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dc.contributor.authorCluver, L.
dc.contributor.authorOrkin, M.
dc.contributor.authorBoyes, Mark
dc.contributor.authorSherr, L.
dc.identifier.citationCluver, L. and Orkin, M. and Boyes, M. and Sherr, L. 2015. Child and adolescent suicide attempts, suicidal behavior, and adverse childhood experiences in South Africa: a prospective study. Journal of Adolescent Health. 57 (1): pp. 52-59.

Purpose: This is the first known prospective study of child suicidal behavior in sub-Saharan Africa. Aims were to determine whether (1) cumulative exposure to adverse childhood experiences (ACEs) predicts later suicidality and (2) heightened risks are mediated by mental health disorder and drug/alcohol misuse. Methods: Longitudinal repeated interviews were conducted 1 year apart (97% retention) with 3,515 adolescents aged 10–18 years in South Africa (56% female; <2.5% refusal). Random selection of census enumeration areas from urban/rural sites within two provinces and door-to-door sampling included all homes with a resident adolescent. Measures included past-month suicide attempts, planning, and ideation, mental health disorders, drug/alcohol use, and ACE, for example, parental death by AIDS or homicide, abuse, and exposure to community violence. Analyses included multivariate logistic regression and multiple mediation tests.Results: Past-month suicidality rates were 3.2% of adolescents attempting, 5.8% planning, and 7.2% reporting ideation. After controlling for baseline suicidality and sociodemographics, a strong, graded relationship was shown between cumulative ACE and all suicide behaviors 1 year later. Baseline mental health, but not drug/alcohol misuse, mediated relationships between ACE and subsequent suicidality. Suicide attempts rose from 1.9% among adolescents with no ACE to 6.3% among adolescents with >5 ACEs (cumulative odds ratio [OR], 2.46; confidence interval [CI], 1.00–6.05); for suicide planning, from 2.4% to 12.5% (cumulative OR, 4.40; CI, 2.08–9.29); and for suicide ideation, from 4.2% to 15.6% (cumulative OR, 2.99; CI, 1.68–5.53). Conclusions: Preventing and mitigating childhood adversities have the potential to reduce suicidality. Among adolescents already exposed to adversities, effective mental health services may buffer against future suicidality.

dc.subjectMental health
dc.subjectSouth Africa
dc.subjectAdverse childhood experiences
dc.subjectSubstance abuse
dc.titleChild and adolescent suicide attempts, suicidal behavior, and adverse childhood experiences in South Africa: a prospective study
dc.typeJournal Article
dcterms.source.titleJournal of Adolescent Health
curtin.departmentSchool of Psychology and Speech Pathology
curtin.accessStatusFulltext not available

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