Partner Abuse and Posttraumatic Stress Disorder as Risk Factors for Suicide Attempts in a Sample of Low-Income, Inner-City Women

Reviewed by
Priscilla Schulz, LCSW

from an article of the same title by:
Martie P. Thompson, Nadine J. Kaslow, J. B. Kingree, Robin Puett, Nancy J. Thompson, and Lindi Meadows

Journal of Traumatic Stress, V. 12 (1), 59-72, 1999

Background: The current study is important because its findings may be useful to those working to prevent suicide, especially in the target group. Previous research found that women who were victims of intimate partner abuse had high rates of suicidal behavior, high rates of Posttraumatic Stress Disorder (PTSD), and that there are strong associations between PTSD and suicide attempts even when depression is eliminated as a factor. However, it was u nclear whether suicidal behavior was primarily from being abused per se, or whether PTSD caused suicidality. 


What is the purpose of this study? 
To understand more about the relationship between intimate partner abuse and suicide, two groups of predominantly African-American women from an inner city clinic were assessed and compared. This study sought to clarify whether suicidal behavior among abused women is a direct or indirect consequence of intimate partner abuse.

How was this study conducted? 
One group of 119 women was recruited from those who sought emergency medical services after self-injury. A comparison group of 85 was recruited from women who sought non-emergency medical services at the same hospital and had no previous suicide attempts. All of the participants were evaluated for 1) history of prior trauma, 2) exposure to physical and emotional partner abuse within the last year, and 3) PTSD. 

What are the findings of this study? 
PTSD was the link between physical partner abuse and victims' attemp ts at suicide. In other words, when PTSD was eliminated as a factor in the equation, physical partner abuse alone did not account for suicide attempts. (Non-physical partner abuse was not found to be a significant risk factor for PTSD.) In addition it was reported that:    
    1. Suicide attempters were approximately three times more likely to have been physically abused by intimate partners than non-attempters.
    2. Suicide attempters were approximately three times more likely than non-attempters to have PTSD
    3. Women from both groups with PTSD were three times more likely than all non-attempters to have been physically abused by intimate partners.
What are the study's limitations?
It is not known whether the symptoms of PTSD that suicide attempters reported precipitated the self-injury or whether they resulted from distress related to the suicide attempt itself. The two groups, though taken from among individuals seen at the same hospital, differed sociodemographically: suicide attempters were significantly younger than non-attempters; attempters were more likely to be married or living with an intimate partner; they were less educated than non-attempters and were more likely to be unemployed. The population used in the study had a lower rate of reported partner abuse than similar populations in other studies.

What are the implications of this study for health and mental health providers?
The findings suggest three levels of intervention to address the issue of partner abuse and suicidal behavior. 
    1. There should be public education efforts to inform about the association of abuse with adult psychological problems, including suicidal behavior. 
    2.  Health and community agencies that serve victims of domestic violence should be educated about the issues of partner abuse, PTSD and s uicidal behavior.
    3. Service providers should be prepared to treat PTSD and carefully screen for suicidal ideation in female victims of domestic violence.
All suicidal women should be carefully screened for the presence of partner violence in their histories, and appropriate referrals for ongoing mental health treatment and other support should be made available to those who indicate a need.

Reviewed by Priscilla Schulz, September 1999
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