Suicidal Thoughts and Behaviors in Late Adolescents Following Childhood Maltreatment Mediated by Enhanced Acute Stress-Responsivity

Abstract

Suicide is the second leading cause of death worldwide for adolescents and emerging adults. Despite knowledge of distal risk factors for suicide (i.e., childhood maltreatment), there is a dearth of developmentally informed psychobiological theories of suicide that test potentially modifiable proximal risk factors. Utilizing a multi-method design, this study integrates cognitive and biological risk factors into a model of suicide risk following maltreatment. Undergraduates completed a screener assessing medical history, trait reward and threat sensitivities, history of suicidal thoughts and behaviors (STBs), and childhood maltreatment. Participants without a history of autoimmune disease completed a reward and threat-salient acute stress task with pre- and post-task blood draws to measure peripheral inflammatory biomarkers. Utilizing ecological momentary assessment, a subset of participants with a history of suicidal ideation completed daily measures (three per day) of STBs and state reward and threat sensitivities for two-weeks before completing follow-up measures of STBs. Mediation models found that inflammatory reactivity to acute stress did not explain the relationship between maltreatment and ideation across the two-week follow-up, but those participants with greater TNF-α reactivity to an acute stress task reported more severe ideation at the study visit. Moderated mediation models showed that the association between inflammatory reactivity and suicidality was not significantly amplified by reward or threat sensitivity. But, at trait and state levels, those with histories of maltreatment who were less sensitive to rewards and more aware of potential threats experienced the most severe ideation. This investigation aimed to understand the processes that immediately precede STBs to inform future prevention and intervention efforts.