Lifetime and acute risk of suicidality by profiles of early life adversity: an observational cohort study in a high-risk population.

Early life adversity in the form of child maltreatment (CM) is a transdiagnostic risk factor for suicidal ideation and behavior (SIB), yet its heterogeneity and relevance for lifetime versus acute SIB and psychotherapy outcomes remain unclear. In an observational cohort of 240 high-risk adults with borderline personality disorder (42.5%) or persistent depressive disorder (57.5%), lifetime and acute SIB were assessed using the Columbia-Suicide Severity Rating Scale. CM profiles were derived using a data-driven clustering approach based on the Childhood Trauma Questionnaire. Associations between CM profiles, SIB, and symptom change during inpatient cognitive behavioral analysis system of psychotherapy (CBASP) or dialectical behavior therapy (DBT) were examined. Seven distinct CM profiles were identified. A profile characterized by physical and emotional abuse and emotional neglect was associated with elevated lifetime risk for active suicidal ideation with plan and intent and for potentially lethal suicide attempts, compared with minimal CM. CM profiles were not associated with acute SIB or their reduction during inpatient psychotherapy, although differential depressive symptom change by CM profile was observed following CBASP but not DBT. These findings suggest that CM profiling may inform lifetime SIB risk assessment and require replication in larger samples.