Association between a history of child abuse and suicidal ideation, plans and attempts among Canadian public safety personnel: a cross-sectional survey

Sarah Turner; Tamara Taillieu; R. Nicholas Carleton; Jitender Sareen; Tracie O. Afifi

doi:10.9778/cmajo.20170153

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Table 1:

Sociodemographic variables by child abuse status in a sample of Canadian public safety personnel

Variable	Status; no. (%) of respondents^*^†		OR (95% CI)
Variable	No child abuse n = 1924	Child abuse n = 2275	OR (95% CI)
Sex
Male	1222 (45.1)	1490 (54.9)	1.00
Female	570 (42.3)	778 (57.7)	1.12 (0.98–1.3)
Age, yr, mean ± SD	41.7 ± 9.3	44.5 ± 8.9	1.04 (1.0–1.0)
Marital status
Married/common-law/remarried	1453 (45.5)	1741 (54.4)	1.00
Single	181 (44.1)	229 (55.9)	1.06 (0.9–1.3)
Separated/divorced/widowed	151 (34.2)	290 (65.8)	1.60 (1.3–2.0)
Region of residence
Western Canada^‡ and territories	962 (43.5)	1249 (56.5)	1.00
Eastern Canada^§	580 (42.4)	787 (57.6)	1.05 (0.9–1.2)
Atlantic Canada^¶	239 (51.6)	224 (48.4)	0.72 (0.6–0.9)
Ethnicity
White	1671 (45.0)	2039 (55.0)	1.00
Other	112 (34.6)	212 (65.4)	1.55 (1.2–2.0)
Education
Some postsecondary or less	1038 (41.8)	1444 (58.2)	1.00
University degree/4 yr of college or higher	714 (48.0)	774 (52.0)	0.78 (0.7–0.9)
Years of service, mean ± SD	16.6 ± 9.4	18.6 ± 9.3	1.02 (1.0–1.0)
Public safety personnel category
Municipal/provincial police	497 (45.6)	594 (54.4)	1.00
Royal Canadian Mounted Police	480 (46.7)	547 (53.3)	0.95 (0.8–1.1)
Correctional workers	234 (40.6)	343 (59.4)	1.23 (1.0–1.5)
Firefighters	279 (45.1)	340 (54.9)	1.02 (0.8–1.2)
Paramedics	218 (39.6)	332 (60.4)	1.27 (1.0–1.6)
Call centre operators/dispatchers	90 (43.1)	119 (56.9)	1.11 (0.8–1.5)

Note: CI = confidence interval, OR = odds ratio, SD = standard deviation.
↵* Except where noted otherwise.
↵† Denominators vary as not all respondents answered all questions.
↵‡ British Columbia, Alberta, Saskatchewan and Manitoba.
↵§ Ontario and Quebec.
↵¶ New Brunswick, Nova Scotia, Prince Edward Island and Newfoundland and Labrador.

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Table 2:

Prevalence of child abuse and career-related trauma by public safety personnel category

Type of abuse/trauma	Category; no. (%) of respondents^*							Significant differences^†
Type of abuse/trauma	Total n = 4073	Municipal/provincial police (a) n = 1091	Royal Canadian Mounted Police (b) n = 1027	Correctional workers (c) n = 577	Firefighters (d) n = 619	Paramedics (e) n = 550	Call center operators/dispatchers (f) n = 209	Significant differences^†
Slapped on face, head or ears, or hit or spanked with something hard	1880 (46.0)	482 (44.2)	440 (42.6)	280 (48.5)	305 (48.9)	278 (50.0)	95 (45.5)	a < e b < c, d, e
Pushed, grabbed or shoved, or something thrown at him/her	831 (20.4)	205 (18.9)	198 (19.3)	144 (25.0)	121 (19.4)	104 (18.7)	59 (28.8)	a < c, f b < c, f d < c, f e < c, f
Kicked, bit, punched, choked, burned or attacked	546 (13.2)	127 (11.5)	124 (11.8)	91 (15.7)	85 (13.3)	86 (15.2)	33 (15.4)	a < c, e b < c
Any physical abuse	2018 (49.4)	523 (47.9)	477 (46.3)	296 (51.2)	326 (52.4)	295 (53.2)	101 (48.6)	a < e b < d, e
Sexual abuse	583 (14.1)	139 (12.7)	129 (12.3)	132 (22.8)	47 (7.4)	86 (15.2)	50 (23.8)	a < c, f b < c, f d < a, b, c, e, f e < f, c
Exposure to intimate partner violence	368 (8.9)	94 (8.5)	94 (9.0)	62 (10.6)	45 (7.0)	48 (8.5)	25 (11.7)	d < c, f
Any child abuse	2275 (55.9)	594 (54.4)	547 (53.3)	343 (59.4)	340 (54.9)	332 (60.4)	119 (56.9)	a < c, e b < c, e
No. of types of child abuse
0	1798 (44.7)	497 (46.4)	480 (47.1)	234 (41.3)	279 (45.7)	218 (40.1)	90 (43.9)	c < a, b e < a, b
1	1622 (40.4)	436 (40.7)	408 (40.0)	209 (36.9)	261 (42.8)	236 (43.4)	72 (35.1)	c < d, e f < e
≥ 2	598 (14.9)	139 (13.0)	132 (12.9)	124 (21.9)	70 (11.5)	90 (16.5)	43 (21.0)	a < c, f b < c, f d < c, e, f e < c
Any career-related trauma	3947 (94.0)	95.2 (1061)	1016 (95.9)	502 (84.9)	614 (94.8)	557 (97.2)	197 (92.1)	c < a, b, d, e, f d < e f < b, e

↵* Denominators vary as not all respondents answered all questions.
↵† Significant differences at p < 0.05 in the prevalence of a history of child abuse and any career-related trauma between different public safety personnel categories based on logistic regression analyses.

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Table 3:

Associations between a history of child abuse and lifetime suicidal behaviours

Type of abuse	Suicidal ideation		Suicide plans		Suicide attempt(s)

	No. (%) of respondents	Adjusted OR^* (95% CI)	No. (%) of respondents	Adjusted OR^* (95% CI)	No. (%) of respondents	Adjusted OR^* (95% CI)
Slapped on face, head or ears, or hit or spanked with something hard	642 (37.0)	2.09 (1.8–2.4)	335 (19.7)	2.41 (2.0–3.0)	118 (6.9)	2.47 (1.8–3.4)

Pushed, grabbed or shoved, or something thrown at him/her	336 (44.0)	2.32 (1.9–2.8)	183 (24.4)	2.42 (2.0–3.0)	73 (9.8)	2.96 (2.1–4.1)

Kicked, bit, punched, choked, burned or attacked	227 (45.0)	2.14 (1.7–2.6)	131 (26.4)	2.42 (1.9–3.1)	52 (10.5)	2.78 (1.9–4.0)

Physical abuse	681 (36.5)	2.12 (1.8–2.5)	351 (19.1)	2.34 (1.9–2.9)	125 (6.8)	2.64 (1.9–3.7)

Sexual abuse	234 (42.5)	2.12 (1.7–2.6)	125 (23.2)	2.06 (1.6–2.7)	58 (10.6)	2.38 (1.6–3.4)

Exposure to intimate partner violence	161 (48.2)	2.63 (2.1–3.4)	85 (25.9)	2.48 (1.9–3.3)	40 (12.2)	3.25 (2.2–4.9)

Any child abuse	749 (35.6)	2.22 (1.9–2.6)	383 (18.5)	2.49 (2.0–3.1)	136 (6. 5)	2.61 (1.8–3.8)

Note: CI = confidence interval, OR = odds ratio.
↵* Adjusted for sex, age, marital status, region of residence, ethnicity, education, years of service and public safety personnel category.

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Table 4:

Individual and cumulative effects of a history of child abuse and career-related trauma on lifetime suicidal behaviours

Abuse/trauma category^*^†	Suicidal ideation		Suicide plans		Suicide attempt(s)

	No. (%) of respondents	Adjusted OR^‡ (95% CI)	No. (%) of respondents	Adjusted OR^‡ (95% CI)	No. (%) of respondents	Adjusted OR^‡ (95% CI)
No child abuse/career-related trauma	16 (12.7)	1.00	NP	1.00	NP	1.00

Child abuse only	31 (31.6)	3.33^§ (1.6–6.8)	16 (16.5)	5.89^§ (1.9–18.5)	NP	3.98^§ (1.0–15.5)

Career-related trauma only	322 (20.8)	1.84^¶ (1.0–3.3)	136 (8.9)	3.00^¶ (1.1–8.4)	40 (2.6)	1.51^¶ (0.4–5.1)

Child abuse and career-related trauma	718 (35.8)	3.97^§ (2.3–7.0)	367 (18.6)	7.12^§ (2.6–19.7)	127 (6.4)	3.80^§ (1.2–12.5)

Note: CI = confidence interval, NP = not presented because of insufficient sample size (i.e., n < 10), OR = odds ratio.
↵* Mutually exclusive categories.
↵† Logistic regression was used to test for statistically significant differences between the 4-level child abuse/career-related trauma variable. Symbols indicate significant differences between categories at p < 0.05.
↵‡ Adjusted for sex, age, marital status, region of residence, ethnicity, education, years of service and public safety personnel category.
↵§ The relation between child abuse only and suicidal behaviours was not significantly different from the relation between both child abuse and career-related trauma and suicidal behaviours.
↵¶ The relation between career-related trauma only and suicidal behaviours was significantly different from the relation between child abuse only and suicidal behavours and both child abuse and career-related trauma and suicidal behaviours.

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Table 5:

Individual and interaction effects of a history of child abuse and career-related trauma on lifetime suicide-related behaviours

Model	Adjusted OR^* (95% CI)
Model	Suicidal ideation	Suicide plans	Suicide attempt(s)
1. Career-related trauma	1.57 (1.1–2.2)	1.78 (1.1–2.9)	1.22 (0.6–2.3)
2. Child abuse	2.22 (1.9–2.6)	2.49 (2.0–3.1)	2.61 (1.8–3.8)
3.
Career-related trauma	1.43 (0.99–2.1)	1.59 (0.97–2.6)	1.10 (0.6–2.1)
Child abuse	2.21 (1.9–2.6)	2.47 (2.0–3.1)	2.60 (1.8–3.8)
4. Career-related trauma × child abuse	0.65 (0.3–1.3)	0.40 (0.1–1.3)	0.63 (0.2–2.6)

Note: CI = confidence interval, OR = odds ratio.
↵* Models 1 and 2: adjusted for sex, age, marital status, region of residence, ethnicity, education, years of service and public safety personnel category; model 3: adjusted for the same variables as in models 1 and 2 with the addition of career-related trauma and child abuse in the same model; model 4: adjusted for the same variables as in model 3 with the main effects of career-related trauma and child abuse in addition to the interaction term for career-related trauma × child abuse.