(Health.com) -- Amanda Todd, the 15-year-old Canadian teenager whose suicide earlier this month provoked a flood of sympathetic outrage, endured one torment after another in the years leading up to her death: sexual exploitation online, cyberbullying, a physical assault at school.
Suicide is always a complicated tragedy that leaves behind many questions and few answers, and Todd's case is no different. Yet her story, and the many others like it that have made headlines recently, are a heartbreaking illustration of the link between victimization and suicide in young people.
A new study, published this week in the Archives of Pediatrics & Adolescent Medicine, offers fresh evidence for this link, showing that several types of abuse, and not just bullying, are closely associated with suicidal thoughts in children and teens.
Researchers conducted a nationally representative survey of young people between the ages of 10 and 17, interviewing them by telephone twice, in 2008 and again in 2010. "In the last month," one of the survey questions asked, "how often have you wanted to kill yourself?"
Overall, roughly 1 in 23 kids reported feeling this way at least once. Being bullied, attacked, physically threatened, or otherwise victimized by peers in the previous 12 months more than doubled the odds of suicidal thoughts, and experiencing any type of sexual assault -- including at the hands of peers -- more than tripled the odds.
Suicidal thinking, also known as suicidal ideation, doesn't always progress to suicidal behavior (none of the participants attempted suicide during the study). But it is an important warning sign, as are depression and anxiety, which the researchers controlled for.
"Exposure to violence -- not just cyberbullying, but peer violence and sexual violence -- increases the risk of suicide," says Dr. Elizabeth Miller, chief of adolescent medicine at the Children's Hospital of Pittsburgh, who was not involved in the study.
Victimization appeared to be even more harmful if it was perpetrated by adults rather than peers. Being physically or emotionally maltreated by a parent or caregiver more than quadrupled a child's odds of suicidal thinking, the researchers found.
Not surprisingly, the risk rose higher still if a young person experienced many different types of victimization within the same year. Experiencing abuse from several directions at once is especially damaging because it can leave kids feeling they have no place to turn, says Heather A. Turner, the lead author of the study and a professor of sociology at the University of New Hampshire, in Durham.
"These are kids who experience threats to their safety and security, who have a lack of support and nurturance at home," Turner says.
"These kinds of violent experiences not only represent an incredible amount of adversity in kids' lives but they're likely also to damage the very resources that adolescents would normally use to help cope with these kinds of things."
The fact that many kids are exposed to more than one type of abuse highlights the need to look beyond bullying when addressing teen suicide, says Miller. "This kind of research helps show that when doing suicide prevention, we also need talk about other forms of violence," she says.
Cyberbullying, which has received the most attention of late, may represent a particularly insidious form of abuse, partly because it can occur anywhere and anytime, says Dr. Victor Fornari, the director of child and adolescent psychiatry at the North Shore-Long Island Jewish Health System, in New Hyde Park, New York.
"Traditionally, there was a distinction between the school day and after school," says Fornari, who was not involved in the study.
"Now kids go to sleep holding their smart phones and check their social networking site before they brush their teeth in the morning. The kinds of social support that might be available at dinnertime or at school lunchtime are often not present when you're the victim of cyberbullying."
Bullying, whether it takes place online or face-to-face, is rarely the only driver of suicidal thinking and behavior, however. Mood disorders like depression -- which Miller and her colleagues purposely sought to isolate from their findings -- can also contribute to the problem, as they reportedly did in Todd's case.
That was among the findings of a second study, also released this week, in which researchers at Dalhousie University in Nova Scotia compiled and analyzed media reports on 41 high-profile teen suicides dating back to 2003.
More than three-quarters of the teens had been bullied at school as well as online, much like Todd, while 17% were cyberbullied exclusively. But nearly 50% of the teens were said to have experienced symptoms of depression or a full-blown mood disorder, according to the study, which was presented on Saturday at an annual meeting of the American Academy of Pediatrics, in New Orleans.
Copyright Health Magazine 2011