Cognitive modulation of the relationship between psychological pain and childhood trauma in patients with a history of suicide attempts.

BACKGROUND

Psychological pain and childhood trauma are strongly associated with suicidal behaviour in mood disorders. This study examined whether specific cognitive functions are associated with variability in the relationship between psychological pain, childhood trauma, and lifetime history of suicide attempt in patients with mood disorders, with or without psychiatric comorbidities.

METHODS

A total of 494 psychiatric inpatients with a current or past major depressive episode were assessed for psychological pain, childhood trauma, and cognitive functioning. Cognitive domains included decision-making, inhibitory control, and semantic and phonemic verbal fluency. Logistic regression models tested the association between these variables and a lifetime history of suicide attempt. Interaction terms were included, adjusting for age, sex, education, and depressive symptom severity.

RESULTS

Higher psychological pain was associated with increased odds of suicide attempt (OR = 1.13, 95% CI [1.03-1.25], p = 0.012), whereas lower semantic verbal fluency was associated with higher odds of a lifetime history of suicide attempt (OR = 0.96, 95% CI [0.93-0.99]). The interaction between psychological pain, childhood trauma, and semantic verbal fluency was statistically significant (OR = 0.999, 95% CI [0.998-1.000], p = 0.029), indicating that the association between psychological pain and suicide attempt varied according to trauma exposure and semantic verbal fluency. No significant interactions were observed for other cognitive domains.

CONCLUSIONS

Semantic verbal fluency was associated with variability in the relationship between psychological pain, childhood trauma, and suicide attempt history, suggesting that cognitive processes contribute to the heterogeneity of suicide vulnerability. Given the cross-sectional design and the small effect sizes, these findings should be considered exploratory and warrant replication.