Understanding Predictors of Suicidal Ideation Among Sexually Abused Adolescent Girls Marianne Girard, M.A., Martine Hébert, Ph.D., Natacha Godbout, Ph.D., Mireille Cyr, Ph.D., Jean-Yves Frappier, Ph.D. October 20, 2020 Child sexual abuse is linked with deleterious consequences on adolescent girls’ mental health. Among these, one particularly harmful repercussion of abuse is suicidal ideation, or suicidal thoughts. Suicidality is an indicator of psychological distress which can lead to disastrous consequences including suicidal attempts or death. Yet, not all sexually abused adolescent girls experience suicidal ideation, hence the importance of gathering a better understanding of the variables influencing suicidality. Previous studies highlighted depressive symptoms and affect dysregulation as potential predictors of suicidal ideation (Alix et al., 2017; DeCou & Lynch, 2019; Miller et al., 2013). However, few studies investigating this possibility have been conducted with adolescents and have relied on a longitudinal design. Our study examined affect dysregulation as a mechanism uniting depressive symptoms and suicidal ideation in a sample of 119 sexually abused adolescent girls. It was expected that higher initial levels of depressive symptoms at the first assessment (Time 1) would be associated with higher levels of affect dysregulation six months later (Time 2), which in turn would be associated with the presence of suicidal ideation one year after the initial assessment (Time 3). In order to test our hypothesis, an integrative mediational model was conceptualized and tested using path analysis with logistic regression. Our results indicated that approximately 1 out of 3 girls (30.9%) reported having seriously thought about suicide one year after they first sought services regarding the sexual trauma they endured. More than half of them (56%) also reported thoughts about suicide at the two prior assessments (Time 1 and 2). In total, more than 1 out of 10 girls (13.1%) maintained suicidal ideation across the year. Analyses revealed that the relationship between depressive symptoms and later suicidal ideation was partly explained by higher affect dysregulation. More precisely, the severity of depressive symptoms at Time 1 was positively associated with higher affect dysregulation at Time 2, which in turn, increased the risk of experiencing suicidal ideation at Time 3. These findings identify potential predictors of suicidal ideation among sexually abused adolescent girls. Our study highlights the role of affect dysregulation in link with suicidal ideation. Affect dysregulation may result from an intense psychological distress (i.e., depressed mood) due to the trauma overwhelming the regulation capacities. Our study illustrates how it can be painful to live with a post-traumatic baggage, and how this experience may impede on daily functioning and bring severe emotional distress, which exceeds the capacities to regulate oneself. As such, when sexually abused adolescent girls are upset or depressed, the overwhelmed capacities to metabolize their distress, the perception of losing control or the lack of understanding of their intrusive emotions may put them at risk of suicidal thoughts as a way to escape negative feelings, end their suffering, and be free from their psychological and emotional burden. Thus, our study highlights affect dysregulation as a proximal predictor of suicidal ideation, especially in the presence of depressive symptoms. Our findings point toward important targets in intervention with sexually abused adolescent girls. As such, interventions with this vulnerable population should aim to decrease depressive symptoms and affect dysregulation to reduce suicidal risk. In order to do so, services need to be readily available to survivors, as it is crucial to intervene when the adolescent victim begins to consider suicide as an option. Furthermore, interventions should guide girls toward the development of improved adaptive emotion regulation strategies through concrete tools and strong therapeutic support, to face the aftermaths of sexual trauma toward recovery. For example, practitioners could increase their ability to tolerate intense negative emotions such as fear with the use of distress tolerance strategies. Tools to improve adolescents' repertoire of affect regulation strategies include keeping a journal, self-soothing strategies or activities to distract momentarily from painful emotions when they cannot make themselves feel better, finding meaning, relaxation, or mindfulness practices. Beyond the general capacity to regulate one’s emotions, the regulation of negative emotions specific to depression, such as hopelessness, should be specifically targeted. Suicidality prevention with sexually abused adolescent girls should not only focus on negative affect, but also how these negative emotions are dealt with, in order to restore a sense of hope and go toward healing and happiness. In conclusion, the current study identifies a possible trajectory of suicidality among sexually abused adolescent girls. Results underscore the necessity of investigating and decreasing affect dysregulation, throughout the whole therapeutic process when working with this vulnerable clientele. It is hoped that better-informed practices might eventually lessen repercussions associated with sexual abuse and reduce suicidality in survivors. References Alix, S., Cossette, L., Hébert, M., Cyr, M., & Frappier, J. Y. (2017). Posttraumatic stress disorder and suicidal ideation among sexually abused adolescent girls: The mediating role of shame. Journal of Child Sexual Abuse, 26(2), 158-174. doi:10.1080/10538712.2017.1280577 Decou, C. R., & Lynch, S. M. (2019). Emotional reactivity, trauma-related distress, and suicidal ideation among adolescent inpatient survivors of sexual abuse. Child Abuse & Neglect, 89, 155-164. doi:10.1016/j.chiabu.2019.01.012 Miller, A. B., Esposito-Smythers, C., Weismoore, J. T., & Renshaw, K. D. (2013). The relation between child maltreatment and adolescent suicidal behavior: A systematic review and critical examination of the literature. Clinical Child and Family Psychology Review, 16(2), 146-172. doi:10.1007/s10567-013-0131-5 Reference Article Girard, M., Hébert, M., Godbout, N., Cyr, M. and Frappier, J.‐Y. (2020), A Longitudinal Study of Suicidal Ideation in Sexually Abused Adolescent Girls: Depressive Symptoms and Affect Dysregulation as Predictors. Journal of Traumatic Stress. doi:10.1002/jts.22608 Questions for Discussion Given our results, should suicidality always be assessed when working with victims of sexual abuse? And what other correlates of suicidality should be considered when assessing sexually abused adolescent girls seeking treatment? What would be examples of adaptive emotion regulation strategies to offer to adolescent girls in order to improve their repertoire? About the Authors Marianne Girard, M.A. (Twitter: @MarianneGirard3) is a doctorate student in sexology at the Université du Québec à Montréal (UQÀM). Martine Hébert, Ph.D. (Twitter: @DrMartineHebert) is a professor in the sexology department at the Université du Québec à Montréal (UQÀM) and both the Tier I Canada Research Chair in Interpersonal Traumas and Resilience and co-holder of the Marie-Vincent Interuniversity Chair in Child Sexual Abuse. Natacha Godbout, Ph.D. (Twitter: @Dr_Godbout @lab_trace) is a clinical psychologist and Professor in the sexology department at the Université du Québec à Montréal (UQÀM). Her research and clinical work center on the effects of interpersonal trauma and the healing process of victims. Mireille Cyr, Ph.D. is the scientific director of the Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse (CRIPCAS) and co-chair of Marie-Vincent Interuniversity Research Chair for Sexual Abuse. Jean-Yves Frappier, Ph.D. is a professor and director at the Pediatric Department of the Université de Montréal and Centre hospitalier universitaire Ste-Justine in Montréal.