title: Childhood sexual abuse and suicidal behavior: a meta-analysis.
abstract: OBJECTIVE
  Self-inflicted injuries are one of the major causes of disease burden and death globally. Understanding the extent to which this is associated with childhood sexual abuse (CSA) exposure can help inform prevention strategies. We aimed to quantify to what extent CSA was associated with incident suicide attempts in men and women.
  
  
  METHODS
  We searched 20 health and social science databases from first record until February 2009 and updated the search in Medline from February 2009 to February 1, 2013. Longitudinal studies and cotwin analyses from twin studies in any population from any year were eligible for inclusion. Of 22 235 abstracts screened as part of a series of reviews, 9 studies met the inclusion criteria for this review. Characteristics, effect estimates, and quality data were extracted. Random-effects meta-analysis was used to generate pooled odds ratios (ORs).
  
  
  RESULTS
  Seven longitudinal and 2 twin studies with 8733 participants met the inclusion criteria. The overall pooled estimate for longitudinal studies was OR = 2.43 (95% confidence interval: 1.94-3.05), I(2) = 87.5%, P < .0001. The pooled OR from cotwin analysis was 2.65 (95% confidence interval: 0.82-4.49, I(2) = 0%, P = .867). Studies adjusted for a range of confounders, but baseline suicidal behavior was not well-controlled. Too few studies met the inclusion criteria to quantitatively examine sources of heterogeneity.
  
  
  CONCLUSIONS
  CSA exposure is associated with suicide attempts when a range of different confounders are controlled for, but the temporality of the association is not well established, and the association is highly heterogeneous.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom; and karen.devries@lshtm.ac.uk.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Devries
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom; and.
authors.forename: Joelle Y T
authors.initials: JY
authors.lastname: Mak
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom; and.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Child
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom; and.
authors.forename: Gail
authors.initials: G
authors.lastname: Falder
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom; and.
authors.forename: Loraine J
authors.initials: LJ
authors.lastname: Bacchus
authors.affiliation: School of Psychology and Psychiatry, Monash University, Melbourne, Australia.
authors.forename: Jill
authors.initials: J
authors.lastname: Astbury
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom; and.
authors.forename: Charlotte H
authors.initials: CH
authors.lastname: Watts
mesh_terms: D000293:Adolescent; D002648:Child; D002650:Child Abuse, Sexual / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D013223:Statistics as Topic; D013406:Suicide, Attempted / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: childhood sexual abuse; meta-analysis; suicide