Department of Psychological and Cognitive Sciences, Tsinghua University, Beijing, 100084, China; Vanke School of Public Health, Tsinghua University, Beijing, 100084, China.
Vanke School of Public Health, Tsinghua University, Beijing, 100084, China.
Soc Sci Med. 2024 Dec;362:117406. doi: 10.1016/j.socscimed.2024.117406. Epub 2024 Oct 9.
Suicide is a leading cause of death worldwide, with childhood maltreatment identified as a significant risk factor for suicidal behavior in adulthood. The link between childhood maltreatment and suicidality is well-documented; however, the role of complex posttraumatic stress disorder (CPTSD), which includes an additional symptom cluster of disturbances in self-organization (DSO) compared to posttraumatic stress disorder (PTSD), remains underexplored. This study aimed to investigate the association between meeting the criteria for ICD-11 PTSD or CPTSD and suicidality in adults with a history of childhood maltreatment across culturally diverse samples.
Data were collected across four sites: the United States, the United Kingdom, China, and Malaysia. The Childhood Trauma Questionnaire (CTQ), Suicidal Behaviors Questionnaire-Revised (SBQ-R), and International Trauma Questionnaire (ITQ) were used to assess childhood maltreatment, suicidality, and PTSD or CPTSD, respectively. Linear regressions were conducted to examine the associations, controlling for demographic variables (age, sex, ethnicity, educational level, and subjective socioeconomic status) as well as the severity of maltreatment (CTQ total scores).
Among the 1324 participants who experienced childhood maltreatment, meeting the criteria for CPTSD was significantly associated with higher suicidality compared to not meeting the criteria for either PTSD or CPTSD (B(SE) = 1.68 (0.30), p < .001), or only meeting the criteria for PTSD (B(SE) = 1.38 (0.43), p < .001). In contrast, meeting the criteria for PTSD alone was not significantly associated with suicidality (B(SE) = 0.35 (0.46), p = .45). These associations remained consistent across different cultural settings.
The study findings highlight the unique association of CPTSD with suicidality in adults with a history of childhood maltreatment, suggesting that the DSO symptom cluster of CPTSD, which distinguish it from PTSD, play a critical role in the development of suicidality in this population. Targeting these symptoms may be essential for effective intervention strategies. Screening for childhood maltreatment and CPTSD in individuals at risk of suicide is crucial for guiding treatment planning.
自杀是全球范围内的主要死亡原因之一，儿童期虐待已被确定为成年后自杀行为的一个重要危险因素。儿童期虐待与自杀之间的联系已有充分的记录；然而，与创伤后应激障碍（PTSD）相比，包含自我组织障碍（DSO）等附加症状群的复杂创伤后应激障碍（CPTSD）的作用仍未得到充分探索。本研究旨在调查在来自不同文化背景的样本中，符合 ICD-11 PTSD 或 CPTSD 标准的成年人与童年期虐待相关的自杀风险。
数据收集跨越四个地点：美国、英国、中国和马来西亚。使用童年创伤问卷（CTQ）、修订后的自杀行为问卷（SBQ-R）和国际创伤问卷（ITQ）分别评估童年期虐待、自杀风险以及 PTSD 或 CPTSD。进行线性回归以检验关联，同时控制人口统计学变量（年龄、性别、种族、教育水平和主观社会经济地位）以及虐待严重程度（CTQ 总分）。
在经历过童年期虐待的 1324 名参与者中，与未符合 PTSD 或 CPTSD 标准，或仅符合 PTSD 标准的人相比，符合 CPTSD 标准与更高的自杀风险显著相关（B(SE) = 1.68 (0.30)，p < 0.001）。相比之下，仅符合 PTSD 标准与自杀风险无显著关联（B(SE) = 0.35 (0.46)，p = 0.45）。这些关联在不同的文化背景下仍然一致。
研究结果强调了 CPTSD 与童年期虐待成年人自杀风险之间的独特关联，表明 CPTSD 的 DSO 症状群将其与 PTSD 区分开来，在该人群的自杀发展中起着关键作用。针对这些症状可能是有效干预策略的关键。对有自杀风险的个体进行儿童期虐待和 CPTSD 的筛查对于指导治疗计划至关重要。
