Corporal punishment bans and adolescent suicide rates: An international ecological study
Introduction
Globally, suicide is a leading cause of death in adolescents aged 10–19 (Liu et al., 2022). The etiology of suicide is complex and includes both environmental and individual factors (Cha et al., 2018). Corporal punishment, defined as “the use of physical force with the intention of causing a child to experience pain but not injury for the purposes of correction or control of the child's behavior” (Straus & Donnelly, 2001, p. 4), may be one such etiological factor. Meta-analyses focused on the consequences of corporal punishment in children found robust associations with indicators of poor mental health and suicide (Ferguson, 2013; Gershoff, 2002; Gershoff & Grogan-Kaylor, 2016; Paolucci & Violato, 2004; Visser et al., 2022). Many of the studies that have examined this issue quantitatively are cross-sectional in nature. To illustrate, Afifi et al. (2017) conducted a large-scale study of 8316 adults and found that, after adjusting for sociodemographic factors and physical and emotional abuse, spanking in childhood was associated with moderate to heavy drinking, drug use, and suicide attempts in adulthood. Two other illustrative cross-sectional studies in China and Jamaica found that children and adolescents who experienced physical punishment were more likely to exhibit suicidal behavior (Boduszek et al., 2021; Liu et al., 2008).
The Global Partnership to End Violence Against Children monitors the legal status of corporal punishment globally as part of the End Corporal Punishment initiative (End Violence Against Children, 2021). As of November 2022, 64 countries have enacted a full ban of corporal punishment in all settings including schools, daycares, alternative care settings, and at home. Bans are associated with decreased adult engagement in these disciplinary techniques (Zolotor & Puzia, 2010). However, knowledge about the potential lag between enactment of a national policy banning corporal punishment and indicators of suicidal behavior is limited. Most salient research focuses on experiences in Sweden, which in 1979 was the first country to fully ban corporal punishment via an official policy. Use of corporal punishment dropped after corporal punishment legislation was enacted (Bussmann, 2004; Durrant & Janson, 2005), but less is known about the effects of this policy decision on specific child health outcomes. In addition, because these studies were conducted in a limited number of countries, conclusions about the universal effects of such bans over time cannot be made. To our knowledge, no study has yet investigated the potential time lag between the enactment of legislation prohibiting corporal punishment and salient health outcomes.
The body of evidence surrounding relationships between legislation banning corporal punishment and adolescent outcomes at the population level is also sparse. Cross-national studies are particularly rare. One exception is a cross-national ecological study of 88 countries that demonstrated that nations with full bans of corporal punishment simultaneously reported significantly lower rates of adolescent physical fighting compared to countries without such bans, in both male and female populations (Elgar et al., 2018). It is highly plausible that bans of corporal punishment may be associated with other forms of adolescent violence and self-harming behaviors and such relationships warrant further study.
We had a unique opportunity to strengthen the available evidence in a cross-national study of the relationship between country-level corporal punishment policies and mortality due to adolescent suicide. Cross-sectionally, we examined the association between corporal punishment bans and adolescent suicide rates in 2017, the most recent year for which data were available, and variations in this association attributable to time lags between implementation of corporal punishment legislation and when the rates of suicide are estimated. Through these analyses our hope was to strengthen the evidence base in support of national bans of corporal punishment in the home, school, and great society, by focusing on an additional adolescent health outcome of great contemporary importance.
Section snippets
Data sources
We retrieved the legal status of national rules surrounding the permitting of corporal punishment in homes, schools, daycares, and alternative care settings by country and year from the End Corporal Punishment reports (End Violence Against Children, 2021). We constructed a categorical exposure variable to identify countries with either no ban (have never prohibited corporal punishment in homes, schools, daycares, or alternative care settings), a partial ban (prohibited corporal punishment in
Results
Table 1 displays the results of the best-fitting negative binomial regression model for each stratum. The best-fitting model had the smallest value in a majority of the three goodness of fit criteria. In most strata, Model 3 had the best fit. This indicates that controlling for continent, most common religious denomination, and religiosity improved model fit. There is no evidence of a statistically significant association between adolescent suicide rates and the additional covariates added to
Discussion
This original cross-national analysis provides new evidence of an association between enactment of bans of corporal punishment and decreased risks for adolescent suicide, both cross-sectionally and longitudinally. Rates of suicide in females aged 15–19 were significantly higher in countries with no ban of corporal punishment compared to those countries with full bans, as well as significantly higher in countries that legally permitted corporal punishment in schools. In one of the most novel
Declaration of competing interest
None.
Acknowledgements
The authors would like to thank Dr. Valerie Michaelson (Brock University) for her contributions to the initial conceptualization of this analysis.
This work was supported by the Canadian Institutes of Health Research [grant number PJT-165971].
Laura Cramm was partially supported by the Ontario Graduate Scholarship program, which was jointly funded by Queen's University and the Province of Ontario.
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