Childhood trauma is linked to suicidal thoughts and attempts in adults with depression and anxiety

An analysis of data from the Netherlands Study of Depression and Anxiety found that among adults with depressive or anxiety disorders, those who experienced more childhood trauma were more likely to report recent suicidal thoughts and past suicide attempts. Personality traits, insomnia, and low social support statistically accounted for part of this link. The paper was published in the Journal of Affective Disorders.

Suicide is a major global health problem, and people living with depression or anxiety are among those at the greatest risk. Experiencing abuse or other serious trauma during childhood can increase this risk further, sometimes many years after the original events. One explanation (called the diathesis-stress model) is that childhood trauma creates a lasting vulnerability that can interact with later stresses, such as mental illness, difficult life events, or lack of social support.

Childhood trauma may shape personality in ways that increase vulnerability, for example by contributing to hopelessness, aggression, neuroticism, or a reduced sense of control over one’s life. It may also affect a person’s social world, increasing the likelihood of loneliness, poor support, and repeated negative life experiences. Additionally, childhood trauma is associated with problems such as disturbed sleep, alcohol use, smoking, physical inactivity, and higher body weight. It may also alter biological stress systems, including inflammatory processes and the hormonal system, further affecting how the body responds to stress.

Study author Jasper X.M. Wiebenga and his colleagues set out to examine the association between childhood trauma and suicidal outcomes (suicidal ideation and suicide attempts), as well as various factors that might mediate this association. In other words, they were interested in identifying factors that may be affected by childhood trauma and that may, in turn, affect the risk that a person will start thinking about suicide or attempt suicide.

The researchers analyzed data from the Netherlands Study of Depression and Anxiety (NESDA), a large, ongoing study designed to investigate depressive and anxiety disorders. They hypothesized that more severe childhood trauma would be associated both with a higher likelihood of having suicidal thoughts without having attempted suicide and with a higher likelihood of having attempted suicide.

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The analysis used data collected between 2004 and 2007 from 1,572 individuals between 18 and 65 years of age who had been diagnosed with a depressive or anxiety disorder in the 12 months before enrolling in the study. Participants were recruited from across the Netherlands. Of these individuals, 24% had a depressive disorder without an anxiety disorder, 30% had an anxiety disorder without a depressive disorder, and 46% had both. Just over half (55%) reported experiencing childhood trauma. Participants’ average age was 41 years, and 67% were women.

To assess childhood trauma, the researchers used the Childhood Trauma Index, a structured interview about emotional neglect, emotional abuse, physical abuse, and sexual abuse before age 16, scored from 0 to 8 based on the number of trauma types and how often they occurred. Suicidal ideation in the past week was assessed with a shortened version of the Scale for Suicide Ideation, and lifetime suicide attempts were assessed with the question “Have you ever made a serious attempt to end your life, for instance by harming or poisoning yourself or by getting into an accident?”

Based on their answers, participants were divided into three groups: those with neither recent suicidal thoughts nor a past attempt (1,248 people), those with recent suicidal thoughts but no past attempt (231 people), and those with recent suicidal thoughts and a past attempt (93 people). People who had attempted suicide in the past but had no recent suicidal thoughts were left out of the analysis.

The researchers also used data on participants’ personality traits (the Leiden Index of Depression Sensitivity-Revised, the NEO Five-Factor Inventory, and the Pearlin Mastery Scale), negative life events (the Recent Life Events Questionnaire), social support, loneliness, lifestyle (alcohol consumption, smoking, sleep quality, physical activity, and body mass index), markers of systemic inflammation (C-reactive protein and interleukin-6, measured from blood samples), and levels of the stress hormone cortisol (from saliva samples).

After controlling for age and sex, each one-point increase in childhood trauma score was associated with 51% higher odds of having recent suicidal thoughts without a past attempt, and 2.68 times higher odds of having recent suicidal thoughts along with a past suicide attempt. When the researchers compared participants with severe childhood trauma (a score of 4 or more) to those with no childhood trauma, the odds of recent suicidal thoughts without an attempt were 2.63 times higher. The odds of having recent suicidal thoughts and a past attempt were almost 10 times higher.

Further analyses tested each potential mediator separately. For both suicide outcomes, a number of factors showed significant indirect associations consistent with mediation: aggression, insomnia, lower social support, loneliness, neuroticism, lower extraversion, hopelessness, and a weaker sense of control over one’s life (people who feel that events in their life are outside their control were more likely to report suicidal thoughts).

Interestingly, higher levels of interleukin-6, a marker of systemic inflammation, also emerged as a potential mediator of the link between childhood trauma and suicide attempts, although it accounted for only about 3% of the association and was no longer significant once other factors were considered together. Other biological markers, including C-reactive protein and cortisol, were not significant mediators. Among lifestyle factors, only insomnia played a role; alcohol use, smoking, physical activity, and body weight were not significant mediators.

The researchers then entered the significant mediators into combined models, which test how much each factor contributes after accounting for the overlap among them. For recent suicidal thoughts without an attempt, neuroticism, lower extraversion, aggression, hopelessness, insomnia, and social support together accounted for about 66% of the association with childhood trauma. For suicidal thoughts with a past attempt, a weaker sense of control, aggression, insomnia, and social support accounted for about 39% of the association. In both cases, childhood trauma remained significantly linked to the suicide outcomes even after accounting for these factors.

“Altogether, CT [childhood trauma] was associated with both suicide outcomes, but SI+SA+ in particular. These associations were substantially attenuated in multiple-mediator models in which multiple personality traits, insomnia, and perceived social support showed significant indirect associations consistent with mediation after accounting for shared variance among variables,” the study authors concluded.

“Aggression, insomnia and social support statistically accounted for the link between CT and the outcomes SI+SA- and SI+SA+. Neuroticism, introversion, and hopelessness linked CT to SI+SA- in particular, whilst locus of control showed a significant indirect association consistent with mediation of the association between CT and SI+SA+. The findings point to potentially modifiable factors relevant for suicide prevention, especially aggression, insomnia and social support, that require further investigation in longitudinal studies.” (In the authors’ shorthand, SI+SA- refers to suicidal ideation without a suicide attempt, and SI+SA+ refers to suicidal ideation with a suicide attempt.)

The study contributes to the scientific understanding of factors associated with suicide attempts and suicidal ideation. However, it should be noted that the design of this study does not allow any causal inferences to be drawn from the results. The potential mediators were measured at the same time as suicidal thoughts, so the study cannot show whether they came before or after them. Additionally, childhood trauma was reported by participants as adults, leaving room for recall bias, although the authors note that research suggests such retrospective reports are generally reliable.

Many of the potential mediators were also correlated with one another, so the combined models capture each factor’s unique contribution rather than its full role. Finally, all participants had depressive or anxiety disorders, and the sample was predominantly Dutch and female, so the findings may not apply to the general population, to men, or to other cultures.

The paper, “Childhood trauma and suicide ideation and attempts: Examining the mediating role of psychosocial, personality, lifestyle and biological factors,” was authored by Jasper X.M. Wiebenga, Lili Lokhorst, Adriaan W. Hoogendoorn, Henriette D. Heering, Merijn Eikelenboom, Erik J. Giltay, Patricia van Oppen, and Brenda W.J.H. Penninx.