Association between Childhood Maltreatment and Suicidal Ideation: A Path Analysis Study

Risk factors of suicide re-attempt: A two-year prospective study

BACKGROUND

History of suicide attempt (SA) is the strongest predictor of a new SA and suicide. It is primordial to identify additional risk factors of suicide re-attempt. The aim of this study was to identify risk factors of suicide re-attempt in patients with recent SA followed for 2 years.

METHODS

In this multicentric cohort of adult inpatients, the median of the index SA before inclusion was 10 days. Clinicians assessed a large panel of psychological dimensions using validated tools. Occurrence of a new SA or death by suicide during the follow-up was recorded. A cluster analysis was used to identify the dimensions that best characterized the population and a variable "number of personality traits" was created that included the three most representative traits: anxiety, anger, and anxious lability. Risk factors of re-attempt were assessed with adjusted Cox regression models.

RESULTS

Among the 379 patients included, 100 (26.4 %) re-attempted suicide and 6 (1.6 %) died by suicide. The two major risk factors of suicide re-attempt were no history of violent SA and presenting two or three personality traits among trait anxiety, anger and anxious lability.

LIMITATIONS

It was impossible to know if treatment change during follow-up occur before or after the re-attempt.

DISCUSSION

One of the most important predictors of re-attempt in suicide attempters with mood disorders, was the presence of three personality traits (anger, anxiety, and anxious lability). Clinicians should provide close monitoring to patients presenting these traits and proposed treatments specifically targeting these dimensions, especially anxiety.

Psychological maltreatment, meaning-centered coping, psychological flexibility, and suicide cognitions: A moderated mediation model

BACKGROUND

Mental health problems are currently diversifying, increasing the possibility of suicide. Exposure to psychological maltreatment is one of the factors that increases suicidal cognitions. In addition, psychological flexibility and meaning-centered approaches may be effective in coping with suicidal cognitions.

OBJECTIVE

A hypothesized model was tested to examine the relationships among psychological maltreatment, suicidal cognitions, psychological flexibility, and meaning-centered coping.

METHOD

Data were collected from a sample of 652 participants. Mediation and moderation analyses were conducted to examine the mediating and moderating role of psychological flexibility and meaning-centered coping in the relationship between childhood psychological maltreatment and suicide cognitions among Turkish adults.

RESULTS

The results of the study indicated significant negative and positive relationships between psychological maltreatment, suicide cognitions, psychological flexibility, and meaning-centered coping. The findings suggest that psychological flexibility and meaning-centered coping have a serial mediating effect on the relationship between psychological maltreatment and suicide cognitions. Furthermore, according to the study results, psychological flexibility plays a moderating role both between psychological maltreatment and suicidal cognitions and between meaning-centered coping and suicidal cognitions.

CONCLUSIONS

The study suggests that psychological maltreatment can be considered as a risk factor and meaning-centered coping and psychological flexibility as protective factors in suicide prevention studies.

Childhood sexual abuse and suicide attempts in patients with substance use disorders: The mediating role of emotion dysregulation

BACKGROUND

Suicide attempts (SA) are a public health concern because of increasing prevalence and clinical implications. Childhood trauma (CT) and emotion dysregulation (ED) have been proposed as predictors of SA, but few data are available in patients with Substance Use Disorder (SUD).

OBJECTIVE

Our study aims to investigate the association of sociodemographic/clinical variables, CT typologies, and ED features with SA in SUD patients.

PARTICIPANTS AND SETTING

Subjects with SUD were screened in an outpatient setting. The final sample consisted of 226 patients, subdivided according to the presence of lifetime SA (SUD, n = 163 vs. SUD-SA, n = 63).

METHODS

Participants were compared for sociodemographic and clinical information. CT and ED were assessed through the Childhood Trauma Questionnaire - Short Form (CTQ-SF) and the Difficulties in Emotion Regulation Scale (DERS), respectively. We performed a mediation analysis to test the effect of CT and ED on SA.

RESULTS

Patients with a history of SA (27.9 %) displayed more psychiatric comorbidities (p = 0.002) and hospitalizations (p < 0.001), higher scores at CTQ-SF sexual abuse (p < 0.001) and DERS 'impulse' (p = 0.002), 'goals', 'non-acceptance', 'strategies' (p < 0.001) subscales. The relationship between CTQ-SF sexual abuse and SA was significantly mediated by DERS 'strategies' (p = 0.04; bootstrapped 95 % LLCI-ULCI = 0.004-0.024).

CONCLUSIONS

CT and different dimensions of ED were associated with SA in SUD patients. In our sample, the effects of childhood sexual abuse on SA were mediated by limited access to emotion regulation strategies. SUD patients are burdened with higher all-cause mortality, and CT and lifetime SA can worsen clinical outcomes. Clarifying the reciprocal interactions of psychopathological dimensions may help deliver targeted interventions and reduce suicide risk in specific populations.

Childhood maltreatment and suicidal ideation among Chinese adolescents: Moderated mediation effect of perceived social support and maladaptive cognitive emotion regulation strategies

BACKGROUND

Although previous studies have shown that childhood maltreatment is a risk factor for adolescent suicidal ideation, less is known about the mediating and moderating mechanisms underlying this association.

OBJECTIVE

The current study aimed to investigate the relationship between childhood maltreatment and suicidal ideation among adolescents, as well as the mediating role of maladaptive cognitive emotion regulation strategies (maladaptive CERSs) and the moderating role of perceived social support.

METHODS

In a cross-sectional design, 4005 adolescents (Mage = 14.24 years, SD = 1.53; 49.0 % males) completed self-report questionnaires regarding childhood maltreatment, maladaptive CERSs, perceived social support and suicidal ideation, along with their basic information.

RESULTS

After controlling for gender, family location, family structure, and depression, childhood maltreatment was positively related to adolescent suicidal ideation, and maladaptive CERSs were found to mediate this association. Moderated mediation analyses revealed that perceived social support buffered the associations between maladaptive CERSs and adolescent suicidal ideation.

CONCLUSIONS

The findings assist in understanding the mechanisms of maladaptive CERSs and perceived social support in the relationship between childhood maltreatment and suicidal ideation and can provide new perspectives for researchers designing interventions for suicidal ideation.

Suicidal ideation in patients with diabetes and childhood abuse - The mediating role of personality functioning: Results of a German representative population-based study

AIMS

Suicidal ideation (SID) in patients with diabetes mellitus is increasingly acknowledged. Still, the underlying mechanisms are unclear. We examined SID prevalences in patients with diabetes, its association with different types of abuse, and a mediating effect of personality functioning.

METHODS

In a representative population sample (N = 2,515), diabetes, SID, abuse (ICAST-R), personality functioning (OPD-SQS), and depression/anxiety (PHQ-4) were assessed by self-report. Statistical analyses comprised Chi2-Tests, logistic regression and mediation analyses.

RESULTS

The prevalence of SID (21.8 %) was three fold higher in patients with diabetes compared to the general population. Abuse further increased the likelihood to report SID in diabetes patients (sexual: 48.1 % vs. 18.2 %; χ2(1) = 12.233, p <.001; emotional: 35.7 % vs. 15.7 %; χ2(1) = 10.892, p <.001). A dose-response relationship between the number of abuse experiences and SID was observed (one abuse experience: OR = 1.138, 95 %-CI [0.433, 2.990], p =.793, >2 abuse experiences: OR = 2.693, 95 %-CI [1.278, 5.675], p =.009). Impaired personality functioning had an indirect effect on the association between emotional abuse and SID (b = 0.25, 95 %-CI [0.037, 0.551]).

CONCLUSIONS

Diabetes patients experience increased SID prevalences, especially those with emotional or sexual abuse. In individuals with a history of emotional abuse, impaired personality functioning partly explained SID and should therefore be considered and addressed in this patient group.

The mediating role of reflective functioning in the association between childhood trauma and suicide attempt

BACKGROUND

Childhood trauma is intimately related with suicidal behaviour. Patients who have suffered childhood trauma develop impaired Reflective Functioning (RF), which refers to the capacity to understand ourselves and others in terms of intentional mental states. An improvement in RF has been associated with a reduction in suicidal attempts, but the mediating role of RF between childhood trauma and suicidal behaviour has not been addressed so far.

OBJECTIVE

We aim to examine the potential mediating effect of RF among childhood trauma and suicide attempts.

METHOD

We included 748 patients who had attempted suicide at least once. They were asked to complete the Reflective Functioning Questionnaire (RFQ-8), the Columbia-Suicide Severity Rating scale (CSSRS), and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). We conducted linear regressions by simple mediating model to examine the role of RF in the indirect association between childhood trauma and the number of suicide attempts.

RESULTS

Our results show significant indirect effects through hypo and hypermentalizing between Emotional Abuse (EA) and Sexual Abuse (SA) in childhood and the number of suicide attempts in lifetime. These results indicate that ineffective RF significantly mediates the association between childhood trauma and suicidality.

CONCLUSION

This is the first study supporting the mediational role of RF in the relationship between EA and SA, and the number of suicide attempt in lifetime. These findings have important implications for reducing suicide rates and preventing future re-attempts. Further studies analysing this mediating role and focusing efforts on increasing RF-based interventions are required.

Social anxiety and suicidal ideation among middle-school students in China: a mediation model of internet addiction

Background

Suicide is a fatal public health issue for adolescents, and it is of great significance to explore the precursors of suicidal behaviors, especially suicidal ideation. However, the relationship between social anxiety and suicidal ideation and its mechanism are still unclear. The study aims to examine the association between social anxiety and suicidal ideation and the mediating effect through Internet addiction.

Methods

A total of 2,278 middle-school students aged 12 to 16 years were recruited through a multistage cluster sampling method in this cross-sectional study. Logistical regression analysis and structural equation modeling (SEM) were conducted to examine the direct and indirect effects of social anxiety.

Results

During the past year, 262 (11.50%) participants reported suicidal ideation. Females had a higher prevalence of suicidal ideation than males (12.9% vs. 10.0%, p = 0.034), and urban adolescents reported a higher prevalence than their rural counterparts (13.4% vs. 9.6%, p = 0.006). In the total sample, social anxiety and Internet addiction were independently associated with suicidal ideation (p < 0.05). In the subgroup analysis, the association between social anxiety and suicidal ideation was significant only among rural females and urban males (p < 0.05). SEM demonstrated that social anxiety had direct and indirect effects on suicidal ideation, and Internet addiction partially mediated the relationship, with a mediating ratio of 30.53%. The partial mediating effect was also significant only in rural females and urban males.

Conclusion

Adolescents may overuse the Internet to cope with social anxiety and further have suicidal ideation. Limiting Internet use and improving interpersonal skills in real life may be efficient for suicide prevention. In addition, targeted interventions should be tailored by different sexes across urban and rural regions.

Childhood maltreatment and suicide risk: The mediating role of self-compassion, mentalization, depression

BACKGROUND

Childhood maltreatment (CM) is a well-established risk factor for depression and increased suicide risk. This study aimed to investigate the distinctive mechanisms of individual types of CM on young adult suicide risk, by exploring the potential mediating role of mentalization, self-compassion, and depression.

METHODS

A total of 4873 adults completed a survey screening for experiences of CM, self-compassion, mentalization, depression, and suicide risk.

RESULTS

The path analysis revealed significant direct effects of mentalization, self-compassion, and depression on suicide risk. Moreover, mentalization, self-compassion, and depression mediated the relationship between emotional abuse/neglect and suicide risk, whereas physical neglect contributed to suicide risk only through mentalization and depression. Furthermore, sexual abuse had a significant direct effect on suicide risk, whereas physical abuse did not show any direct or indirect effects.

LIMITATIONS

The cross-sectional design of the study limits its ability to establish causality, and the risk of recall bias in reporting physical or sexual abuse cannot be ignored.

CONCLUSIONS

This study represents the first identification of disturbances in self-compassion, mentalization, and depression that mediate the relationship between various types of CM and suicide risk in young adults. Our findings suggest substantive differences in the impact of emotional CM compared to other forms of CM. Enhancing self-compassion and mentalization abilities could be valuable intervention strategies for individuals with a history of emotional CM. Addressing factors that hinder the recall of relevant subjective experiences of physical and sexual abuse is also critical.

Enduring Effects of Early Life Traumas on Adult Suicidal Ideation

Exposure to traumas early in life has been found to have a range of negative health effects later in adulthood, including a higher risk for suicidal behavior. Using data from the Waves I (1994/95) and IV (2008) of the National Longitudinal Study of Adolescent to Adult Health (N = 14,385; 49.35% female; Mage in Wave IV = 29), this study examines the effects of exposure to three different types of early life traumas-emotional abuse, physical abuse, and sexual abuse before the age of 18-on adult suicidal ideation. Guided by the stress process model incorporated with a life-course perspective, potential mediating roles of psychological distress, subjective powerlessness, and perceived social rejection were also investigated. A series of regression and Karlson-Holm-Breen (KHB) mediation analyses were performed using Stata 14 to assess the total, direct, and indirect effects. All three early life trauma measures were found to be significantly and independently associated with a higher risk of suicidal ideation in adulthood. A substantive portion (between 30 and 50%) of the effects was mediated by psychological distress (i.e., depression and anxiety), subjective powerlessness, and perceived social rejection. The general policy implications of this study include evaluating suicidal individuals for prior childhood abuse experiences and assessing abuse survivors for suicidality.

The Mediating Role of Tolerance for Psychological Pain in the Relationship Between Different Types of Childhood Traumatic Experiences and Suicidal Ideation

The aim of the present research was to evaluate the mediating effects of facets of the tolerance for psychological pain on the relationship between childhood trauma and suicidal ideation. A sample of 437 community individuals and a sample of 316 college students participated. For the community sample, managing the pain mediated the relationship between childhood trauma, the different types of traumatic experiences and suicidal ideation. In the college sample, managing the pain and enduring the pain mediated the relationship between childhood trauma, the different types of traumatic experiences and suicidal ideation, except for the case of sexual abuse. The present results have potential clinical implications. Mental health professionals should be aware of the long-term consequences of exposure to childhood trauma and need to assess the ability to tolerate psychological pain so as to implement appropriate psychological interventions that help individuals cope with their pain.

The relationship between abuse and neglect and adolescent suicidality: A moderated mediation model

Abuse and neglect can lead to suicide in adolescents; however, the internal mechanisms between abuse and neglect and suicidality remain unclear. We hypothesized that abuse and neglect could affect adolescent suicidality, and that mediating and moderating mechanisms exist between these two variables. We tested the mediating effects of stressful life events (misunderstanding and discrimination by others, poor academic performance, failed exams, interpersonal problems, and school punishment) on suicidal tendencies and moderating effects of resilience among 5,852 adolescents from 37 middle schools in five provinces of North, south, East, west, and central China. We used a questionnaire to collect data and adopted structural equation modeling to verify the correlation, mediating, and moderating effects among the variables. The results showed that stressful life events mediated the relationship between abuse, neglect, and suicide. Furthermore, resilience moderated the direct effect and second half of the mediating effect.

Transition from Depression to Suicidal Attempt in Young Adults: The Mediation Effect of Self-Esteem and Interpersonal Needs

BACKGROUND

Depression increases the risk of suicide. Depression and suicide attempts are significantly impacted by low self-esteem and interpersonal needs (i.e., thwarted belongingness (TB) and perceived burdensomeness (PB)). More research is required to clarify how these factors affected the change from depression to suicidal attempts, which would dramatically lower the suicide fatality rate. We sought to examine the mediating roles of self-esteem, TB, and PB in Chinese young adults, since previous research shows that self-esteem has a strong relationship with TB, while TB and PB have strong relationships with suicide attempts.

METHODS

Measures on depression, interpersonal needs, and attempted suicide were completed by a sample of 247 Chinese social media users who had stated suicidal ideation online.

RESULTS

The findings showed that people who attempted suicide had significantly higher levels of TB and PB. Suicidal attempts were also impacted by depression via the mediational chains, which included self-esteem, TB, and PB.

CONCLUSIONS

Our findings might contribute to the expansion of the interpersonal theory of suicide and have an impact on effective suicide prevention.

Improving care for SUD patients with complex trauma-relationships between childhood trauma, dissociation, and suicidal behavior in female patients with PTSD and SUD

BACKGROUND

Posttraumatic disorders are among the most frequent co-occurring diagnoses in patients with substance use disorders (SUD). Individuals with this dual diagnosis often present with special treatment needs, especially after childhood traumatic experiences (CT). Along with posttraumatic stress disorder (PTSD) and dissociative symptoms, suicidal behaviors belong to the clinical challenges in this group of patients and may influence the course and outcome of SUD treatment. Therefore, a better understanding of the relationships between different forms of CT, psychopathology and suicidal behaviors seems to be important to tailor adequate concepts of care.

MATERIALS AND METHODS

We examined 343 female patients with SUD and Posttraumatic stress disorder (PTSD). All patients completed the Childhood Trauma Questionnaire (CTQ), the Dissociative Experiences Scale-Taxon (DES-T) and the Structured Clinical Interview Axis I Disorders (SCID-I). To determine relationships between different symptoms with potential importance for concepts of treatment, we conducted analyses of moderated mediation for different models. We examined the direct and indirect effects of associations between the type of CT, dissociation and suicidal behavior, as well as the moderation effect of PTSD.

RESULTS

All participants met DSM-criteria for either full PTSD (75.2%) or subsyndromal PTSD (24.8%). Almost all (94.5%) received at least one substance dependence diagnosis and the remaining 5.5% met substance abuse criteria. Most participants (93.3%) reported at least one type of childhood trauma. In all models, dissociation was a risk factor for suicidal ideation (SI) and for suicide attempts (SA). In both, participants with subsyndromal PTSD and participants with full PTSD, dissociation mediated the relationship between childhood sexual abuse and SI as well as SA. Moreover, we report direct effects between different childhood traumas and SI and SA. Furthermore, emotional abuse was a significant predictor of dissociation.

DISCUSSION

In our sample of female patients with SUD and co-occurring PTSD, dissociation significantly increased suicidal behavior and served as a mediator of the relationship between childhood sexual abuse and suicidal behavior. Our findings underline the need to include interventions to address dissociative symptoms and other more complex consequences of childhood trauma into concepts of care for patients with SUD.