Pérez-Balaguer Ana, Peñuelas-Calvo Inmaculada, Alacreu-Crespo Adrián, Baca-García Enrique, Porras-Segovia Alejandro
Department of Psychiatry, University Hospital Puerta de Hierro de Majadahonda, Madrid, Spain.
Department of Child and Adolescent Psychiatry, University Hospital 12 de Octubre, Madrid, Spain.
J Psychiatr Res. 2022 Jul;151:95-107. doi: 10.1016/j.jpsychires.2022.04.021. Epub 2022 Apr 21.
Childhood maltreatment is a known risk factor for the development of suicidal behavior. Possible mediators of the association between childhood maltreatment and suicide have been analyzed. Some studies have considered impulsivity as one of these mediators, but there are no previous reviews on this topic. We, therefore, present a systematic review and mediation meta-analysis of the literature summarizing the evidence on impulsivity as a mediator of the relationship between childhood maltreatment and lifetime suicidal behavior. This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The review was registered in the PROSPERO database. We searched PubMed, PsycINFO, WebOfScience, and EMBASE databases up to February 2021 to identify studies exploring the association between childhood maltreatment and suicide through impulsivity. Fourteen articles met the selection criteria and were included in the review. Seven articles could be included in the mediation meta-analysis. Impulsivity was a significant mediator of the relationship between childhood maltreatment and suicidal behavior in ten of the fourteen included studies. This result was confirmed using mediation meta-analysis (β = .06, 95% CI 0.03-0.10). Studies suggest that exposure to traumatic situations in childhood affects the proper neurobiological, cognitive, and affective development of individuals. This may increase impulsivity, which in turn would be related to an increased risk of suicide. The effects of childhood maltreatment and impulsivity may be both therapeutic targets of interest to reduce suicide rates.
童年期受虐是自杀行为发展的一个已知风险因素。人们已经分析了童年期受虐与自杀之间关联的可能中介因素。一些研究将冲动性视为其中一种中介因素，但此前尚无关于该主题的综述。因此，我们对文献进行了系统综述和中介效应荟萃分析，总结了冲动性作为童年期受虐与终生自杀行为之间关系的中介因素的证据。本综述遵循系统综述和荟萃分析的首选报告项目（PRISMA）指南。该综述已在PROSPERO数据库中注册。我们检索了截至2021年2月的PubMed、PsycINFO、WebOfScience和EMBASE数据库，以识别通过冲动性探讨童年期受虐与自杀之间关联的研究。14篇文章符合入选标准并被纳入综述。7篇文章可纳入中介效应荟萃分析。在纳入的14项研究中的10项中，冲动性是童年期受虐与自杀行为之间关系的显著中介因素。使用中介效应荟萃分析证实了这一结果（β = 0.06，95%可信区间0.03 - 0.10）。研究表明，童年期经历创伤性情境会影响个体正常的神经生物学、认知和情感发展。这可能会增加冲动性，进而与自杀风险增加相关。童年期受虐和冲动性的影响可能都是降低自杀率的有意义的治疗靶点。
