Childhood Trauma and Insomnia Increase Suicidal Ideation in Schizophrenia Patients: A Cross-Sectional Study

Prevalence and risk factors of suicide attempts among Chinese elderly patients over 50 years with schizophrenia

BACKGROUND

Several research efforts have found that older schizophrenia patients are at higher risk for suicide. Related risk factors for suicide attempts in the elderly with schizophrenia are poorly understood. This study sought to assess the prevalence of suicide attempts and related risk variables in schizophrenia patients over the age of 50.

METHODS

We recruited 591 elderly patients over the age of 50. Demographic, clinical and blood parameters of all patients were collected. Patients with schizophrenia were evaluated for psychopathological symptoms using the Positive and Negative Syndrome Scale (PANSS).

RESULTS

The rate of suicide attempts among elderly Chinese schizophrenia patients was 15.2%. In these elderly schizophrenia patients, those who with suicide attempts had significantly higher scores for insomnia, depression and smoking addiction, and higher levels of red blood cells, Hc1 glycosylated hemoglobin and free T3, but significantly lower levels of hypersensitive C-reactive protein and -globulin. Binary logistic regression analysis showed that higher depression scores and smoking addiction were risk factors for suicide attempts in these patients. Additionally, multiple regression analyses showed that higher BMI and insomnia scores were associated with suicide risk scores in elderly schizophrenia patients.

CONCLUSIONS

Our research shows that there is a high incidence of suicide attempts in people over 50 years of age with schizophrenia. A number of clinically relevant factors and metabolic markers are associated with suicide attempts among elderly patients with schizophrenia.

Longitudinal Association between Stressful Life Events and Suicidal Ideation in Adults with Major Depression Disorder: The Mediating Effects of Insomnia Symptoms

Stressful life events (SLEs) and suicidal ideation (SI) are prevalent in persons with major depression disorder (MDD). Less is known about the underlying role of insomnia symptoms in the association between SLEs and SI. This three-wave prospective cohort study sought to investigate the longitudinal association among SLEs, insomnia symptoms, and SI in persons with MDD. The study population included 511 persons with MDD (mean [SD] age, 28.7 [6.7] years; 67.1% were females). Generalized estimated equations (GEEs) were utilized to explore prospective association among exposure of SLEs, insomnia symptoms, and SI. Additionally, a structural equation model (SEM) was employed to estimate the longitudinal mediating effect of insomnia symptoms in the relationship between SLEs and SI. Our study demonstrated that cumulative SLEs were determined to be longitudinally associated with SI in persons with MDD. We further observed that the association between SLEs and SI was significantly mediated by insomnia symptoms. Clinicians assessing persons with MDD, especially those with the history of SLE, could carefully evaluate and promptly treat insomnia symptoms as part of personalized assessment of their depressive illness, thereby achieving early prevention and intervention for suicidal behaviors in persons with MDD.

Association between childhood maltreatment and suicidal ideation among Chinese patients with chronic schizophrenia: the mediating role of insomnia

BACKGROUND

Childhood maltreatment is a well-established transdiagnostic risk factor for suicidal ideation; however, previous studies on their association in schizophrenia have produced highly varied results. Moreover, the mechanism linking childhood maltreatment and suicide ideation remains unclear in schizophrenia.

AIMS

This cross-sectional study aimed to investigate the association between childhood maltreatment and suicide ideation in people with schizophrenia and tested whether insomnia mediated this relationship.

METHOD

Positive and Negative Syndrome Scale (PANSS), Insomnia Severity Index (ISI), Childhood Trauma Questionnaire - Short Form and Beck Suicidal Ideation Inventory were employed. Logistic regression and mediation analysis were performed.

RESULTS

(a) The prevalence of suicide ideation, insomnia, sexual abuse, emotional neglect, emotional abuse, physical abuse and physical neglect was 10% (n = 61), 18% (n = 111), 11% (n = 68), 25% (n = 153), 6.3% (n = 39), 17% (n = 106) and 39% (n = 239), respectively. In all, 52% (n = 320) reported childhood maltreatment; (b) patients with suicide ideation demonstrated higher insomnia and childhood maltreatment. PANSS depression factor, ISI, lifetime suicidal attempts and emotional abuse were independently associated with suicide ideation; (c) insomnia partially mediated the effects of emotional abuse and emotional neglect on suicide ideation, and insomnia completely mediated the effects of physical neglect and physical abuse on suicide ideation.

CONCLUSION

Our study calls for formal assessments for childhood maltreatment and insomnia in schizophrenia, which might help identify suicide ideation early. In addition, interventions targeting insomnia might help reduce suicide ideation among people with schizophrenia who experience childhood maltreatment.

Pathway from childhood trauma to nonsuicidal self-injury in adolescents with major depressive disorder: the chain-mediated role of psychological resilience and depressive severity

This study aimed to explore the pathway from childhood trauma to nonsuicidal self-injury (NSSI) in adolescents with major depressive disorder (MDD) and to examine the chain-mediating role of psychological resilience and depressive symptoms in this pathway. A total of 391 adolescents with MDD were recruited in the present study. The Chinese version of the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Chinese version of the Symptoms Check List-90 (SCL-90), the Chinese version of the Conner-Davidson Resilience Scale (CD-RISC), and the Ottawa Self-Injury Inventory Chinese Revised Edition (OSIC) were used to evaluate childhood trauma, depressive symptoms, psychological resilience and NSSI, respectively. Our results showed that 60.87% of adolescents with MDD had NSSI in the past month. Childhood trauma frequency was negatively correlated with psychological resilience but positively correlated with depressive symptoms and NSSI severity in adolescents with MDD. The stepwise logistic regression analysis identified that age, childhood trauma and depressive symptoms could independently predict the occurrence of NSSI, and the three-step hierarchical regression showed that childhood trauma, psychological resilience and depressive symptoms were all significantly associated with NSSI frequency in adolescents with MDD. Furthermore, the chain-mediation analysis revealed that psychological resilience and depression serially mediated the relationship between childhood trauma and NSSI in adolescents with MDD. Interventions targeted at improving resilience and depression may mitigate the impact of childhood trauma severity on NSSI risk in adolescents with MDD.

Association between adverse childhood experiences and suicidal behavior in schizophrenia spectrum disorders: A systematic review and meta-analysis

Assessing and managing suicide behaviors is highly relevant to individuals with schizophrenia spectrum disorders. Our study aims to assess the association between adverse childhood experiences and suicidal behaviors in individuals with schizophrenia spectrum disorders. We included observational studies comparing the probability of suicide behaviors in adults with schizophrenia spectrum disorders exposed and unexposed to adverse childhood experiences. Odds ratio estimates were obtained by pooling data using a random-effects pairwise meta-analysis. Standardized criteria were used to assess the strength of the association of the pooled estimate. We found 21 eligible studies reporting outcomes for 6257 individuals from 11 countries. The primary outcome revealed an association between any suicidal behavior and adverse childhood experiences, which resulted "highly suggestive" according to validated Umbrella Criteria. Similarly, a positive association was confirmed for suicidal ideation and suicide attempt and for any subtype of adverse childhood experience. This meta-analysis showed that exposure to adverse childhood experiences strongly increases the probability of suicide behaviors in people with schizophrenia spectrum disorders.

Meta-analysis of insomnia, suicide, and psychopathology in schizophrenia

PURPOSE OF REVIEW

Insomnia is common in schizophrenia. Insomnia has been associated with suicidal ideation and behavior, as well as greater severity of psychopathology, in schizophrenia. This review performs a meta-analysis of associations between insomnia, suicide, and psychopathology in patients with schizophrenia.

RECENT FINDINGS

We searched major electronic databases from inception until November 2022 for studies of insomnia, suicide, and psychopathology in patients with schizophrenia. Random effects meta-analysis calculating odds ratios (ORs, for suicide) and effect sizes (ESs, for psychopathology) and 95% confidence intervals (CIs) were performed. Ten studies met the inclusion criteria, comprising 3428 patients with schizophrenia. Insomnia was associated with a significant increased odds of suicidal ideation (OR = 1.84, 95% CI 1.28-2.65, P  < 0.01) and suicide attempt or death (OR = 5.83, 95% CI 1.61-2.96, P  < 0.01). Insomnia was also associated with total (ES = 0.16, 95% CI 0.09-0.23, P  < 0.01), positive (ES = 0.14, 95% CI 0.08-0.20, P  = 0.02), and general (ES = 0.17, 95% CI 0.08-0.27, P  < 0.01) psychopathology. In meta-regression analyses, BMI was negatively associated with suicidal ideation. Otherwise, age, sex, and study year were all unrelated to the associations.

SUMMARY

Insomnia is associated with suicide and psychopathology in schizophrenia. Formal assessment and treatment of insomnia appears relevant to the clinical care of schizophrenia.