Childhood maltreatment and risk for suicide attempts in major depression: a sex-specific approach
Abstract : Background:
Childhood maltreatment increases the risk of suicide attempts in the
general population, possibly having similar effects among patients with
major depressive disorder (MDD). The few studies that have addressed
this association have been restricted to specific populations (e.g.
treatment-resistant depression, personality disorders) and have rarely
taken sex into account.
Objective: To examine the impact of childhood maltreatment on suicide
attempts among MDD patients above and beyond other risk factors and
potential confounders, while considering potential sex-specific effects.
Methods: The study assessed 165 patients with a principal diagnosis of
MDD. Neurological alterations, psychiatric comorbidities, and drug abuse
were reasons for exclusion. Logistic regressions using the whole
sample, and divided by sex, were run to test the association between
childhood maltreatment and history of suicide attempts, controlling for
symptom severity, comorbidities, and treatment-resistant depression.
Results: There was a significant and clinically relevant association
between childhood maltreatment and history of suicide attempts in the
total sample. Patients with childhood maltreatment were 3.01 times more
likely to present a history of suicide attempts than patients without
childhood maltreatment. A family history of psychiatric disorders also
contributed to the variance of attempted suicide, but its interaction
with childhood maltreatment was not statistically significant. When
testing the model separately, the effect of childhood maltreatment on
suicide attempts remained for females, whereas for males, age of MDD
onset and Childhood Trauma Questionnaire minimization–denial scale were
predictive variables.
Conclusions: Childhood maltreatment is a clear predictor of suicidal
behaviour among MDD patients, and this effect remains significant after
controlling for potential confounders. Also, the sex of patients emerges
as a relevant factor that may model the mechanisms underlying the
prediction of suicide attempts. Since suicide is the main cause of
premature death among MDD patients, interventions targeting childhood
maltreatment should be included in preventive and clinical strategies.
