Sexual abuse in childhood increases the risk of suicide in men by up to ten times, say researchers from the University of Bath. A recent study of Australian men has found that those who were sexually abused as children are more likely than women to contemplate taking their own lives. Whilst gender and mental health problems are the most important risk factors for contemplating suicide, it is increasingly acknowledged that traumatic experiences such as childhood sexual abuse may be a significant risk factor.

Dr Patrick O'Leary and Professor Nick Gould from the University's Department of Social & Policy Sciences conducted a series of surveys and face-to-face interviews with men in a study funded by the University of South Australia. The findings have been published online in the peer-reviewed British Journal of Social Work.

They found that men who were sexually abused as children were up to ten times more likely to have suicidal tendencies; many of these men had not been clinically diagnosed as depressed. Dr O'Leary said: "Childhood sexual abuse is an under-recognised problem in men - most of the studies exploring the link with suicide have been in women. "Men are particularly vulnerable because they don't like to talk to others about their problems. It's difficult for anyone to come to terms with traumatic experiences such as childhood sexual abuse, but for men the stigma is worse because they don't tend to confide in their friends as much.

"Many suffer feelings of failure and isolation and think that it is a sign of weakness to discuss their past abuse with others. Men also tend to visit their doctors less frequently, so those who are at risk of suicide often slip under the radar of the healthcare system. Men are particularly vulnerable to suicide and are three and a half times more likely than women to end their own lives, with more than 2,000 men dying as a result of suicide in the UK each year. However it is estimated that for every suicide, there are between 20 and 25 failed attempts. We carried out the study in Australia, which shares a similar 'stiff upper lip' culture that we see in the UK. We're planning to do our next study in the UK to see if there are any differences."

Dr O'Leary suggested that lives could be potentially saved if abuse victims are identified earlier. He explained: "The abuse that these men have suffered as children often sees them attempting to cope by suppressing the experience through substance abuse, alcohol abuse and obsessive behaviour, with many ending up in the criminal justice system. "Greater awareness in the healthcare and criminal justice systems will help identify those who are at risk and give them treatment before it is too late."

“In psychiatry no one knows the causes of anything, so classification can be driven by all sorts of factors” — political, social and financial. “What you have in the end,” Mr. Shorter [a historian of psychiatry] said, “is this process of sorting the deck of symptoms into syndromes, and the outcome all depends on how the cards fall.”

The DSM-V is expected to fall into place in 2011-2012.

The article, Psychiatrists Revise the Book of Human Troubles, can be found at the New York Times online

Adolescents with major depression who received cognitive behavioral therapy (CBT) after responding to an antidepressant were less likely to experience a relapse or recurrence of symptoms compared to teens who did not receive CBT, according to a small, NIMH-funded pilot study published in the December 2008 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Background
Studies have found that adults with depression who have responded to medication treatment are less likely to have a relapse if they receive CBT during the follow-up treatment phase, according to researchers Betsy Kennard, Psy.D., of the University of Texas Southwestern Medical Center, and colleagues. Scientists theorize that initial antidepressant treatment may help improve symptoms enough so that a patient becomes more receptive to CBT or other psychosocial component. Kennard and colleagues aimed to determine if a similar sequential treatment strategy would be effective with depressed adolescents.

In this pilot study, 46 depressed youths ages 11 to 18 who had responded to 12 weeks of treatment with the antidepressant fluoxetine (Prozac) were randomly assigned to either six months of continued medication management (MM), or to medication management plus cognitive behavioral therapy (MM+CBT) designed to prevent relapse.

Results of the Study
Kennard and colleagues found that the youths who received only MM were significantly more likely to relapse than the youths who received MM+CBT. The researchers estimated that 37 percent of those in the MM group were likely to relapse, while 15 percent of those in the MM+CBT group were likely to relapse. Patients getting MM+CBT also reported higher rates of satisfaction compared to those getting MM only.

Significance
This pilot study demonstrates that, as in adult studies, introducing CBT in follow-up treatment after a patient responds to antidepressant treatment may be a promising strategy in preventing relapse among depressed adolescents.

What’s Next
The researchers currently are conducting a larger trial of MM+CBT to further evaluate the effectiveness of this treatment strategy in youths with depression.

Reference
Kennard B, et al. Cognitive-behavioral therapy to prevent relapse in pediatric responders to pharmacotherapy for major depressive disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 2008 Dec; 47(12):1395-1404

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Posted at the National Institute of Mental Health (NIMH)
5 December 2008