Over 800 000 people across the world die by suicide every year. The economic burden of childhood maltreatment in terms of health care and medical costs, losses in productivity, welfare and special education costs are estimated around $124 billion in the USA alone (Fang et al., 2012). Experiences of childhood abuse and/or neglect precede the occurrence of psychiatric disorders in adult life, whereas 2.2% of incidents of childhood maltreatment result in fatalities (US Department of Health and Human Services, 2012). Physical, sexual and emotional or psychological abuse and neglect are among the most common types of maltreatment encountered by children and young people (Finkelhor et al., 2013). It is estimated that up to 30% of the general population have experienced childhood maltreatment (Hussey et al., 2006). The main outstanding challenge is to better understand the mechanisms which underpin the development of suicidality in people exposed to childhood maltreatment because current evidence is scarce. We conclude that there is solid evidence that childhood maltreatment is associated with increased odds for suicidality in adults. Variations across the studies in terms of demographic and clinical characteristics of the participants and other core methodological factors did not affect the findings of the main analyses. Complex childhood abuse was associated with a particularly high risk for suicide attempts in adults (OR 5.18, 95% CI 2.52–10.63).

Similar results were found for the association between childhood maltreatment and suicidal ideation. All different types of childhood maltreatment including sexual abuse, physical abuse (OR 2.52, 95% CI 2.09–3.04) and emotional abuse (OR 2.49, 95% CI 1.64–3.77) were associated with two- to three-fold increased risk for suicide attempts. Data from 68 studies based on n = 261.660 adults were pooled. The methodological quality of the studies was critically appraised and accounted in the meta-regression analyses. Heterogeneity was quantified using the I 2 statistic and formal publication bias tests were undertaken.

Random-effects meta-analysis was employed followed by univariable and multivariable meta-regressions. We searched five bibliographic databases, including Medline, PsychINFO, Embase, Web of Science and CINAHL, until January 2018. This comprehensive systematic review and meta-analysis aims to quantify the association between different types of childhood maltreatment and suicidality.

Cry of fear suicide