Childhood Maltreatment Severity and Suicidal Ideation Among Adults Receiving Acute-Care Psychiatric Inpatient Services: The Role of Distress Tolerance

Objective: Persons in psychiatric inpatient hospitals represent a unique population with high rates of suicidal ideation and behavior as well as childhood maltreatment. Lower levels of perceived distress tolerance (DT) are associated with a history of childhood maltreatment and suicidal ideation and behavior in adulthood. Our study examined the association of childhood maltreatment severity with self-report and behavioral indices of suicide through perceived DT in a sample of adults in an acute-care psychiatric inpatient unit. We hypothesized that lower levels of perceived DT would account for the association between (a) childhood maltreatment severity and suicidal ideation severity and (b) childhood maltreatment severity and prehospitalization suicidality. Method: The sample was composed of 94 trauma-exposed adults (60% men; M-age = 33.43; SD = 12.06) admitted to a psychiatric acute-care inpatient hospital in a large metropolitan area in the southern United States. Approximately 55% of the sample were hospitalized due to suicidality, with an average number of 1.28 (SD = 2.42) prior suicide attempts; 3% of patients exhibited suicidality during their hospitalization. All patients reported experiencing at least one type of childhood maltreatment, with varying degrees of exposure. We conducted indirect effects analyses using PROCESS Macro for SPSS. Results: Childhood maltreatment severity was indirectly associated with both suicidal ideation severity and prehospitalization suicidality through DT. Conclusions: Findings advance our understanding of the association between childhood maltreatment and increased risk for suicidal ideation and behavior in adulthood, specifically among the psychiatric inpatient population. Clinical Impact Statement Findings indicate that, among adults receiving psychiatric inpatient services, a lower perceived capacity to tolerate negative emotional states accounted for (a) the association between childhood maltreatment severity and suicidal ideation severity and (b) the association between childhood maltreatment severity and prehospitalization suicidality (i.e., ideation with intent/plan; behavior). Findings advance our understanding for why adults receiving psychiatric inpatient services may be at increased risk for experiencing suicidal ideation and behavior.

Automated summary

The study found that the severity of childhood maltreatment indirectly influences suicidal ideation severity and prehospitalization suicidality through distress tolerance in psychiatric inpatient adults. This advances our understanding of the association between childhood maltreatment and increased risk for suicidal ideation and behavior among psychiatric inpatient populations.