Childhood Trauma Associated With Increased Risk for Suicide in Schizophrenia

Individuals with schizophrenia who experienced high levels of childhood trauma expressed higher current suicidal ideation, depression, and psychotic symptoms compared with patients with low childhood trauma, according to a study published in Psychiatry Research. Furthermore, sexual abuse and physical neglect are unique risk factors for suicidality.

The investigators of this cross-sectional study sought to examine the dimensions of childhood trauma in patients with schizophrenia and to use dimensions of childhood trauma and clinical factors to predict suicidal risk.

The study included 82 inpatients with schizophrenia recruited from the Rahnema Psychiatric In-patient Center in Tehran, Iran, who were maintained on antipsychotic medication. Participants completed the Childhood Trauma Questionnaire-Short Form to assess dimensions of childhood trauma, including sexual abuse, physical abuse, emotional abuse, physical neglect, and emotional neglect; established cutoff scores were used to define patients with high or low childhood trauma.

In addition, participants were administered the Beck Depression Inventory-II, the Beck Scale for Suicide Ideation, and the Positive and Negative Syndrome Scale (PANSS). Structured diagnostic clinical interviews were used to assess the presence of lifetime suicide attempts. Pearson’s correlations were used to test the associations between current suicidal ideation and different childhood trauma dimensions, depression, and PANSS scores; logistic regression analyses were used to examine associations with lifetime suicide attempts and presence of current suicidal ideation.

Based on cutoff scores, 39% of participants were shown to have high childhood trauma; these participants were associated with higher PANSS scores, current suicidal ideation, and depression compared with those with low childhood trauma. After controlling for depression severity, participants with lifetime suicide attempts had higher sexual abuse scores compared with participants without suicide attempts. Similarly, participants with high suicidal risk had higher physical neglect scores than those without high suicidal risk. In logistic regression analyses, sexual abuse was found to be the only significant predictor of lifetime suicide attempts (OR, 1.54; 95% CI, 1.07-1.98; P <.05), while physical neglect (OR, 2.26; 95% CI, 1.70-2.80; P <.001) and depression (OR, 1.44; 95% CI, 1.10-1.75; P <.01) were unique predictors of suicidal ideation.

Limitations to the study included lack of controls, not measuring personality disorders (which are known factors for suicidal risk), and the cross-sectional design in which causation cannot be inferred. Findings from an inpatient sample may not apply to a broader population of patients with schizophrenia, and the relatively small size lacks statistical power. Finally, self-reported measures may introduce potential response bias.

The investigators suggest that patients with schizophrenia who experienced high childhood trauma have an association with increased suicidal risk: When sexual abuse is a part of their history, this uniquely predicted the presence of suicide attempts, while physical neglect and depression predicted suicidal ideation. Therapists should screen for these dimensions of childhood trauma to prevent suicide in this patient population.

Reference

Mohammadzadeh A, Azadi S, King S, Khosravani V, Sharifi Bastan F. Childhood trauma and the likelihood of increased suicidal risk in schizophrenia [published online March 14, 2019]. Psychiatry Res. doi: 10.1016/j.psychres.2019.03.023