Extending Models of Deliberate Self-Harm and Suicide Attempts to Substance Users: Exploring the Roles of Childhood Abuse, Posttraumatic Stress, and Difficulties Controlling Impulsive Behavior When Distressed

The current study examined models of risk for deliberate self-harm (DSH) and suicide attempts (SA) in a sample of 180 inner-city substance users. The factors of childhood physical, sexual, and emotional abuse, posttraumatic stress (PTS) symptoms, and difficulties controlling impulsive behaviors when distressed were examined, with path modeling used to explore the interrelationships between variables. Analyses examined the utility of a model wherein childhood abuse is associated with DSH and SA as a result of its relationship with PTS symptoms. Further, we examined whether difficulties controlling impulsive behaviors when distressed accounted for the relationship between PTS symptoms and DSH and SA. DSH and SA were both related to physical abuse and sexual abuse, PTS symptoms, and difficulties controlling impulsive behavior when distressed; only SA was associated with emotional abuse. Further, results demonstrated that the effect of childhood sexual abuse on DSH and SA was partially explained by PTS symptoms; however, difficulties controlling impulsive behaviors when distressed contributed little to either model. Findings suggest the importance of developing targeted interventions for PTS symptoms in order to reduce risk for SA and DSH.