Childhood trauma and its psychosocial sequelae: a thesis portfolio
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Background: It is widely understood that survivors of childhood trauma (emotional abuse, physical abuse, sexual abuse and emotional, physical neglect) have poorer mental health outcomes than their non-abused counterparts; one of which is an increased risk of suicidality. The disclosure of childhood abuse is key to safeguarding against further victimization and promoting better psychosocial outcomes for survivors in the long-term. Aims: The aims of this thesis portfolio are twofold. Firstly, to review the published literature investigating the barriers and facilitators to disclosing sexual abuse as perceived by children and adolescents (Chapter 1). Secondly, to research the relationship between childhood trauma and suicidality in a cohort of socio-economically deprived men living in Scotland (Chapter 3). The bridging chapter (Chapter 2) discusses the main themes that connect chapters one and three, notably the possible negative impact of childhood trauma on adult psychosocial functioning. Method: An exploratory systematic review and meta-synthesis of the literature was carried out. Strict eligibility criteria were predefined and a comprehensive search strategy identified a total of thirteen studies for review. For the empirical study, a total of 86 adult men with past and/or present suicidality participated in a quantitative cohort study and completed measures on childhood trauma, emotion regulation, interpersonal difficulties and suicidal behaviour. Multiple mediation analysis was used to analyse the data and to answer the study’s research questions. Results: The exploratory review highlighted that existing research into child and adolescent disclosures of sexual abuse is still in its infancy and that robust, longitudinal studies with more sophisticated methodologies are required to replicate findings. The collective body of literature identified that limited support, perceived negative consequences and feelings of self-blame, shame and guilt serve as significant barriers to disclosure whilst being asked or prompted through the provision of developmentally appropriate information facilitates young people to tell. The empirical study found that emotion regulation and interpersonal difficulties mediate the relationship between childhood trauma and suicidality in a sample of adult men. Conclusion: Several important clinical implications were identified in both parts of the thesis portfolio. Firstly, the systematic review identified the need for family members, friends and frontline professionals to explicitly ask children about the possibility of sexual abuse. It was also considered imperative that recipients are supported in responding to disclosures in positive and supportive ways so as to reduce young peoples’ feelings of responsibility, self-blame, shame and guilt. The empirical study concluded that dysfunctional emotion regulation and interpersonal difficulties are implicated in the overall collateral and compounding psychosocial sequelae of childhood trauma. The provision of psychological interventions for men with past and/or present suicidality should support individuals to develop healthy social problem-solving and emotion regulation skills. Providing effective, trauma-informed interventions for these individuals will move their treatment beyond simple risk management and focus, instead, on instilling recovery and resilience.