Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-10-31T23:03:23.718Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  10 January 2019

Łukasz Gawęda Open the ORCID record for Łukasz Gawęda [Opens in a new window] ,
Renata Pionke ,
Martyna Krężołek ,
Dorota Frydecka ,
Barnaby Nelson  and
Andrzej Cechnicki
Łukasz Gawęda*
Affiliation:
Psychopathology and Early Intervention Lab, II Department of Psychiatry, the Medical University of Warsaw, Warsaw, Poland
Renata Pionke
Affiliation:
Psychopathology and Early Intervention Lab, II Department of Psychiatry, the Medical University of Warsaw, Warsaw, Poland
Martyna Krężołek
Affiliation:
Psychopathology and Early Intervention Lab, II Department of Psychiatry, the Medical University of Warsaw, Warsaw, Poland
Dorota Frydecka
Affiliation:
Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
Barnaby Nelson
Affiliation:
Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
Andrzej Cechnicki
Affiliation:
Department of Community Psychiatry, Chair of Psychiatry, Medical College Jagiellonian University, Krakow, Poland
*
Author for correspondence: Łukasz Gawęda, E-mail: lgaweda@wum.edu.pl
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Childhood trauma, psychosis risk, cognition, and depression have been identified as important risk markers for suicidal behaviors. However, little is known about the interplay between these distal and proximal markers in influencing the risk of suicide. We aim to investigate the interplay between childhood trauma, cognitive biases, psychotic-like experiences (PLEs) and depression in predicting suicidal behaviors in a non-clinical sample of young adults.

Methods

In total, 3495 young adults were recruited to an online computer-assisted web interview. We used the Prodromal Questionnaire to assess PLEs. Childhood trauma was assessed with the Traumatic Experience Checklist (three items) and Childhood Experience of Care and Abuse Questionnaire (CECA.Q, three items). Cognitive biases were assessed with a short version of the Davos Assessment of Cognitive Biases Scale. Suicidality, psychiatric diagnoses, and substance use were screened with a self-report questionnaire.

Results

Childhood trauma, as well as PLEs, was associated with an approximately five-fold increased risk of suicidal thoughts and plans as well as suicide attempts. Participants with depression were six times more likely to endorse suicidal behaviors. Path analysis revealed that PLEs, depression and cognitive biases are significant mediators of the relationship between trauma and suicidal behaviors. The model explained 44.6% of the variance in lifetime suicidality.

Conclusions

Cognitive biases, PLEs, and depression partially mediate the relationship between childhood trauma and suicidal behaviors. The interplay between distal and proximal markers should be recognized and become part of clinical screening and therapeutic strategies for preventing risk of suicidality.

Keywords

Cognitive distortionsdepressionlife adversityrisk of psychosissuicide
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 1 , January 2020 , pp. 116 - 124
Copyright
Copyright © Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alaräisänen, A, Miettunen, J, Räsänen, P, Fenton, W, Koivumaa-Honkanen, H-TJ and Isohanni, M (2009) Suicide rate in schizophrenia in the Northern Finland 1966 birth cohort. Social Psychiatry and Psychiatric Epidemiology 44, 1107–1110.10.1007/s00127-009-0033-5Google Scholar
Armando, M, Nelson, B, Yung, AR, Ross, M, Birchwood, M, Girardi, P and Nastro, PF (2010) Psychotic-like experiences and correlation with distress and depressive symptoms in a community sample of adolescents and young adults. Schizophrenia Research 119, 258–265.10.1016/j.schres.2010.03.001Google Scholar
Barbosa, LP, Quevedo, L, da Silva, GDG, Jansen, K, Pinheiro, RT, Branco, J, Lara, D, Oses, J and da Silva, RA (2014) Childhood trauma and suicide risk in a sample of young individuals aged 14–35 years in southern Brazil. Child Abuse & Neglect 38, 1191–1196.10.1016/j.chiabu.2014.02.008Google Scholar
Beevers, CG and Miller, IW (2004) Perfectionism, cognitive bias, and hopelessness as prospective predictors of suicidal ideation. Suicide and Life-Threatening Behavior 34, 126–137.10.1521/suli.34.2.126.32791Google Scholar
Brodsky, BS (2016) Early childhood environment and genetic interactions: the diathesis for suicidal behavior. Current Psychiatry Reports 18, 86.10.1007/s11920-016-0716-zGoogle Scholar
Brown, S (1997) Excess mortality of schizophrenia: a meta-analysis. The British Journal of Psychiatry 171, 502–508.10.1192/bjp.171.6.502Google Scholar
Caldwell, CB and Gottesman, II (1990) Schizophrenics kill themselves too: a review of risk factors for suicide. Schizophrenia Bulletin 16, 571.10.1093/schbul/16.4.571Google Scholar
Capra, C, Kavanagh, DJ, Hides, L and Scott, JG (2015) Subtypes of psychotic-like experiences are differentially associated with suicidal ideation, plans and attempts in young adults. Psychiatry Research 228, 894–898.10.1016/j.psychres.2015.05.002Google Scholar
Chang, B, Franklin, J, Ribeiro, J, Fox, K, Bentley, K, Kleiman, E and Nock, M (2016) Biological risk factors for suicidal behaviors: a meta-analysis. Translational Psychiatry 6, e887.10.1038/tp.2016.165Google Scholar
Chen, Y-W and Dilsaver, SC (1996) Lifetime rates of suicide attempts among subjects with bipolar and unipolar disorders relative to subjects with other axis I disorders. Biological Psychiatry 39, 896–899.10.1016/0006-3223(95)00295-2Google Scholar
Compton, MT, Thompson, NJ and Kaslow, NJ (2005) Social environment factors associated with suicide attempt among low-income African Americans: the protective role of family relationships and social support. Social Psychiatry and Psychiatric Epidemiology 40, 175–185.10.1007/s00127-005-0865-6Google Scholar
Davidson, JT, Hughes, DC, George, LK and Blazer, DG (1996) The association of sexual assault and attempted suicide within the community. Archives of General Psychiatry 53, 550–555.10.1001/archpsyc.1996.01830060096013Google Scholar
de Araújo, R and Lara, DR (2016) More than words: the association of childhood emotional abuse and suicidal behavior. European Psychiatry 37, 14–21.10.1016/j.eurpsy.2016.04.002Google Scholar
de Mattos Souza, LD, Molina, ML, da Silva, RA and Jansen, K (2016) History of childhood trauma as risk factors to suicide risk in major depression. Psychiatry Research 246, 612–616.10.1016/j.psychres.2016.11.002Google Scholar
DeVylder, JE, Lukens, EP, Link, BG and Lieberman, JA (2015) Suicidal ideation and suicide attempts among adults with psychotic experiences: data from the collaborative psychiatric epidemiology surveys. JAMA Psychiatry 72, 219–225.10.1001/jamapsychiatry.2014.2663Google Scholar
Gawęda, Ł, Pionke, R, Krężołek, M, Prochwicz, K, Kłosowska, J, Frydecka, D, Misiak, B, Kotowicz, K, Samochowiec, A and Mak, M (2018a) Self-disturbances, cognitive biases and insecure attachment as mechanisms of the relationship between traumatic life events and psychotic-like experiences in non-clinical adults – a path analysis. Psychiatry Research 259, 571–578.10.1016/j.psychres.2017.11.009Google Scholar
Gawęda, Ł, Prochwicz, K, Adamczyk, P, Frydecka, D, Misiak, B, Kotowicz, K, Szczepanowski, R, Florkowski, M and Nelson, B (2018b) The role of self-disturbances and cognitive biases in the relationship between traumatic life events and psychosis proneness in a non-clinical sample. Schizophrenia Research 193, 218–224.10.1016/j.schres.2017.07.023Google Scholar
Gawęda, L, Prochwicz, K, Krężołek, M, Klosowska, J, Staszkiewicz, M and Moritz, S (2018c) Self-reported cognitive distortions in the psychosis continuum: a Polish 18-item version of the Davos Assessment of Cognitive Biases Scale (DACOBS-18). Schizophrenia Research 192, 317–326.10.1016/j.schres.2017.05.042Google Scholar
Gibson, LE, Reeves, LE, Cooper, S, Olino, TM and Ellman, LM (2018) Traumatic life event exposure and psychotic-like experiences: a multiple mediation model of cognitive-based mechanisms. Schizophrenia Research. doi: 10.1016/j.schres.2018.02.005.Google Scholar
Gvion, Y, Levi-Belz, Y, Hadlaczky, G and Apter, A (2015) On the role of impulsivity and decision-making in suicidal behavior. World Journal of Psychiatry 5, 255.10.5498/wjp.v5.i3.255Google Scholar
Hassan, AN, Stuart, EA and De Luca, V (2016) Childhood maltreatment increases the risk of suicide attempt in schizophrenia. Schizophrenia Research 176, 572–577.10.1016/j.schres.2016.05.012Google Scholar
Honings, S, Drukker, M, Groen, R and van Os, J (2016) Psychotic experiences and risk of self-injurious behaviour in the general population: a systematic review and meta-analysis. Psychological Medicine 46, 237–251.10.1017/S0033291715001841Google Scholar
Howes, OD and Murray, RM (2014) Schizophrenia: an integrated sociodevelopmental-cognitive model. The Lancet 383, 1677–1687.10.1016/S0140-6736(13)62036-XGoogle Scholar
Hu, LT and Bentler, PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal 6, 1–55.10.1080/10705519909540118Google Scholar
Ising, HK, Veling, W, Loewy, RL, Rietveld, MW, Rietdijk, J, Dragt, S, Klaassen, RM, Nieman, DH, Wunderink, L and Linszen, DH (2012) The validity of the 16-item version of the Prodromal Questionnaire (PQ-16) to screen for ultra high risk of developing psychosis in the general help-seeking population. Schizophrenia Bulletin 38, 1288–1296.10.1093/schbul/sbs068Google Scholar
Jager-Hyman, S, Cunningham, A, Wenzel, A, Mattei, S, Brown, GK and Beck, AT (2014) Cognitive distortions and suicide attempts. Cognitive Therapy and Research 38, 369–374.10.1007/s10608-014-9613-0Google Scholar
Jang, JH, Lee, YJ, Cho, S-J, Cho, IH, Shin, NY and Kim, SJ (2014) Psychotic-like experiences and their relationship to suicidal ideation in adolescents. Psychiatry Research 215, 641–645.10.1016/j.psychres.2013.12.046Google Scholar
Johnston, AK, Pirkis, JE and Burgess, PM (2009) Suicidal thoughts and behaviours among Australian adults: findings from the 2007 national survey of mental health and wellbeing. Australian & New Zealand Journal of Psychiatry 43, 635–643.10.1080/00048670902970874Google Scholar
Joiner, T (2007) Why People die by Suicide. Cambridge, MA: Harvard University Press.10.2307/j.ctvjghv2fGoogle Scholar
Kelleher, I, Connor, D, Clarke, MC, Devlin, N, Harle, M and Cannon, M (2012 a) Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies. Psychological Medicine 42, 1857–1863.10.1017/S0033291711002960Google Scholar
Kelleher, I, Lynch, F, Harley, M, Molloy, C, Roddy, S, Fitzpatrick, C and Cannon, M (2012 b) Psychotic symptoms in adolescence index risk for suicidal behavior: findings from 2 population-based case-control clinical interview studies. Archives of General Psychiatry 69, 1277–1283.10.1001/archgenpsychiatry.2012.164Google Scholar
Kelleher, I, Cederlöf, M and Lichtenstein, P (2014) Psychotic experiences as a predictor of the natural course of suicidal ideation: a Swedish cohort study. World Psychiatry 13, 184–188.10.1002/wps.20131Google Scholar
Kinoshita, Y, Shimodera, S, Nishida, A, Kinoshita, K, Watanabe, N, Oshima, N, Akechi, T, Sasaki, T, Inoue, S and Furukawa, TA (2011) Psychotic-like experiences are associated with violent behavior in adolescents. Schizophrenia Research 126, 245–251.10.1016/j.schres.2010.08.028Google Scholar
Kuo, C-J, Tsai, S-Y, Lo, C-H, Wang, Y-P and Chen, C-C (2005) Risk factors for completed suicide in schizophrenia. The Journal of Clinical Psychiatry 66, 579–585.10.4088/JCP.v66n0506Google Scholar
Linscott, R and Van Os, J (2013) An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: on the pathway from proneness to persistence to dimensional expression across mental disorders. Psychological Medicine 43, 1133–1149.10.1017/S0033291712001626Google Scholar
Martin, G, Thomas, H, Andrews, T, Hasking, P and Scott, J (2015) Psychotic experiences and psychological distress predict contemporaneous and future non-suicidal self-injury and suicide attempts in a sample of Australian school-based adolescents. Psychological Medicine 45, 429–437.10.1017/S0033291714001615Google Scholar
Milner, A, Page, A and LaMontagne, AD (2013) Long-term unemployment and suicide: a systematic review and meta-analysis. PloS One 8, e51333.10.1371/journal.pone.0051333Google Scholar
Moritz, S, Andreou, C, Schneider, BC, Wittekind, CE, Menon, M, Balzan, RP and Woodward, TS (2014) Sowing the seeds of doubt: a narrative review on metacognitive training for schizophrenia. Clinical Psychology Review 34, 358–366.10.1016/j.cpr.2014.04.004Google Scholar
Nijenhuis, E, Van der Hart, O and Vanderlinden, J (1999) The traumatic experiences checklist (TEC). In Nijenhuis E (ed.), Somatoform Dissociation: Phenomena, Measurement, and Theoretical Issues. Assen, The Netherlands: Van Gorcum, 188–193.Google Scholar
Nijenhuis, ER, Van der Hart, O and Kruger, K (2002) The psychometric characteristics of the Traumatic Experiences Checklist (TEC): first findings among psychiatric outpatients. Clinical Psychology & Psychotherapy 9, 200–210.Google Scholar
Nishida, A, Sasaki, T, Nishimura, Y, Tanii, H, Hara, N, Inoue, K, Yamada, T, Takami, T, Shimodera, S and Itokawa, M (2010) Psychotic-like experiences are associated with suicidal feelings and deliberate self-harm behaviors in adolescents aged 12–15 years. Acta Psychiatrica Scandinavica 121, 301–307.10.1111/j.1600-0447.2009.01439.xGoogle Scholar
Nishida, A, Shimodera, S, Sasaki, T, Richards, M, Hatch, SL, Yamasaki, S, Usami, S, Ando, S, Asukai, N and Okazaki, Y (2014) Risk for suicidal problems in poor-help-seeking adolescents with psychotic-like experiences: findings from a cross-sectional survey of 16131 adolescents. Schizophrenia Research 159, 257–262.Google Scholar
O'Connor, RC (2011) The Integrated Motivational-Volitional Model of Suicidal Behavior. Boston, MA: Hogrefe Publishing.Google Scholar
Palmer, BA, Pankratz, VS and Bostwick, JM (2005) The lifetime risk of suicide in schizophrenia: a reexamination. Archives of General Psychiatry 62, 247–253.Google Scholar
Park, S, Hong, JP, Jeon, HJ, Seong, S and Cho, MJ (2015) Childhood exposure to psychological trauma and the risk of suicide attempts: the modulating effect of psychiatric disorders. Psychiatry Investigation 12, 171–176.Google Scholar
Phillips, MR, Yang, G, Zhang, Y, Wang, L, Ji, H and Zhou, M (2002) Risk factors for suicide in China: a national case-control psychological autopsy study. The Lancet 360, 1728–1736.Google Scholar
Poorolajal, J, Haghtalab, T, Farhadi, M and Darvishi, N (2016) Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: a meta-analysis. Journal of Public Health 38, e282–e291.Google Scholar
Preacher, KJ and Hayes, AF (2008) Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods 40, 879–891.Google Scholar
Rogers, ML and Joiner, TE Jr (2016) Borderline personality disorder diagnostic criteria as risk factors for suicidal behavior through the lens of the interpersonal theory of suicide. Archives of Suicide Research 20, 591–604.Google Scholar
Rössler, W, Riecher-Rössler, A, Angst, J, Murray, R, Gamma, A, Eich, D, van Os, J and Gross, VA (2007) Psychotic experiences in the general population: a twenty-year prospective community study. Schizophrenia Research 92, 1–14.Google Scholar
Rotenstein, LS, Ramos, MA, Torre, M, Segal, JB, Peluso, MJ, Guille, C, Sen, S and Mata, DA (2016) Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA 316, 2214–2236.Google Scholar
Saha, S, Scott, JG, Johnston, AK, Slade, TN, Varghese, D, Carter, GL and McGrath, JJ (2011) The association between delusional-like experiences and suicidal thoughts and behaviour. Schizophrenia Research 132, 197–202.Google Scholar
Schmidt, SJ, Schultze-Lutter, F, Bendall, S, Groth, N, Michel, C, Inderbitzin, N, Schimmelmann, BG, Hubl, D and Nelson, B (2017) Mediators linking childhood adversities and trauma to suicidality in individuals at risk for psychosis. Frontiers in Psychiatry 8, 242.Google Scholar
Simon, GE and VonKorff, M (1998) Suicide mortality among patients treated for depression in an insured population. American Journal of Epidemiology 147, 155–160.Google Scholar
Slotema, C, Niemantsverdriet, M, Blom, J, van der Gaag, M, Hoek, H and Sommer, I (2017) Suicidality and hospitalisation in patients with borderline personality disorder who experience auditory verbal hallucinations. European Psychiatry 41, 47–52.Google Scholar
Smith, N, Lam, D, Bifulco, A and Checkley, S (2002) Childhood experience of care and abuse questionnaire (CECA.Q). Social Psychiatry and Psychiatric Epidemiology 37, 572–579.Google Scholar
Tarrier, N, Kelly, J, Maqsood, S, Snelson, N, Maxwell, J, Law, H, Dunn, G and Gooding, P (2014) The cognitive behavioural prevention of suicide in psychosis: a clinical trial. Schizophrenia Research 156, 204–210.Google Scholar
Taylor, PJ, Hutton, P and Wood, L (2015) Are people at risk of psychosis also at risk of suicide and self-harm? A systematic review and meta-analysis. Psychological Medicine 45, 911–926.Google Scholar
Tunnard, C, Rane, LJ, Wooderson, SC, Markopoulou, K, Poon, L, Fekadu, A, Juruena, M and Cleare, AJ (2014) The impact of childhood adversity on suicidality and clinical course in treatment-resistant depression. Journal of Affective Disorders 152, 122–130.Google Scholar
van der Berg, DPG and ven der Gaag, M (2012) Treating trauma in psychosis with EMDR: a pilot study. Journal of Behavior Therapy and Experimental Psychiatry 43, 663–671.Google Scholar
van der Gaag, M, Schutz, C, Ten Napel, A, Landa, Y, Delespaul, P, Bak, M, Tschacher, W and de Hert, M (2013) Development of the Davos assessment of cognitive biases scale (DACOBS). Schizophrenia Research 144, 63–71.Google Scholar
World Health Organization (WHO) (2015) Preventing Suicide: A Global Imperative (2014). World Health Organization. Available at http://www.who.int/mental_health/suicide-prevention/World_report_2014/en.Google Scholar
Wu, WCH and Bond, MH (2006) National differences in predictors of suicide among young and elderly citizens: linking societal predictors to psychological factors. Archives of Suicide Research 10, 45–60.Google Scholar
Xie, P, Wu, K, Zheng, Y, Guo, Y, Yang, Y, He, J, Ding, Y and Peng, H (2018) Prevalence of childhood trauma and correlations between childhood trauma, suicidal ideation, and social support in patients with depression, bipolar disorder, and schizophrenia in southern China. Journal of Affective Disorders 228, 41–48.Google Scholar
Young, G (2015) Causality in psychiatry: a hybrid symptom network construct model. Frontiers in Psychiatry 6, 164.Google Scholar
Zatti, C, Rosa, V, Barros, A, Valdivia, L, Calegaro, VC, Freitas, LH, Ceresér, KMM, da Rocha, NS, Bastos, AG and Schuch, FB (2017) Childhood trauma and suicide attempt: a meta-analysis of longitudinal studies from the last decade. Psychiatry Research 256, 353–358.Google Scholar
Supplementary material: File

Gawęda et al. supplementary material

Figures S1-S3 and Tables S1-S6

Download Gawęda et al. supplementary material(File)
File 49.7 KB