Raimo K R Salokangas1, Paul Patterson2, Jarmo Hietala1,3, Markus Heinimaa1, Tiina From1, Tuula Ilonen1, Heinrich Graf von Reventlow4, Frauke Schultze-Lutter5, Georg Juckel6, Don Linszen7,8, Peter Dingemans7,9, Max Birchwood10, Joachim Klosterkötter11, Stephan Ruhrmann11. 1. Department of Psychiatry, University of Turku, Turku, Finland. 2. FTB-Birmingham Women's and Children's NHS Hospital Trust, Birmingham, UK. 3. Department of Psychiatry, Turku University Hospital, Turku, Finland. 4. NEXUS-Klinik, Baden-Baden, Germany. 5. Department of Psychiatry and Psychotherapy, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany. 6. Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital, Bochum, Germany. 7. Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. 8. Department of Psychiatry and Psychology, University of Maastricht, Maastricht, Netherlands. 9. Mediant, Enschede, Netherlands. 10. Warwick Medical School, University of Warwick, Coventry, UK. 11. Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
Abstract
AIM: Depression and suicidal ideation (SUI) and behaviour are more prevalent in females than males, and common in clinical high-risk (CHR) patients. Childhood adversities and trauma (CAT) are associated with adult depression and SUI. The role of gender as a moderator and depression as a mediator for the effect of CAT on SUI has not been explored in CHR patients. METHODS: In all, 245 young help-seeking CHR patients were assessed for SUI (thoughts of killing themselves) with the Beck Depression Inventory at baseline, 9-month and 18-month follow-ups. At baseline, clinical depression was assessed by the Structured Clinical Interview for DSM-IV (SCID-I), and CAT by the Trauma and Distress Scale (TADS) which includes the five domains of emotional, physical and sexual abuse, emotional and physical neglect. RESULTS: CAT total and all domains except physical neglect predicted SUI over the study period. The effect of CAT on SUI was mediated via clinical depression and concurrent depression symptoms differently for females and males. In females, the effect of emotional abuse and neglect on SUI was mediated via baseline depression. In males, emotional and physical abuse had a direct effect on SUI, and the effect of sexual abuse and emotional neglect was partly mediated via concurrent depression symptoms. CONCLUSIONS: For CHR females, the effect of CAT on adult SUI is mediated via depression, while for males, CAT and its domains have mainly direct effects in maintaining SUI. These gender differences should be taken into account when treating CHR patients with SUI.
AIM: Depression and suicidal ideation (SUI) and behaviour are more prevalent in females than males, and common in clinical high-risk (CHR) patients. Childhood adversities and trauma (CAT) are associated with adult depression and SUI. The role of gender as a moderator and depression as a mediator for the effect of CAT on SUI has not been explored in CHRpatients. METHODS: In all, 245 young help-seeking CHRpatients were assessed for SUI (thoughts of killing themselves) with the Beck Depression Inventory at baseline, 9-month and 18-month follow-ups. At baseline, clinical depression was assessed by the Structured Clinical Interview for DSM-IV (SCID-I), and CAT by the Trauma and Distress Scale (TADS) which includes the five domains of emotional, physical and sexual abuse, emotional and physical neglect. RESULTS: CAT total and all domains except physical neglect predicted SUI over the study period. The effect of CAT on SUI was mediated via clinical depression and concurrent depression symptoms differently for females and males. In females, the effect of emotional abuse and neglect on SUI was mediated via baseline depression. In males, emotional and physical abuse had a direct effect on SUI, and the effect of sexual abuse and emotional neglect was partly mediated via concurrent depression symptoms. CONCLUSIONS: For CHR females, the effect of CAT on adult SUI is mediated via depression, while for males, CAT and its domains have mainly direct effects in maintaining SUI. These gender differences should be taken into account when treating CHRpatients with SUI.
Authors: Raimo K R Salokangas; Tiina From; Tuula Ilonen; Sinikka Luutonen; Markus Heinimaa; Reetta-Liina Armio; Heikki Laurikainen; Maija Walta; Janina Paju; Anna Toivonen; Päivi Jalo; Lauri Tuominen; Jarmo Hietala Journal: BMC Psychiatry Date: 2021-12-02 Impact factor: 3.630