The mediating role of anxiety in the association between childhood trauma and suicidal ideation in depression.

PURPOSE: Suicidal ideation (SI) is a major public health concern, especially in patients with major depressive disorder (MDD). Although various psychosocial factors are associated with SI, the complex interrelationships among childhood trauma (CT), anxiety symptoms, depressive symptoms, and anhedonia remain inadequately understood. This study examined these relationships and their associations with SI.

METHODS

This cross-sectional study included 782 patients with MDD consecutively recruited from the inpatient and outpatient clinics of the Department of Psychiatry at Renmin Hospital of Wuhan University between April 2019 and August 2023. Assessments were conducted using validated Chinese versions of the Childhood Trauma Questionnaire-Short Form, Hamilton Anxiety Rating Scale, Snaith-Hamilton Pleasure Scale, Hamilton Depression Scale, Patient Health Questionnaire-15, and Life Event Scale. Statistical analyses comprised chi-square tests, t-tests, binary logistic regression, Pearson’s correlation analysis, and structural equation modeling (SEM).

RESULTS

Anxiety symptoms were present in 425 patients (54.35%), of whom 84.24% reported SI. Patients with anxiety symptoms demonstrated significant differences in emotional neglect, physical neglect, emotional abuse, physical abuse, anhedonia, depressive symptoms, somatic symptoms, negative life events, and SI compared to those without anxiety. SEM analysis indicated direct associations of CT, depressive symptoms, and anhedonia with SI. Additionally, anxiety symptoms showed indirect associations with SI, linked through their connections with CT, anhedonia, and depressive symptoms.

CONCLUSIONS

The findings highlight the clinical relevance of assessing CT and the interrelated symptom cluster of anxiety, anhedonia, and depression in MDD patients with SI. This supports the consideration of integrated treatment strategies that concurrently address these domains. CLINICAL TRIAL NUMBER: Not applicable.