Negative schema and rumination as mediators of the relationship between childhood trauma and recent suicidal ideation in patients with early psychosis

Objective: High rates of childhood trauma and adult suicidality have been reported in patients who have schizophrenia. This study sought to explore mediators between childhood trauma and suicidality in adulthood to help determine therapeutic approaches. Methods: This study included 314 adult patients with early psychosis who were participants in the Korean Early Psychosis Cohort Study, which was a prospective naturalistic observational cohort study started in December 2014. DSM-5 criteria were used to assign the diagnosis of schizophrenia spectrum and other psychotic disorders. Cross-sectional data obtained at baseline were used for analysis. The Early Trauma Inventory Self Report-Short Form and the Columbia Suicide Severity Rating Scale were employed to collect data on childhood trauma and suicidal ideation and attempts. Other measures were used to evaluate depression, empathy, psychopathology, and rumination. Results: A total of 90.1% of the participants experienced at least 1 childhood traumatic event. The rates of significant` physical punishment, emotional abuse, and sexual events were 37.3%, 35.6%, and 6.4%, respectively. The rates of recent suicidal ideation and attempts were 32.0% and 10.0%, respectively. Independent predictors of recent suicidal ideation included depression, negative schema, and rumination. Furthermore, negative schema and rumination played partial or full mediating roles in the relationship between childhood trauma and recent suicidal ideation. Conclusions: These findings highlight the importance of performing careful evaluations of childhood trauma and suicidality and of developing effective strategies to reduce mediating factors that may be amenable to psychosocial approaches.