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Comment & Response
October 12, 2020

Child Abuse and Neglect Contributing to Youth Suicide—Reply

Author Affiliations
  • 1Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus
  • 2Rockefeller Neuroscience Institute, Behavioral Medicine and Psychiatry, West Virginia University, Morgantown
JAMA Pediatr. 2020;174(12):1214-1215. doi:10.1001/jamapediatrics.2020.2576

In Reply We thank Gordon for his interest in our research. While we fail to appreciate how our article1 is a “demonstration of the major clinical problems created by the inadequacies of the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) paradigm for the classification of mental disease,” it is well understood that childhood trauma and maltreatment have been strongly associated with suicide, depression, and other phenomenological psychiatric diagnoses.2,3 The limitations associated with health claims data–related research, and particularly with regard to coded mental health–related diagnoses, are well understood. We agree with Gordon that clinicians may undercode or fail to properly consider diagnostic codes related to child abuse and trauma in filing health claims. Given this reality and the lack of validation for child abuse and trauma-related codes in health claims research,4,5 they were not included in study analyses. This was related to the nature of the available data used to perform study analyses rather than being “restricted by the DSM-5.” We defer any dialogue regarding the nosological issues raised by Dr Gordon to others, acknowledging that they are beyond the scope of our study and that the relationship between childhood maltreatment and descriptive psychopathology in childhood and adolescence is complex.6

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