The mediating role of suicidal ideation in the relationship between childhood sexual abuse and suicide attempts among Chinese patients with major depressive disorder.

BACKGROUND

This study aimed to identify the risk factors for suicide attempts among Chinese patients with major depressive disorder (MDD) and explore the mediating role of suicidal ideation between childhood sexual abuse and suicide attempts.

METHODS

Data were derived from a multi-center investigation conducted in nine hospitals across six provinces of China. Suicide attempt status was assessed using the suicide module of the Mini International Neuropsychiatric Interview (MINI), and childhood maltreatment was evaluated via the Childhood Trauma Questionnaire (CTQ). Multivariable logistic regression was used to identify factors associated with suicide attempts, and path analysis-based mediation models were performed to examine the mediating role of suicidal ideation in the relationship between childhood sexual abuse and suicide attempts.

RESULTS

A total of 1084 MDD patients were enrolled, among whom 120 (10.1%) had a history of suicide attempts. Logistic regression analysis showed that suicidal ideation (OR = 8.73, P < 0.001) and an earlier age at depression onset (OR = 0.95, P = 0.015) were independent factors associated with suicide attempts. Mediation analysis revealed that childhood sexual abuse was significantly and positively associated with suicidal ideation (β = 0.072, P = 0.018), which in turn was strongly positively associated with suicide attempts (β = 0.267, P < 0.001).

CONCLUSION

Earlier depression onset and suicidal ideation are associated with suicide attempts in Chinese MDD patients. Childhood sexual abuse is indirectly associated with suicide attempts through its positive association with suicidal ideation. This finding provides targeted insights for suicide prevention strategies for Chinese MDD patients.