Suicide is one of the leading causes of global mortality (O’Conor et al., 2020). According to Xe et al. (2018), over 800,000 commit suicide every year. Research has identified various risk factors that lead to the onset of suicidality, such as physical health issues, mental disorders, and childhood traumatic events (Zatti et al., 2017). According to Bach et al. (2018), children exposed to traumatic events are highly likely to develop posttraumatic stress disorder (PTSD), which leads to the development of other risk behaviors such as suicide. Zatti et al. (2017) define childhood trauma as adversity caused by events like parental criminality, sexual and physical abuse, parental mental disorder and drug abuse, familial death, witnessing domestic violence, and child maltreatment. PTSD is associated with movements of revival, avoidance behavior, and high levels of anxiety which could lead to suicidal ideation and eventually suicidal behavior (Bach et al., 2018). Additionally, the study establishes that persons with PTSD are six times more likely to engage in suicidal behaviors compared to other healthy people and that PTSD is the number one anxiety disorder leading to suicide deaths. Some traumatic events that could lead to PTSD and eventual suicide ideation and behavior are rejection, neglect, sexual and physical abuse, and extreme domestic violence (Bach et al., 2018). These conclusions are consistent with those of Zatti et al. (2017), that childhood trauma has a modifiable effect on adulthood suicide behavior. However, the extent to which various traumatic events increase suicide attempt risk is unclear (Zatti et al., 2017).
Bahk et al. (2017) contend that while empirical evidence suggests childhood trauma is a risk factor in suicidal behavior and ideation, there is little understanding of how various types of childhood traumatic events influence suicidality as well as the mediating variables that influence the link between childhood adversity and suicidal ideation. After conducting a study, Bahk et al. (2017) established that sexual abuse was the only traumatic event among the tested types of childhood maltreatment that directly predicted suicide behavior. Childhood emotional and physical abuse indirectly predicted suicidality through their association with adulthood anxiety and childhood neglect through its association with perceptions of social support (Bahk et al., 2017).
These findings are consistent with the conclusion of Barbosa et al. (2014) that interventions to combat suicidal behavior among victims of childhood adversity should focus on anxiety disorders and symptoms and enhance their social support. Xe et al. (2018) also concluded that suicidal ideation is associated with both childhood traumatic events and lack of or poor social support. Additionally, childhood trauma is more prevalent and more severe in individuals with mental disorders such as schizophrenia, bipolar disorder, and depression than in healthy persons (Xe et al., 2018). According to Hassan, Stuart, and De Luca (2016), childhood trauma has been empirically established to be a common and strong independent risk factor for suicide behavior among schizophrenic patients. The study explains that this risk is aggravated by the onset of feelings of loneliness and depressive symptoms in schizophrenia (Hassan, Stuart, and De Luca, 2016)
According to O’Conor et al. (2020), Empirical evidence has shown that childhood trauma is correlated with cortisol levels and stress in adulthood. The study found that people with suicidal thoughts and attempts have significantly lower levels of dysregulated cortisol reactivity (O’Conor et al., 2020). O’Conor et al. (2018) also established that childhood trauma led to lower cortisol levels and thus caused suicide ideation and behavior. However, daily stress and emotions were unrelated to cortisol levels (O’Conor et al., 2018). These findings are consistent with those of O’Conor et al. (2020), that dysregulated cortisol reactivity is negatively correlated with suicidal thoughts and attempts, while childhood trauma increases the likelihood of low cortisol levels. Vulnerable populations and individuals who have attempted suicide exhibit lower cortisol levels when responding to stressors.
Affective disorders and childhood trauma have been empirically confirmed as risk factors for suicidal behavior in adulthood (Ihme et al., 2022). According to Ihme et al. (2022), insecure attachment has mediating effects related to childhood trauma and could lead to suicidal behavior. Childhood trauma and avoidant attachment alter an individual’s perceptions and eventual rejection by social support, thereby presenting a high suicide risk in adulthood. Wu et al. (2022) also investigate mediating effects of sleep and stress in the relationship between childhood trauma and suicide. Specifically, they investigate the relationship between sleep quality, perceived stress, and suicide risk. Childhood trauma, sleep, and stress are positively correlated with suicide ideation and behavior. The study also found that the average effect of emotional abuse without the mediating factors on suicide ideation and behavior was 49.5%. In comparison, mediating effects led to the total effect of childhood trauma on suicidal ideation and behavior at 73.7% (Wu et al., 2022).
The literature review reveals that the extent to which various types of child maltreatment aggravate suicidal ideation and behavior, and their mediating factors is still a gray area in the scholarly work on the relationship between childhood trauma and suicide.
Bahk, Y. C., Jang, S. K., Choi, K. H., & Lee, S. H. (2017). The relationship between childhood trauma and suicidal ideation: role of maltreatment and potential mediators. Psychiatry investigation, 14(1), 37.
Barbosa, L. P., Quevedo, L., da Silva, G. D. G., Jansen, K., Pinheiro, R. T., Branco, J., … & da Silva, R. A. (2014). Childhood trauma and suicide risk in a sample of young individuals aged 14–35 years in southern Brazil. Child Abuse & Neglect, 38(7), 1191-1196.
Hassan, A. N., Stuart, E. A., & De Luca, V. (2016). Childhood maltreatment increases the risk of suicide attempt in schizophrenia. Schizophrenia research, 176(2-3), 572-577.
O’Connor, D. B., Branley-Bell, D., Green, J. A., Ferguson, E., O’Carroll, R. E., & O’Connor, R. C. (2020). Effects of childhood trauma, daily stress, and emotions on daily cortisol levels in individuals vulnerable to suicide. Journal of abnormal psychology, 129(1), 92.
Xie, P., Wu, K., Zheng, Y., Guo, Y., Yang, Y., He, J., … & 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.
Zatti, C., Rosa, V., Barros, A., Valdivia, L., Calegaro, V. C., Freitas, L. H., … & Schuch, F. B. (2017). Childhood trauma and suicide attempt: A meta-analysis of longitudinal studies from the last decade. Psychiatry research, 256, 353-358.
Bach, S. D. L., Molina, M. A. L., Jansen, K., da Silva, R. A., & Souza, L. D. D. M. (2018). Suicide risk and childhood trauma in individuals diagnosed with posttraumatic stress disorder. Trends in psychiatry and psychotherapy, 40, 253-257.
O’Connor, D. B., Green, J. A., Ferguson, E., O’Carroll, R. E., & O’Connor, R. C. (2018). Effects of childhood trauma on cortisol levels in suicide attempters and ideators. Psychoneuroendocrinology, 88, 9-16.
Ihme, H., Olié, E., Courtet, P., El-Hage, W., Zendjidjian, X., Mazzola-Pomietto, P., … & Belzeaux, R. (2022). Childhood trauma increases vulnerability to attempt suicide in adulthood through avoidant attachment. Comprehensive psychiatry, 117, 152333.