Mediators Linking Childhood Adversities and Trauma to Suicidality in Individuals at Risk for Psychosis

Abstract

Suicidality is highly prevalent in patients at clinical high risk (CHR) for psychosis. Childhood adversities and trauma are generally predictive of suicidality. However, the differential effects of adversity/trauma-domains and CHR-criteria, i.e., ultra-high risk and basic symptom criteria, on suicidality remain unclear. Furthermore, the underlying mechanisms and, thus, worthwhile targets for suicide-prevention are still poorly understood. Therefore, structural equation modeling was used to test theory-driven models in 73 CHR-patients. Mediators were psychological variables, i.e., beliefs about one’s own competencies as well as the controllability of events and coping styles. In addition, symptomatic variables (depressiveness, basic symptoms, attenuated psychotic symptoms) were hypothesized to mediate the effect of psychological mediators on suicidality as the final outcome variable. Results showed two independent pathways. In the first pathway, emotional and sexual but not physical adversity/trauma was associated with suicidality, which was mediated by dysfunctional competence/control beliefs, a lack of positive coping-strategies and depressiveness. In the second pathway, cognitive basic symptoms but not attenuated psychotic symptoms mediated the relationship between trauma/adversity and suicidality. CHR-patients are, thus, particularly prone to suicidality if adversity/trauma is followed by the development of depressiveness. Regarding the second pathway, this is the first study showing that adversity/trauma led to suicidality through an increased risk for psychosis as indicated by cognitive basic symptoms. As insight is generally associated with suicidality, this may explain why self-experienced basic symptoms increase the risk for it. Consequently, these mediators should be monitored regularly and targeted by integrated interventions as early as possible to enhance resilience against suicidality.

Suicidal Ideation in People With Psychosis Not Taking Antipsychotic Medication: Do Negative Appraisals and Negative Metacognitive Beliefs Mediate the Effect of Symptoms?

“…51 The BDI data were treated as interval for the analyses. This is in line with previous studies, [45][46][47][48] and dichotomizing the data for logistic regression would incur a substantial loss of statistical power. 52,53 There is debate over the best way to conceptualize questionnaire data, 54 but we encourage attempts to replicate these findings using full-scale measures (eg, the Beck Scale for Suicidal Ideation 55 ).…”

“…44 All models were conducted with biascorrected confidence intervals based on 5000 samples. In line with previous studies, [45][46][47][48] suicidal ideation scores were treated as a continuous variable in all analyses.…”

Childhood adversities in people at ultra-high risk (UHR) for psychosis: a systematic review and meta-analysis

“…The differential effects of childhood trauma subtypes reported here corroborate previous findings. Compared with other types of abuse, emotional abuse had the strongest associations with negative psychiatric outcomes (Barbosa et al ., 2014; de Araujo and Lara, 2016; Schmidt et al ., 2017), hypothalamic–adrenal–pituitary axis dysregulation (Braehler et al ., 2018) and suicidality (Anestis and Joiner, 2011; Schmidt et al ., 2017). It seems that emotional trauma amplifies the negative feelings of perceived burdensome and the lack of sense of belonging, more so than other types of adversities (Anestis and Joiner, 2011).…”

The interplay between childhood trauma, cognitive biases, psychotic-like experiences and depression and their additive impact on predicting lifetime suicidal behavior in young adults

“…‘The causal triangle’ between childhood trauma, cognitive biases and PLEs has been suggested in some theoretical accounts (Howes and Murray, 2014) and has recently been confirmed in independent studies (Gawęda et al ., 2018 a , 2018 b ; Gibson et al ., 2018). A recent study (Schmidt et al ., 2017) on ultra-high risk for psychosis patients showed that exposure to early life adversities is related to the risk of suicidality through cognitive disturbances and beliefs (e.g. negative self-concept and external attributions).…”