Childhood trauma and suicidal behaviour: Exploring psychological mediators

Background:Childhood trauma is an oft cited risk factor for suicidal behaviour, however, the reasons behind this relationship are not well understood. This project aimed to uncover psychological factors which may mediate the relationship between childhood trauma and suicidal behaviour. Based on previous theoretical perspectives and empirical findings, psychological factors within the domains of self-perception, relational functioning, and emotion regulation were focused on. Understanding such mediating factors is essential in developing interventions aimed at minimising suicide risk within the childhood trauma population.Methods:Study 1: Previously identified theoretical pathways between childhood trauma and Non-Suicidal Self-Injury (NSSI), in addition to demographic features, were tested for their association with suicidality in a sample of traumatised adults (N=113). Data were gathered through self-report questionnaires, with relationships explored through logistic regression analyses.Study 2: Mediating pathways between childhood trauma and suicide attempt through attachment style, Complex Posttraumatic Stress Disorder symptomatology, and cognitive emotion regulation strategies were explored in a sample of traumatised adults (N=330). Mediating relationships were examined through bias-corrected bootstrapped mediation models.ResultsStudy 1: Results did not support the ability of the NSSI theory tested to predict the presence of suicidality. Childhood emotional abuse and unemployment were found to be associated with lifetime experiences of suicidality.Study 2: The relationship between childhood trauma and suicidal behaviour was found to be mediated by disturbances of self-organisation (DSO) in the areas of self-concept, relational disturbances, and emotion dysregulation. The relationship between childhood trauma and DSO was mediated by insecure attachment, internal attributions of blame, a sense of current threat, and intrusive thoughts or memories.DiscussionA theoretical framework is proposed whereby disturbances of self-organisation in the areas of emotional dysregulation, negative self-concept, and disturbed relationships operate in combination to mediate the relationship between childhood trauma and suicide risk. This framework could be used to inform clinical interventions aimed at reducing suicide risk following childhood trauma by treating disturbances of self-organisation. Further implications for trauma-informed training for health and social care professionals are discussed

Suicidal histories in adults experiencing psychological trauma: exploring vulnerability and protective factors

Objective: This study aimed to identify vulnerability and protective factors for suicidal histories among adults experiencing psychological trauma.Method: Adults seeking treatment for psychological trauma (N=113) completed self-report questionnaires measuring childhood trauma history, self-concept, relational functioning, emotion regulation, living arrangements, employment status, marital status, and suicidal history. Independent samples t-tests were used to determine variables on which those with and without suicidal histories differed significantly. These variables were then entered into a binary logistic regression model to identify factors which independently distinguished between those with and without a suicidal history.Results: Univariate differences were found for childhood emotional abuse (CEA), childhood emotional neglect (CEN), emotion deactivation, and employment status, with those in the suicidal history group scoring higher on all of these. CEA (OR=1.13, 95% CI=1.01-1.27) and employment status (OR=4.12, 95% CI=1.23-13.73) remained significant predictors of suicidal status in the multivariable logistic regression.Conclusions: CEA was an independent vulnerability factor for suicidal risk, highlighting the need for clinicians to assess exposure to such trauma in those presenting with proximal traumatic experiences. Being in employment was an independent protective factor against suicidal risk, highlighting the importance of social buffers or networks when faced with traumatic situations

ICD-11 Posttraumatic Stress Disorder (PTSD), Complex PTSD (CPTSD) and Adjustment Disorder (AjD): The importance of stressors and traumatic life events

Background Although ICD-11 adjustment (AjD), posttraumatic stress (PTSD) and complex posttraumatic stress (CPTSD) are commonly diagnosed disorders following exposure to stressful or traumatic life events, their dimensional structure and co-occurrence has never been tested in a single study. The present study explored the latent structure of AjD, PTSD, and CPTSD symptoms and their relationship to stressful and traumatic life events to determine the degree of distinctiveness between these constructs. Methods Participants were clinical patients (N = 331) who completed self-report measures of stressful and traumatic life events, AjD (The Adjustment Disorder – New Module 8 (ADNM-8) and PTSD / CPTSD (The International Trauma Questionnaire – ITQ). Results Using confirmatory factor analysis, a second-order model comprised of correlated latent variables of AjD, PTSD, and CPTSD provided the best fit of the data. It was also found that stressors and traumatic life events were positively associated with all of these conditions although childhood trauma was only associated with CPTSD. Conclusions The current findings support the ICD-11 model of related-but-distinct stress-related disorders. We discuss the existence of a stress-response continuum and how the current findings impact the development of clinical interventions that may be shared across, or unique to, each stress-related disorder

Vulnerability assessment across the frontline of law enforcement and public health: a systematic review

Assessing vulnerability is an international priority area across law enforcement and public health (LEPH). Most contacts with frontline law enforcement professions now relate to ‘vulnerability’; frontline health responders are experiencing a similar increase in these calls. To the authors’ best knowledge there are no published, peer-reviewed tools which specifically focus on assessing vulnerability, and which are specifically designed to be applicable across the LEPH frontline. This systematic review synthesised 33 eligible LEPH journal articles, retaining 18 articles after quality appraisal to identify assessment guidelines, tools, and approaches used relevant to either law enforcement and/or public health professions. The review identifies elements of effective practice for the assessment of vulnerability, aligned within four areas: prevention, diversion/triage, specific interventions, and training across LEPH. It also provides evidence that inter-professional/integrated working, shared training, and aligned systems are critical to effective vulnerability assessment. This systematic review reports, for the first time, effective practices in vulnerability assessment as reported in peer-reviewed papers and provides evidence to inform better multi-agency policing and health responses to people who may be vulnerable

Childhood trauma, attachment orientation and Complex PTSD (CPTSD) symptoms in a clinical sample: Implications for treatment

Although there has been significant work on the association between Posttraumatic Stress Disorder (PTSD) and attachment orientation, this is less the case for Complex PTSD (CPTSD). The primary aim of this paper was to assess the strength of the association between the four adult attachment styles (i.e. secure, dismissing, preoccupied, and fearful) and severity of CPTSD symptoms (i.e. symptoms of PTSD and Disturbances in Self Organisation (DSO)). We hypothesised that attachment orientation would be more strongly associated with DSO symptoms compared to PTSD symptoms. A trauma exposed clinical sample (N = 331) completed self-report measures of traumatic life events, CPTSD symptoms, and attachment orientation. It was found that secure attachment and fearful attachment were significantly associated with DSO symptoms but not with PTSD symptoms. Dismissing attachment style was significantly associated with PTSD and DSO symptoms. Preoccupied attachment was not significantly associated with CPTSD symptoms. Treatment implications for CPTSD using an attachment framework are discussed

Childhood trauma, attachment orientation and Complex PTSD (CPTSD) symptoms in a clinical sample: Implications for treatment

Although there has been significant work on the association between Posttraumatic Stress Disorder (PTSD) and attachment orientation, this is less the case for Complex PTSD (CPTSD). The primary aim of this paper was to assess the strength of the association between the four adult attachment styles (i.e. secure, dismissing, preoccupied, and fearful) and severity of CPTSD symptoms (i.e. symptoms of PTSD and Disturbances in Self Organisation (DSO)). We hypothesised that attachment orientation would be more strongly associated with DSO symptoms compared to PTSD symptoms. A trauma exposed clinical sample (N = 331) completed self-report measures of traumatic life events, CPTSD symptoms, and attachment orientation. It was found that secure attachment and fearful attachment were significantly associated with DSO symptoms but not with PTSD symptoms. Dismissing attachment style was significantly associated with PTSD and DSO symptoms. Preoccupied attachment was not significantly associated with CPTSD symptoms. Treatment implications for CPTSD using an attachment framework are discussed

Borderline Personality Disorder (BPD) and Complex Post Traumatic Stress Disorder (CPTSD): A network analysis in a highly traumatised clinical sample

Whether Complex Posttraumatic Stress Disorder (CPTSD) and Borderline Personality Disorder (BPD) diagnoses differ substantially enough to warrant separate diagnostic classifications, has been a subject of controversy for years. To contribute to the nomological network of cumulative evidence, the main goal of the present study was to explore, using network analysis, how the symptoms of ICD-11 PTSD and DSO are interconnected with BPD in a clinical sample of polytraumatised individuals (n=330). Participants completed measures of life events, CPTSD and BPD. Overall, our study suggests that BPD and CPTSD are largely separated. The bridges between BPD and CPTSD symptom clusters were scarce with “Affective Dysregulation” items being the only items related to BPD. The present study contributes to the growing literature on discriminant validity of CPTSD and supports its distinctiveness to BPD. Implications for treatment are discussed

Adverse and Benevolent Childhood Experiences in Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD): Implications for Trauma-Focused Therapies

Objectives We set out to test, using latent variable modelling, whether adverse and benevolent childhood experiences could be best described as a single continuum or two correlated constructs. We also modelled the relationship between adverse and benevolent childhood experiences and ICD-11 PTSD and Complex PTSD (CPTSD) symptoms and explored if these associations were indirect via psychological trauma. Methods Data were collected from a trauma-exposed sample (N = 275) attending a specialist trauma care centre in the United Kingdom. Participants completed measures of childhood adverse and benevolent experiences, traumatic exposure, and PTSD and CPTSD symptoms. Results Findings suggested that adverse childhood experiences operate only indirectly on PTSD and CPTSD symptoms through lifetime trauma exposure, and with a stronger effect for PTSD. Benevolent childhood experiences directly predicted only CPTSD symptoms. Conclusions Benevolent and traumatic experiences seem to form unique associations with PTSD and CPTSD symptoms. Future research is needed to explore how benevolent experiences can be integrated within existing psychological interventions to maximise recovery from traumatic stress

Childhood adversity, mental health and suicide (CHASE): a protocol for a longitudinal case-control linked data study

IntroductionSuicide is a tragic outcome with devastating consequences. In 2018, Scotland experienced a 15% increase in suicide from 680 to 784 deaths. This was marked among young people, with an increase of 53% in those aged 15-24, the highest since 2007. Early intervention in those most at risk is key, but identification of individuals at risk is complex, and efforts remain largely targeted towards universal suicide prevention strategies with little evidence of effectiveness. Recent evidence suggests childhood adversity is a predictor of subsequent poor social and health outcomes, including suicide. This protocol reports on methodology for harmonising lifespan hospital contacts for childhood adversity, mental health, and suicidal behaviour. This will inform where to 1) focus interventions, 2) prioritise trauma-informed approaches, and 3) adapt support avenues earlier in life for those most at risk.MethodsThis study will follow a case-control design. Scottish hospital data (physical health SMR01; mental health SMR04; maternity/birth record SMR02; mother’s linked data SMR01, SMR04, death records) from 1981 to as recent as available will be extracted for people who died by suicide aged 10-34, and linked on Community Health Index unique identifier. A randomly selected control population matched on age and geography at death will be extracted in a 1:10 ratio. International Classification of Disease (ICD) codes will be harmonised between ICD9-CM, ICD9, ICD10-CM and ICD10 for childhood adversity, mental health, and suicidal behaviour.ResultsICD codes for childhood adversity from four key studies are reported in two categories, 1) Maltreatment or violence-related codes, and 2) Codes suggestive of maltreatment. ‘Clinical Classifications Software’ ICD codes to operationalise mental health codes are also reported. Harmonised lifespan ICD categories were achieved semi-automatically, but required labour-intensive supplementary manual coding. Cross-mapped codes are reported.ConclusionThere is a dearth of evidence about touchpoints prior to suicide. This study reports methods and harmonised ICD codes along the lifespan to understand hospital contact patterns for childhood adversity, which come to the attention of hospital practitioners