Childhood Trauma and Insomnia Increase Suicidal Ideation in Schizophrenia Patients: A Cross-Sectional Study

Abstract

Objectives: This study aimed to investigate the effect of childhood trauma, especially its specific dimensions, and clinical risk factors for suicidal ideation in patients with schizophrenia.Methods: A total of 83 inpatients with schizophrenia were enrolled and divided into two groups: with suicidal ideation (n = 33) and without suicidal ideation (n = 50). All participants were administered the Childhood Trauma Questionnaire-Short Form, the Insomnia Severity Index, the Beck Scale for Suicide Ideation, the Modified Overt Aggression Scales, the auditory hallucination rating scale, the Hamilton Rating Scale of Depression and the Positive and Negative Syndrome Scale.Results: In our sample, 39.8% of the subjects had suicidal ideation, and 60.6% of them had suffered from childhood trauma. Patients with suicidal ideation had a higher Insomnia Severity Index score, Physical neglect score, the Childhood Trauma Questionnaire-Short Form total score (all P < 0.05) compared to those without. The logistic regression analysis revealed that physical neglect in Childhood Trauma Questionnaire was significantly associated with suicidal ideation (OR = 5.46, P < 0.05, 95% CI = 0.007–0.483). Further stepwise multiple linear regression identified that insomnia (β = 0.272, P = 0.011) and physical neglect (β = 0.257, P = 0.017) were strong risk factors for the severity of suicidal ideation in patients with schizophrenia. Mediation analysis showed that insomnia played a complete mediating role between physical neglect and suicidal ideation.Conclusion: Our results indicate that childhood maltreatment of physical neglect is a strong independent risk factor for suicidal ideation in schizophrenia. The risk is probably aggravated by the poor quality of sleep. Early screening and psychosocial treatment are recommended for psychotic individuals with a trauma history.

Meta-analysis of insomnia, suicide, and psychopathology in schizophrenia

“…After searches and review of study methods, 10 studies met the criteria for inclusion [5,6 ▪ ,7,15 ▪ ,18,19,20 ▪ ,21–23]. Nine studies contributed data on insomnia and suicide, and eight studies contributed data on insomnia and psychopathology.…”

“…This finding is particularly relevant for patients with schizophrenia, given a 27% lifetime prevalence of suicide attempt [13] and a 5% lifetime prevalence of suicide death [14] in the disorder. Several studies have found that insomnia is an indicator of suicidal ideation, suicide attempt, and suicide death in patients with schizophrenia [5,6 ▪ ,7,15 ▪ ,16–19,20 ▪ ]. However, to our knowledge, these associations have not been systematically reviewed.…”

Longitudinal Association between Stressful Life Events and Suicidal Ideation in Adults with Major Depression Disorder: The Mediating Effects of Insomnia Symptom

“…Life adversities during critical developmental stages of life, especially childhood, are associated with more severe and persistent symptoms that negatively affect health outcomes [47]. In addition, it is reported that physical abuse could increase the risk of suicide tendency in adolescents [48], young people [49], persons with MDD [50],…”

Association between childhood maltreatment and suicidal ideation among Chinese patients with chronic schizophrenia: the mediating role of insomnia

“…First, previous studies have produced highly varied results. 6 – 13 Several studies reported no association between childhood maltreatment and suicide ideation in people with chronic schizophrenia 10 or people with first-episode schizophrenia, 6 while other studies demonstrated a positive relationship. 7 , 11 …”

“… 16 , 17 However, the connection between suicidality and specific types of childhood maltreatment in individuals with schizophrenia remains debatable. For example, while physical neglect is highlighted as the sole predictor for suicide ideation in some studies, 11 , 13 one separate study in 216 Chinese people with schizophrenia demonstrated that suicide ideation was only positively correlated with emotional abuse and emotional neglect, but not with physical neglect. 12 Another study in individuals with relapse schizophrenia demonstrated that suicide ideation could be related to emotional neglect and sexual abuse, while suicide ideation was not associated with other types of childhood maltreatment.…”