Risk of suicidal behavior in children and adolescents exposed to maltreatment: the mediating role of borderline personality traits and recent stressful life events

Abstract

Childhood maltreatment (CM) is associated with increased non-suicidal self-injury (NSSI) and suicidal behavior (SB), independently of demographic and mental health conditions. Self-Trauma Theory and Linehan's Biopsychosocial Model might explain the emergence of Borderline Personality Disorder (BPD) symptoms as mediators of the association between CM and the risk of SB. However, little is known regarding such relationships when the exposure is recent for young persons. Here, we study 187 youths aged 7-17, with or without mental disorders. We explore CM experiences (considering the severity and frequency of different forms of neglect and abuse), recent stressful life events (SLEs), some BPD traits (emotion dysregulation, intense anger and impulsivity), and the risk of SB (including NSSI, suicide threat, suicide ideation, suicide plan and suicide attempt). We study the direct and mediating relationships between these variables via a structural equation analysis using the statistical software package EQS. Our findings suggest that youths exposed to more severe/frequent CM have more prominent BPD traits, and are more likely to have experienced recent SLEs. In turn, BPD traits increase the risk of SLEs. However, only emotion dysregulation and recent SLEs were found to be correlated with SB. Therefore, targeted interventions on emotion dysregulation are necessary to prevent NSSI or SB in children and adolescents exposed to CM, as is the minimization of further SLEs.

Supported by the Spanish Ministry of Economy and Competitiveness Instituto de Salud Carlos III through the University of Barcelona multicentre project (PI15/00097): PI L. Fañanas; Hospital Universitario Araba (PI15/00793): PI I. Zorrilla; Hospital Gregorio Marañón (PI15/00723): PI M. Rapado; and Hospital Clinic (PI15/00685): PI S. Romero. Co-financed by the European Regional Development Fund project, “A way of making Europe”. We thank the Network Centre for Biomedical Research in Mental Health (CIBERSAM). This study was facilitated by a pre-doctoral research grant from the Catalonian authorities to Laia Marques-Feixa (AGAUR- FI_B100023-2018) and the Bosch i Gimpera Foundation. The work is also supported by the Comissionat per a Universitats i Recerca del DIUE, of the Generalitat de Catalunya regional authorities (2017SGR1577) and by the Spanish Ministry of Science, Innovation and Universities (RTI2018-099800-B-I00). Rapado-Castro was supported by a Ramon y Cajal Research Fellowship (RYC-2017-23144), from the Spanish Ministry of Science, Innovation and Universities.