Distinct and cumulative effects of child maltreatment on suicidality among Chinese college freshmen: A prospective cohort study.

BACKGROUND

Child maltreatment (CM) is a well-documented risk factor for suicidality in young adulthood. However, the unique and cumulative effects of various CM subtypes, as well as the independent influence of each CM type when considering current psychological distress or other forms of CM, remain less explored among Chinese college freshmen.

OBJECTIVE

This study aimed to prospectively examine the associations between five types of CM (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and the onset of non-suicidal self-injury (NSSI), suicidal ideation, and suicide plan/attempts among college freshmen, while controlling for covariables.

METHODS

We assessed a cohort of 8097 college freshmen for CM experiences, psychological distress, and suicidality at two time points. Multivariate models were used to estimate the associations between each CM subtype and suicidality outcomes, with psychological distress and other forms of CM statistically controlled.

RESULTS

CM was linked to higher risks of NSSI, suicidal ideation, and suicide planning/attempts across all forms, with emotional abuse showing the strongest association. Emotional abuse resulted in significantly higher rates of NSSI (7.7 % vs. 1.4 %), suicidal ideation (18.5 % vs. 3.7 %), and suicide planning/attempt (7.1 % vs. 0.6 %) compared to non-exposed peers (all p < 0.001). A dose-response relationship was noted, with risks escalating with more types of CM: Odds Ratios(ORs) for suicide planning/attempt increased from 3.27 for one maltreatment type to 39.16 for exposure to all five. After controlling for other CM types, only emotional and physical abuse remained significant predictors of suicidality, with emotional abuse showing ORs of 2.82, 2.65, and 5.10, and physical abuse showing 1.61, 1.63, and 1.86 for NSSI, suicidal ideation, and planning/attempt, respectively. These findings underscore emotional and physical abuse, with a dose-dependent effect, as a critical predictor of suicidality.

CONCLUSION

The findings underscore the importance of recognizing both the unique and cumulative contributions of CM to suicidality in college freshmen, particularly the substantial impact of emotional and physical abuse. Early identification and intervention efforts should target students with multiple CM exposures and specifically address the repercussions of emotional and physical abuse.