Pathways to Suicidal Behavior in Children and Adolescents: Examination of Child Maltreatment and Post-Traumatic Symptoms

Exploring the Relationship Between Childhood Maltreatment and Suicidal Ideation: Gender Differences in the Mediating Roles of Self-Compassion and Posttraumatic Stress Disorder

Existing studies and theories suggest that childhood maltreatment by parents is a significant risk factor for suicidal ideation. While prior research has examined various influencing factors, further exploration is needed to clarify the shared mechanisms underlying this relationship. This study examines the mediating roles of self-compassion and posttraumatic stress disorder (PTSD), and whether this association differs by gender. Adopting a longitudinal design, we conducted self-report surveys at three different time points, each 6 months apart. The final sample comprised 517 students (299 women; Mage = 19.00, SD = 1.31) from four universities in China, all of whom had been exposed to at least one type of childhood maltreatment before the age of 16. Bias-corrected bootstrap estimation was employed to examine the mediating relationships. After controlling for negative life events, our analysis revealed gender-specific mediating pathways. We found that uncompassionate self-responding and PTSD played a chain mediating role in the relationships between childhood maltreatment and suicidal ideation for women only. In contrast, for men, there was a positive relationship between childhood maltreatment and suicidal ideation via an indirect path from compassionate self-responding to PTSD. Our findings suggest that compassionate self-responding may serve as a protective factor for those who were abused or neglected during their childhood, while uncompassionate self-responding may aggravate negative psychological outcomes such as PTSD and later suicidal ideation. In addition, special attention should be given to the observed gender differences in these pathways. Gender-specific interventions may be more effective in mitigating the long-term psychological impacts of childhood maltreatment.

Trends and Disparities in Suicidal Thoughts and Behaviors Among an Ethno-Racially Diverse Group of Adolescents: 2013-2022

OBJECTIVE

Suicide is a leading cause of death among adolescents and research on aggregated data conceals unique vulnerabilities across ethno-racial subpopulations. Adverse childhood experiences (ACEs) increase risk for suicide ideation (SI) and suicide attempts (SA), but these associations may vary across different ethno-racial groups and years.

METHOD

Data from the 2013-2022 Minnesota Student Survey were used to assess trends in past-year SI and SA (grades 8, 9, and 11, n = 421,709). We described frequencies of demographics and evaluated trends using the Mantel-Haenszel tests of linear associations stratified by 12 ethno-racial groups and sex. Using logistic regression models, we assessed how SI and SA outcomes varied across ethno-racial groups when adjusting for grade and ACEs.

RESULTS

Overall, SI and SA increased among 8 th and 9 th grade female students. Female students more frequently reported SI (14.0-20.1%, p < 0.001) and SA (4.9-5.6%, p < 0.001), compared to male students (SI 6.3-8.8%; SA 1.9-2.5%, p < 0.001), with Black Latine, American Indian/Alaskan Native (AIAN), and multiracial students consistently reporting high rates. Rates of SA significantly increased among AIAN male and AIAN and Black female students. ACEs were strongly related to SI and SA, but time trends were not limited to changes in ACEs for most groups.

CONCLUSION

These marked differences in SI and SA call for targeted and multipronged prevention approaches that account for shared and distinct factors across sex, developmental stages, and ethno-racial subgroups. To develop acceptable and efficacious interventions identifying amenable targets within subgroups is critical.

Suicidal Ideation, Clinical Worsening and Outcomes among Child Participants in Trauma-Focused Treatment

Research on clinical trajectories of children with suicidal ideation (SI) and clinical worsening (CW) during cognitive behavioral therapy (CBT) for childhood trauma is limited. The current study utilized secondary data from a randomized clinical trial comparing Trauma-Focused CBT versus Stepped care CBT to examine (1) clinical profile and outcomes of children with SI, recurrent thoughts of death/dying, and past attempts; and (2) clinical worsening during treatment and difference in outcomes. Children (ages 4-12) and their parents (N = 183) participated and 132 completed treatment. Interviews assessing SI, thoughts of death/dying, past attempts, and number/type of trauma were conducted with children (ages 7-12) and parents. Outcome measures (baseline and post-treatment) completed by parents included child posttraumatic stress symptoms, impairment, and internalizing and externalizing problems and an independent evaluator rated overall severity. Children (ages 7-12), parents and therapists completed ratings during treatment that indicated CW. Results did not differ by treatment group; thus, the pooled sample was used. Children with SI at baseline had higher severity than children without. For completers, no children (n = 14) with SI at baseline had SI at post-treatment. Child (n = 3) and therapist (n = 5) ratings of CW were low. Eighteen children (13.64%) were rated as CW by parents. Most ratings occurred at the beginning of treatment. Children with therapist ratings of CW had higher internalizing problems. Findings suggest that children with SI and CW can improve from trauma-focused CBT. More research is needed on the clinical trajectory of children with SI and trauma, and on clinical tools to monitor CW. Clinical trial registration information: https://clinicaltrials.gov : NCT02537678.

Risk Factors and Clinical Predictors of Suicidal Behaviors and Non-Suicidal Self-Injury Among Pediatric Psychiatry Emergency Admissions Pre- and Post-Pandemic: A Retrospective Cohort Study

BACKGROUND

Suicidal behavior (SB) and non-suicidal self-injury (NSSI) are significant public health concerns among adolescents. The COVID-19 pandemic may have exacerbated these issues.

METHODS

This retrospective cohort study analyzed data from 341 adolescents (aged 6-18 years) presenting to a Romanian pediatric psychiatry emergency department during the years 2019 (pre-pandemic) and 2022 (post-pandemic). All participants underwent a thorough psychiatric assessment, and, together with their caregivers, were questioned on a wide range of potentially relevant issues, such as family, social, school, and life history factors. Logistic regression and random forest models were used to identify predictors of SB and NSSI.

RESULTS

SB was significantly predicted in regression models based on a prior suicidal ideation (OR = 68.410; p < 0.001), having a parent living abroad (OR = 11.438; p = 0.020), depression (OR = 6.803; p < 0.001), and conflicts with peers (OR = 0.325, p = 0.042), teachers (OR = 0.119, p = 0.024), or both (OR = 0.166, p = 0.012). The random forest model featured a slightly different order of the main predictors and highlighted the importance of additional predictors, such as prior suicide attempts, gender, and past non-suicidal self-injury. NSSI was mainly predicted by a history of self-harm (OR = 52.437; p < 0.001), the number of comorbid psychiatric disorders (OR = 1.709; p = 0.003), and conduct disorder (OR = 0.184; p < 0.001), to which are added, according to random forest models, new predictors, such as borderline personality disorder, suicidal ideation, and school performance. Post-pandemic increases were observed in depression, suicidal ideation, and possible psycho-traumatic negative life event exposure.

CONCLUSIONS

This study underscores the complex interplay of individual, familial, and societal factors influencing adolescent self-harm. Comprehensive interventions are needed, with early intervention crucial for those with a history of self-harm. Further research using prospective designs is recommended.

Self-compassion as a protective factor against post-traumatic stress symptoms induced by adverse childhood experiences: A cross-sectional study among Japan air self-defense force new recruits

Adverse childhood experiences (ACEs) may result in long-term mental health complications, including post-traumatic stress disorder (PTSD). ACEs are known to be more frequent among military personnel, despite their need to maintain their mental health to accomplish their missions. Self-compassion, or treating oneself with kindness and understanding, can mitigate the psychological effects of adversity but is also affected by adversity. This cross-sectional study aimed to identify the complex relationships between ACEs, self-compassion, and PTSD symptoms among 752 new recruits of the Japan Air Self-Defense Force, of whom 537 with ACEs completed the PTSD Checklist for DSM-5. Hierarchical multiple regression analysis was used to examine the independent effect of self-compassion, measured using the Self-Compassion Scale, on PTSD symptoms. Mediation effect analysis with self-compassion as a mediator was conducted on the relationship between ACEs and PTSD symptoms. We confirmed high levels of ACEs among our participants compared to a healthy population of a previous study, and approximately 6% presented PTSD symptoms above a threshold. Self-compassion was significantly negatively associated with PTSD symptoms (β = -.22, 95% confidence interval [CI], -.34 to -.11). Mediation effect analysis revealed that self-compassion partially mediated the relationship between ACEs and PTSD symptoms, explaining 6.9% of this effect, and ACEs were negatively associated with self-compassion (β = -.13, 95% CI, -.22 to -.04). These findings suggested that self-compassion is a protective factor against PTSD symptoms, whereas ACEs can decrease self-compassion. Further research should explore educational interventions to enhance self-compassion among individuals with ACEs to mitigate PTSD symptoms.

[Patient-reported outcomes in chronic diseases under treatment with cannabis medicines : Analysis of the results of the Copeia survey]

BACKGROUND

The survey of Copeia captured early 2022 patient-reported outcomes (PRO) in Germany under cannabis medicinal product (CAM) therapy, with particular attention to symptoms, symptom changes, indications, side effects, dosages, and cost bearers.

GOAL

This study investigated the question of whether associations emerge from the results that could play a role in the indication and treatment monitoring of CAM in chronically ill patients.

MATERIALS AND METHODS

A standardized questionnaire was administered online nationwide in dialogue form over a 15-week period to collect itemized symptoms and PRO. Recruitment was supported by pharmacies, prescribing physicians, and patient associations. Inclusion criteria included physician-prescribed CAM therapy.

RESULTS AND DISCUSSION

Of 1582 participants, 1030 data sets (65%) could be completely analyzed. There was a heterogeneous patient population, whose common feature was disease chronicity. The frequency distribution of symptoms showed a homogeneous pattern for the respective indications, in which the most frequent six (pain 71%, sleep disturbance 64%, stress/tension 52%, inner restlessness 52%, depressive mood 44% and muscle tension 43%) seem to have a special significance. According to subjective assessment, quality of life improved significantly in 84% of all participating patients.

CONCLUSION

A symptom matrix (SMX) composed of different symptoms seems to play a special role in CAM therapy to improve the quality of life of chronically ill patients, regardless of the underlying disease. The SMX could contribute to the identification of an indication and to targeted treatment monitoring.

Childhood Maltreatment and Creativity among Chinese College Students: A Serial Mediation Model

Creativity plays a very crucial impact on our cultural life and has also been important to the improvement of human civilization. Numerous studies have indicated that family circumstance plays an important role in the development of individual creativity. However, little is known about the mediating mechanisms underlying the association between childhood maltreatment and creativity. This study intended to explore the serial multiple mediation model in which undergraduates' cognitive flexibility and self-efficacy were proposed to mediate the potential influence of childhood maltreatment on their creativity. Participants were 1069 undergraduates (573 males and 496 females, mean age was 20.57 ± 1.24 years ranging from 17 to 24) from a university in Shandong Province, China. Participants were required to complete an internet survey including the Short Form of Childhood Trauma Questionnaire (CTQ-SF), General Self-Efficacy Scale (GSES), Cognitive Flexibility Inventory (CFI), and Williams Creativity Aptitude Test (WCAT). Serial multiple mediation analysis and the bootstrap method were used to investigate the mediation effects of cognitive flexibility and self-efficacy. The results showed that childhood maltreatment indirectly influenced undergraduates' creativity through three indirect paths: childhood maltreatment→cognitive flexibility→creativity, childhood maltreatment→self-efficacy→creativity, and childhood maltreatment→cognitive flexibility→self-efficacy→creativity. The ratios of the total indirect effects and branch-indirect effects to the total effects were 92.73%, 34.61%, 35.68%, and 22.44%, respectively. These results indicated that cognitive flexibility and self-efficacy could completely mediate the potential impact of childhood maltreatment on individuals creativity.

Days with and without self-injurious thoughts and behaviors: Impact of childhood maltreatment on adolescent online social networking

INTRODUCTION

Among adolescents, an increasing rate of interpersonal interactions occurs online. Previous research has shown that interpersonal context exerts a robust impact on suicidal thoughts or behaviors, yet little attention has focused on examining the content of online interactions surrounding self-injurious thoughts or behaviors. As such, the present study sought to compare online social networking behaviors among adolescents on days with and without experiencing self-injurious thoughts or behaviors, as influenced by childhood maltreatment history.

METHOD

Adolescents aged 13-18 hospitalized for self-injurious thoughts or behaviors were recruited as part of an ongoing longitudinal study. A subsample (N = 22) of adolescents provided data from their online social networking platforms (i.e., text messages, Facebook, Instagram, and Twitter). Using a mixed-methods approach, online social networking data on days of experiencing self-injurious thoughts or behaviors and days of not experiencing self-injurious thoughts or behaviors were compared.

RESULTS

Results indicate the frequency and content of online social networking messaging do not change by day of self-injurious thoughts or behaviors or history of childhood maltreatment. However, childhood maltreatment predicts received conflictual messages as well as sent symptomatic messages on days of experiencing self-injurious thoughts or behaviors.

CONCLUSIONS

Childhood maltreatment may play a role in the content of adolescent online behaviors, particularly on days when they experience self-injurious thoughts or behaviors. Implications for intervention are discussed.