Longitudinal trajectories of suicidal ideation among Chinese medical students: the role of childhood trauma

doi:10.21203/rs.3.rs-2120375/v1

Download PDF

Research Article

Longitudinal trajectories of suicidal ideation among Chinese medical students: the role of childhood trauma

https://doi.org/10.21203/rs.3.rs-2120375/v1

This work is licensed under a CC BY 4.0 License

Journal Publication

published 06 Feb, 2023

Read the published version in BMC Psychiatry →

You are reading this latest preprint version

Background: The aim of this study was to understand the longitudinal trajectory of suicidal ideation among Chinese medical students and the role of childhood trauma.

Methods: Using a whole-group sampling method, we assessed suicidal ideation in 2192 (male = 834, female = 1358) medical students on three occasions over a period of one year. The Self-rating Idea of Suicide Scale (SIOSS) and the Childhood Trauma Questionnaire-Short Form (CTQ-SF) were used to assess suicidal ideation and childhood trauma. The regression of mixed models was used to analyze the developmental trajectory of suicidal ideation.

Results: Chinese medical students scored higher on suicidal ideation than the general population, and the prevalence of suicidal ideation increased during the COVID-19 pandemic. The trajectory of suicidal ideation among Chinese medical students was divided into two groups: a low-level, slowly rising group and a high-level, continuous group. The low-level, slowly rising group had a significant time effect (B=1.57, p<0.001) and showed a slowly increasing trend. Emotional neglect, somatic neglect, emotional abuse and somatic abuse all had significant positive predictive effects for the low-risk, slowly rising group (B=0.18-0.65, P<0.01).

Conclusion: The trajectory of suicidal ideation among medical students can be divided into a low-risk, slow-rising group and a high-risk, continuous group; the more emotional neglect, somatic neglect, emotional abuse and physical abuse experienced during childhood, the more likely medical students are to develop a high-risk, continuous state of suicidal ideation.

Suicidal ideation

Childhood trauma

Growth mixture modelling

COVID-19

Suicide is a serious global public health problem. More than 700,000 people worldwide commit suicide each year, and suicide is the fourth leading cause of death among people aged 15–29 years [1]. Suicide rates in China have continued to decline (from 2002 to 2015), but suicide is still a concern [2, 3]. The process of suicide in individuals generally goes through three stages: developing suicidal ideation, making a suicide plan, and committing suicidal acts [4]. According to the interpersonal theory of suicide, an individual will only commit suicide if he or she has the following: a sense of unmet belonging, a sense of perceived burdensomeness and the ability to commit suicide. Additionally, he or she is highly vulnerable to suicidal ideation when both unmet belonging and perceived burdensomeness are present, but both are not stable traits and are susceptible to interpersonal factors and the individual's early experiences[5]. Suicide is a behavior initiated by suicidal ideation, and although having suicidal thoughts without actually committing suicide, suicidal ideation provides the individual with an opportunity to reexamine the meaning of life and is an important predictor of suicidal behavior factors[4, 6].Therefore, it is important to understand the characteristics of suicidal ideation and to develop targeted prevention and intervention approaches to reduce the occurrence of suicidal ideation.

Globally, the college student population has high levels of suicidal ideation, planning, and attempts [7–9]. As college students move from adolescence into early adulthood, they are faced with multiple pressures from performing in academics, developing a sense of self-identity, maintaining interpersonal relationships, and planning for a career. Medical students are a special group with a higher incidence of mental health problems than the general population [10]. Long hours of study, heavy academic loads, competition with peers and other stressors can affect the mental health of medical students [11, 12] and lead to high levels of suicidal ideation [10, 13]. The common view is that suicidal ideation is a fleeting thought; however, longitudinal findings found that 16% of those who reported suicidal ideation at baseline levels still reported suicidal ideation at follow-up 9 years later, meaning that there is a persistent effect of suicidal ideation [14]. The same results were confirmed in the adolescent population [15]. There is no consensus on the characteristics of the trajectory of suicidal ideation, with findings indicating that suicidal ideation fluctuates widely across seven time points [16]. There are three types of trajectories of suicidal ideation: low level-stable, high level-declining, and a moderate level that is either declining or rising [17]. However, another follow-up study showed no change in the overall level of suicidal ideation among Chinese adolescents [18]. There is no research on the development of suicidal ideation among medical students, so is there a unique trajectory of suicidal ideation among this unique student population?

The cumulative situational risk model suggests that the more negative situations an individual experiences early in life, the higher the likelihood of cumulative or superimposed developmental risk and the greater the risk of suicidal ideation [19]. Among the negative situations that lead to suicidal ideation, childhood trauma is a significant predictor. Childhood trauma is defined as actual or potential harm to a child's health, survival, development or self-esteem by the child's guardian or someone the child trusts and includes various forms of emotional abuse, physical abuse, sexual abuse, neglect, and commercial exploitation [20]. Individuals who have been abused in childhood have a high frequency of suicidal thinking and suicide attempts, and will encounter more difficulties in the subsequent development tasks, showing more depression, suicidal ideation and suicide attempts[21–23]. Although most studies confirm the strong relationship between childhood abuse and suicidal ideation and suicidal behaviour, some studies have found that only childhood sexual abuse directly affects suicidal ideation[24]. It has also been shown that childhood maltreatment, such as physical and emotional abuse, does not effectively predict suicidal ideation [25] and that some individuals maltreated in childhood have relatively lower suicidal ideation [26, 27]. Based on previous research, the relationship between childhood maltreatment and suicidal ideation is uncertain, but childhood maltreatment has a cumulative negative impact and is associated with the development of negative emotions and behaviours in individuals. This study therefore seeks to understand whether different forms of childhood maltreatment over time affect changes in suicidal ideation.

The COVID-19 epidemic has led adolescents to develop negative emotions such as anxiety, depression and even suicidal ideation [28–30]. During the pandemic, severe suicidal ideation was most common among 18- to 24-year-olds [31],and the total number of suicidal ideations increased by almost 63.3% [32]. A total of 36.4% of rural Chinese high school students reported suicidal ideation during the COVID-19 pandemic [33]. Although many studies have confirmed that the COVID-19 epidemic affects suicidal ideation among college students, the impact on suicidal ideation among Chinese medical students is elusive.

In summary, most of the existing studies on suicidal ideation are cross-sectional surveys, which do not well reflect developmental characteristics and trends in suicidal ideation. The few longitudinal studies on suicidal ideation have only described simple outcomes and have not examined trends and changes in suicidal ideation, nor have they explored group heterogeneity. While studies on factors influencing suicidal ideation generally support the association of gender, place of origin, major, and childhood maltreatment with suicidal ideation, there are a few studies with different results, and the use of longitudinal follow-up studies and exploration of heterogeneity would be more effective in clarifying the relationship of these studies to the mainstream. Therefore, this study uses a latent variable mixed growth model with medical students to first explore the trajectory of suicidal ideation among college students and whether there are heterogeneous latent category differences and second, to further understand the predictive effects of gender, place of birth, major, and childhood maltreatment on the trajectory of suicidal ideation among college students. In this study, we aim to enrich existing theories and provide references for the prevention of suicide among medical students.

Participants

A total of 2192 Chinese medical students were tested using an online questionnaire in December 2019 (Time 1), June 2020 (Time 2) and December 2020 (Time 3). A total of 2713 questionnaires were distributed in T1, and a total of 2192 valid samples were obtained after the three tests were completed. The subjects who participated in the study were aged 18–23 years old, of whom 834 were male and 1358 were female; 1045 were medical students while 1147 were nonmedical students, and 941 were rural while 1251 were urban. This study was reviewed by the Ethics Committee of Hainan Medical College (HYLL2021234).

Measures

Self-rating Idea of Suicide Scale (SIOSS)

The scale developed by Xia Chaoyun, was used to assess individuals’ suicidal ideation and intensity over the past 12 months[34]. A total of 26 items, including four subscales of despair, optimism, sleep, and camouflage, were scored on a "yes = 1" and "no = 0" scale, and the measure was unreliable if the camouflage subscale score was ≥ 4. The higher the score, the stronger the suicidal ideation. The scale has good reliability and validity among Chinese university students[34]. The Cronbach's alpha coefficients for the three measures in this study were 0.81, 0.87 and 0.83, respectively.

Childhood Trauma Questionnaire-Short Form (CTQ-SF)

The CTQ-SF is used to assess traumatic experiences in childhood. Fu Wenqing tested the reliability of the scale when applied to Chinese university students [35]. There are 28 items, including 5 subscales of emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect (25 items in total) and a validity scale (3 items in total), scored on a scale of 1 (never) − 5 (always), with higher scores indicating more severe childhood abuse. The validity scale is scored on a two-point scale of 0–1, and a total validity score of greater than 3 invalidates the questionnaire. The reliability of the scale is good, with a Cronbach's alpha coefficient of 0.81 in this study.

Statistical analysis

Statistical analysis was conducted using IBM SPSS Version 22.0, and Mplus 7.0 was used for growth mixture modelling (GMM) analysis, which can accurately distinguish the differences between individuals while analyzing the trajectory of suicidal ideation, providing an empirical basis and theoretical reference for the identification of suicidal ideation and planned interventions. The data analysis was conducted in three steps.

In the first step, descriptive statistical analysis was conducted. Independent sample t tests were conducted using SPSS 22 to compare the differences between the two groups of continuous-type variables, and Pearson product-difference correlation was used to examine the correlations between the continuous-type study variables.

In the second step, Latent category model fit was assessed to analyse whether there were heterogeneous latent category differences in the trajectories of change in suicidal ideation among university students. The indicators and criteria used in this study to evaluate the model fit were as follows: (1)Akaike information criterion (AIC) and Bayesian information criterion (BIC) in which the smaller the value is, the better; (2)entropy, which has a value approximately equal to 0.8, indicates that the classification accuracy exceeds 90%, and is more accurate the closer it is to 1; (3)the Likelihood Ratio Test (Lo-Mendell-Rubin, LMR) and Bootstrapped Likelihood Ratio Test (BLRT), which were used to determine if the model for the current category is significantly better than the model for the previous category, as judged by the significance of the p value (the number of categories starts from 1 and is set in increasing order).

In the third step, the effects of the covariates gender, major and childhood trauma on the potential trajectories of change in suicidal ideation among medical students were tested. Based on the potential categories of the trajectory of change in suicidal risk obtained in step 2, an unordered multivariate logistic regression model was developed using the classification of potential categories as the dependent variable and gender, major and childhood trauma as predictor covariates.

Traditional analysis of suicidal ideation

The prevalence of suicidal ideation fluctuated in three stages, 3.9% at T1, 5.2% at T2, and 5.1% at T3, with an overall increase. The continuous variables in this study conformed to a normal distribution. A Pearson product difference correlation analysis of the suicidal ideation scores at the three time points (Table 1) revealed a statistically significant two-by-two positive correlation between the suicidal ideation scores at the three time points (p < 0.05).

Table 1

Descriptiveness and correlation of suicidal ideation (r)
Time	M ± SD	T1	T2	T3
T1	4.26 ± 3.54	-
T2	7.40 ± 2.85	0.39^***	-
T3	6.64 ± 3.21	0.28^***	0.34^***	-
Noted: ^* P < 0 .05, ^P < 0.01, ^* P < 0.001.

We compared suicidal ideation scores across demographic characteristics at T1(Table 2). we found that female, nonmedical students had higher and significantly different suicidal ideation scores (P < 0.05); there were no significant differences in suicidal ideation scores by birthplace (P > 0.05).

Table 2

Independent t tests for suicidal ideation scores among college students with different demographic characteristics
Variables		M ± SD	t	P
Gender	Male	4.04 ± 2.45	-2.28	0.024
	Female	4.39 ± 2.59
Birthplace	Urban	4.22 ± 2.49	-0.65	0.518
	Rural	4.31 ± 2.62
Major	Medicine	4.09 ± 2.48	-2.57	0.010
	Non medicine	4.48 ± 2.61

Results Of The Mixed Growth Model

Potential category for suicidal ideation

As seen from Table 3, the information indices AIC, BIC, and aBIC continue to decrease as the number of categories increases, with the highest entropy when two categories are retained. The LMR and BLRT values reached significance levels when both categories were retained, and on balance, retaining 2 categories was the optimal classification model.

Table 3

The latent growth mixture model analysis indicators of suicide ideation
Model	K	Log(L)	AIC	BIC	aBIC	Entropy	LMR	BLRT	category probability
C = 1	8	-17025.69	34067.39	34112.93	34087.51	-	-	-	-
C = 2	27	-16687.26	33428.53	33582.23	33496.45	0.83	< 0.001	< 0.001	84.5/15.5
C = 3	46	-16580.10	33252.20	33514.06	33367.91	0.65	0.594	0.595	46.1/43.5/10.4
Note: C:number of potential categories; K:number of freely estimated parameters; Log(L):Log likelihood test; AIC: Akaike information criterion; aBIC: adjusted BIC; Entropy: entropy value; LMR: likelihood ratio test; BLRT: Bootstrap-based likelihood ratio test; Category probability: number of people in each category Proportion.

Trajectory Of Each Potential Category Of Suicidal Ideation

Analysis of the fitted information indices for the mixed growth model revealed that a division into 2 potential categories was most appropriate. We will therefore build on this to further examine the trajectory of each potential category. The mean values of the intercept (α) and slope (B) are available in the mixed model.

The intercept (α) describes the average initial state of the individuals, while the mean of the slope (B) describes the average growth rate between time points. As the results in Table 4 show, the mean values of the intercept (α) for each potential category were C1: 4.00 (SE = 0.12, t = 31.32, P < 0.001) and C2: 10.32 (SE = 0.33, t = 31.06, P < 0.001). There were significant differences in the mean intercept values between each potential category, with C2 having a higher initial value and C1 having a lower value.

The average growth rate of each potential category was described by the mean of the slopes (B) of the potential categories; the results in Table 5 show that the means of the slopes (B) of the 2 potential categories were C1: 1.57 (SE = 0.12, t = 12.57, p < 0.001) and C2: -0.68 (SE = 0.41, t = 31.32, p = 0.098). The slope of group C1 is a significantly different, smaller positive number, indicating that the level of suicidal ideation in group C1 increased significantly over time. The slope of group C2 was negative, and the absolute value was small, indicating that the level of suicidal ideation in group C2 showed a decreasing trend over time, but the difference in the level of suicidal ideation between the three time points was not significant.

Combining the results of the intercept (α) mean with the slope (B) mean, the trajectory characteristics of the 2 potential categories of suicidal ideation groups can be derived. The C1 group showed a low to high change in the level of suicidal ideation, but the difference in the level of suicidal ideation between the three time points was low, so the C1 group could be named a “low-risk, slowly rising” group (84.5% of the sample), whereas the C2 group showed a high to low change in the level of suicidal ideation, but the change was not significant. Therefore, the C2 group can be named a “high risk, continuous” suicidal ideation group (15.5% of the sample).

Table 4

The mean intercept values of the latent class
category	Estimate	S.E.	Est./S.E.	P
C1	4.00	0.12	31.32	< 0.001
C2	10.32	0.33	31.06	< 0.001

Table 5

The mean slope values of the latent class
category	Estimate	S.E.	Est./S.E.	P
C1	1.57	0.12	12.57	< 0.001
C2	-0.68	0.41	-1.65	0.098

Analysis Of Factors Influencing Suicidal Ideation In Potential Category Groups

To further examine the effects of gender, place of birth, major, and childhood trauma on suicidal ideation in each potential category group, this study conducted regression analyses using the identified potential categories as dependent variables and gender, place of birth, major, and childhood maltreatment as predictor covariates, with the C1 (low risk of suicidal ideation) group as the reference group. The results showed (Table 6) that gender, place of birth, major, and sexual abuse had no significant effect on the shift in category outcome, whereas emotional neglect, somatic neglect, emotional abuse, and somatic abuse had a significant positive effect on the shift to the C2 (high, continuous risk of suicidal ideation) group (Β = 0.33, 0.32, 0.65, and 0.18, all P < 0.01).

Table 6

The predictive effects of covariates (C1 as reference)
covariate	β	S.E.	P
Gender	-0.11	0.20	0.559
Major	-0.04	0.03	0.129
Birthplace	0.07	0.17	0.674
Emotional Neglect	0.33	0.02	< 0.001
Physical Neglect	0.32	0.04	< 0.001
Emotional Abuse	0.65	0.05	< 0.001
Physical Abuse	0.18	0.05	0.001
Sexual Abuse	0.08	0.08	0.313

This is the first study to examine the trajectory of suicidal ideation among medical students. We investigated suicidal ideation over a period of one year and used an individual-centered, latent variable, growth mixed model to explore the trajectory of suicidal ideation among medical students to capture some of the developmental patterns of suicidal ideation over time.

Our study found that the incidence of suicidal ideation among medical students increased significantly during the COVID-19 pandemic, declined later, and was higher in the post pandemic period than in the pre pandemic period, with results consistent with those of Chinese university students[36]. However, the results of all three follow-up data surveys were lower than those of previous studies of healthcare workers and medical students with migraine [37, 38], and higher than those of the naval officer group [39].That is, the COVID-19 pandemic had a negative impact on the level of suicidal ideation among medical students but did not seriously worsen the incidence of suicidal ideation in this group.

We found heterogeneity in the trajectory of suicidal ideation development. There were two types of trajectories of suicidal ideation among medical school students: a low-level, slowly rising group and a high-level, continuous group. First, the most representative group was the low-level, slowly rising group, accounting for 84.5% of the total, a finding that is inconsistent with previous studies [6]. This suggests that the majority of medical students were at a very low initial level of suicidal ideation that slowly increased over time, meaning that medical students are at increasing risk of suicide over time. This study lasted for 1 year, and the study participants went from the first semester to the third semester of their undergraduate studies. The increased number and difficulty of courses at this more advanced level may have made them feel academically stressed and generated negative emotions such as fear of academic failure, burnout, anxiety and depression, which in turn would make the frequency and level of suicidal ideation higher [40]. Additionally, at the time of the COVID-19 pandemic, China was on full alert, and the fear among the public and depression among medical students were at their maximum, leading to increased levels of suicidal ideation. The high-level, continuous ideation group accounted for 15.5% of the total. This group started at a high level of suicidal ideation, and while over time, these ideas subsided, the decrease was nonsignificant, leaving the group at a high-risk level. This may be due to the lower level of mental resilience, lower levels of feelings of pleasure and lower abilities to cope with adversity when faced with negative events. These combined factors indicate that the individual does not have insufficient intrinsic resources to cope with the impact of negative life events [41], resulting in the level of suicidal ideation remaining at a high level. When faced with an unexpected public health event, for the general medical student population, mental health lectures and psychological knowledge should be conducted to alleviate panic and anxiety and avoid serious psychological problems, and these professionals conducting the intervention need to be properly resourced and appropriately trained[42]. For specific groups, such as medical students with depression, suicidal ideation and previous hospitalization history in psychiatric hospitals, we need to focus on using psychological treatment methods such as diagnostic behavior therapy skills training (DBT) and Internet-based cognitive behavior therapy (ICBT) to prevent suicidal ideation from turning into suicide attempt[43, 44].

The close relationship between emotional neglect, somatic neglect, emotional abuse, and physical abuse and suicidal ideation in childhood abuse is consistent with previous studies [45, 46]. Individuals who have been traumatized in childhood live with the stressful expectation that they may be abused at any time in their lives and are prone to higher than usual levels of cortisol arousal; they are insecure about relationships and lack people to turn to for understanding and support when they experience negative events. They are also prone to self-loathing and suicidal thoughts in response to negative events. Emotional neglect, somatic neglect, emotional abuse and physical abuse can affect the development of suicidal ideation both independently and in combination. We did not find an association between sexual abuse and suicidal ideation, which is inconsistent with previous findings[47] and may be due to group variability in the study population. Most studies on sexual abuse have focused on psychiatric inpatients, patients with bipolar disorder, and patients with depression[48, 49]. These groups all have some impairment in social functioning and poorer interpersonal interactions and are more likely to develop suicidal ideation than healthy groups, whereas most of the university students in this study were in a psychologically healthy state and fewer individuals had experienced sexual abuse, so this study did not find any association between sexual abuse and suicidal ideation. We also found that gender, place of birth, and major were not associated with the trajectory of suicidal ideation development among medical students, which is consistent with previous research findings [36].

Study Limitations

We should note that there are some shortcomings in the present study. First, this study has some limitations in terms of data collection, as only students from one medical university in China were tracked, and it is uncertain whether the findings of the study can be generalized to other schools; future studies could validate the results at medical schools in different regions. In addition, this study examined only the association between childhood maltreatment and the trajectory of suicidal ideation, and future research could focus on the association of other influences, such as family functioning, core self-evaluation and school climate, with the trajectory of suicidal ideation. Future studies could also incorporate endocrine and brain structure findings in individuals with suicidal ideation. Finally, we conducted only a longitudinal follow-up and did not develop an intervention programme to improve suicidal ideation. Future research could consider developing targeted programme for intervention or guidance based on the characteristics of different heterogeneous groups.

Overall, our study identified trajectories of suicidal ideation among Chinese medical students in a low-level, slowly rising group and a high-level, continuous group. Emotional neglect, somatic neglect, emotional abuse, and somatic abuse can both independently and jointly influence the development of suicidal ideation. The findings suggest attention should be given to the effects of childhood trauma for medical students with high suicidal ideation.

Ethics approval and consent to participate

This study was approved by the ethics committee of Hainan Medical University(HYLL2021234). We provided all participants with all information about the study and signed the informed consent form, and all researchers were voluntary participants. All research procedures were conducted in accordance with the declaration of Helsinki.

Consent for publication

Not applicable.

Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests

We declare that all authors have no relationship that could be construed as a potential conflict or competing interest.

Funding

This study was supported by the Natural Science Foundation of Hainan Province(821RC1124),Hainan Medical University (grant numbers HYPY2020028). The funder had no role in study design, data collection and analysis, or preparation of the manuscript.

Authors’ contributions

JJH and JN designed the study and wrote the study plan. JJH participated in data collection and NS analyzed the data. JN wrote the manuscript. NS and STC do the final check. All authors have read and agreed to the published version of the manuscript.

Acknowledgements

We would like to thank Hainan Medical University for their support of this study. We also thank the participants for their active cooperation.

World Health Organization.Suicide.2021.https://www.who.int/news-room/fact sheets/detail/suicide. Accessed on 3 June 2022.
Jiang H, Niu L, Hahne J, et al. Changing of suicide rates in China, 2002–2015 [published correction appears in J Affect Disord. 2019 Jun 15;253:]. J Affect Disord. 2018;240:165–170. doi:10.1016/j.jad.2018.07.043.
Sun L, Zhou C, Xu L, Li S, Kong F, Chu J. Suicidal ideation, plans and attempts among medical college students in china: The effect of their parental characteristics. Psychiatry Res. 2017;247:139–43.
Klonsky ED, May AM, Saffer BY. Suicide. Suicide Attempts, and Suicidal Ideation. Annu Rev Clin Psychol. 2016;12:307–30. doi:10.1146/annurev-clinpsy-021815-093204.
Van Orden KA, Cukrowicz KC, Witte TK, Joiner TE. Thwarted belongingness and perceived burdensomeness: construct validity and psychometric properties of the Interpersonal Needs Questionnaire. Psychol Assess. 2012;24(1):197–215. doi:10.1037/a0025358.
Groleger U, Tomori M, Kocmur M. Suicidal ideation in adolescence–an indicator of actual risk? Isr J Psychiatry Relat Sci. 2003;40(3):202–8.
Eskin M, Sun JM, Abuidhail J, et al. Suicidal Behavior and Psychological Distress in University Students: A 12-nation Study. Arch Suicide Res. 2016;20(3):369–88. doi:10.1080/13811118.2015.1054055.
Miletic V, Lukovic JA, Ratkovic N, Aleksic D, Grgurevic A. Demographic risk factors for suicide and depression among Serbian medical school students. Soc Psychiatry Psychiatr Epidemiol. 2015;50(4):633–8. doi:10.1007/s00127-014-0950-9.
Yang LS, Zhang ZH, Sun L, Sun YH, Ye DQ. Prevalence of suicide attempts among college students in China: a meta-analysis. PLoS ONE. 2015;10(2):e0116303. doi:10.1371/journal.pone.0116303. Published 2015 Feb 9.
Fan AP, Kosik RO, Su TP, et al. Factors associated with suicidal ideation in Taiwanese medical students. Med Teach. 2011;33(3):256–7.
Hill MR, Goicochea S, Merlo LJ. In their own words: stressors facing medical students in the millennial generation. Med Educ Online. 2018;23(1):1530558. doi:10.1080/10872981.2018.1530558.
Jiang Nan H, Jiang L, Lin, et al. Analysis of potential categories and related factors of suicidal ideation among medical higher vocational college freshmen. Chin J health Psychol. 2022;30(02):275–81.
Van Niekerk L, Scribante L, Raubenheimer PJ. Suicidal ideation and attempt among South African medical students. S Afr Med J. 2012;102(6 Pt 2):372–3. doi:10.7196/samj.5503. Published 2012 May 8.
Kivelä L, Krause-Utz A, Mouthaan J, et al. Longitudinal course of suicidal ideation and predictors of its persistence - A NESDA study. J Affect Disord. 2019;257:365–75. doi:10.1016/j.jad.2019.07.042.
Goldston DB, Erkanli A, Daniel SS, Heilbron N, Weller BE, Doyle O. Developmental Trajectories of Suicidal Thoughts and Behaviors From Adolescence Through Adulthood. J Am Acad Child Adolesc Psychiatry. 2016;55(5):400–7.e1. doi:10.1016/j.jaac.2016.02.010.
Chen J, Yang J, Zhu Xiong Z, et al. A qualitative-stress model of suicidal ideation in high school students: A multitemporal follow-up study. Psychological Science,2011,(03):733–737.
Xiao Y, Lindsey MA. Adolescent social networks matter for suicidal trajectories: disparities across race/ethnicity, sex, sexual identity, and socioeconomic status [J]. Psychol Med, 2021, 1–12. doi:10.1017/S0033291721000465.
Liu Y, Yang Y, Wang CX, et al. The effects of school climate and negative emotions on adolescent suicidal ideation: a cross-lagged study. Psychol Behav Res. 2020;18(06):784–90.
Appleyard K, Egeland B, van Dulmen MH, Sroufe LA. When more is not better: the role of cumulative risk in child behavior outcomes. J Child Psychol Psychiatry. 2005;46(3):235–45. doi:10.1111/j.1469-7610.2004.00351.x.
Schulz A, Becker M, Van der Auwera S, et al. The impact of childhood trauma on depression: does resilience matter? Population-based results from the Study of Health in Pomerania. J Psychosom Res. 2014;77(2):97–103. doi:10.1016/j.jpsychores.2014.06.008.
Bryan CJ, McNaugton-Cassill M, Osman A, Hernandez AM. The associations of physical and sexual assault with suicide risk in nonclinical military and undergraduate samples. Suicide Life Threat Behav. 2013;43(2):223–34. doi:10.1111/sltb.12011.
Silverman AB, Reinherz HZ, Giaconia RM. The long-term sequelae of child and adolescent abuse: a longitudinal community study. Child Abuse Negl. 1996;20(8):709–23. doi:10.1016/0145-2134(96)00059-2.
IRELAND TO, SMITH CA, THORNBERRY TP, DEVELOPMENTAL ISSUES IN, THE IMPACT OF CHILD MALTREATMENT ON LATER DELINQUENCY AND DRUG USE. Criminology. 2002;40: 359–400. https://doi.org/10.1111/j.1745-9125.2002.tb00960.x.
Bahk YC, Jang SK, Choi KH, Lee SH. The Relationship between Childhood Trauma and Suicidal Ideation: Role of Maltreatment and Potential Mediators. Psychiatry Investig. 2017;14(1):37–43. doi:10.4306/pi.2017.14.1.37.
Kwok SY, Chai W, He X. Child abuse and suicidal ideation among adolescents in China. Child Abuse Negl. 2013;37(11):986–96. doi:10.1016/j.chiabu.2013.06.006.
Wilson LC, Newins AR, Kimbrel NA.. "An examination of the interactive effects of different types of childhood abuse and perceived social support on suicidal ideation." Children s Health Care 48.4(2019):394–409. doi:10.1080/02739615.2019.1630282.
Zhou Han, Yu S, Liu QX, et al. The relationship between child psychological abuse and neglect and suicidal ideation:A mediated model with moderation. Psychol Sci. 2019;42(02):335–42.
Haddad JM, Macenski C, Mosier-Mills A, et al. The Impact of Social Media on College Mental Health During the COVID-19 Pandemic: a Multinational Review of the Existing Literature. Curr Psychiatry Rep. 2021;23:70. https://doi.org/10.1007/s11920-021-01288-y.
Chi X, Becker B, Yu Q, et al. Prevalence and Psychosocial Correlates of Mental Health Outcomes Among Chinese College Students During the Coronavirus Disease (COVID-19) Pandemic. Front Psychiatry. 2020;11:803. doi:10.3389/fpsyt.2020.00803. Published 2020 Aug 7.
Jiang Hj, Nan J, Lv Zy, Yang J. Psychological impacts of the COVID-19 epidemic on Chinese people: Exposure, post-traumatic stress symptom, and emotion regulation. Asian Pac J Trop Med. 2020;13:252–9. doi:10.4103/1995-7645.281614.
Czeisler M, Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic - United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1049–57. doi:10.15585/mmwr.mm6932a1. Published 2020 Aug 14.
Kaparounaki CK, Patsali ME, Mousa DV, et al. University students' mental health amidst the COVID-19 quarantine in Greece. Psychiatry Res. 2020;290:113111. doi:10.1016/j.psychres.2020.113111.
Hou T, Mao X, Shao X, et al. Suicidality and Its Associated Factors Among Students in Rural China During COVID-19 Pandemic: A Comparative Study of Left-Behind and Non-Left-Behind Children. Front Psychiatry. 2021;12:708305. doi:10.3389/fpsyt.2021.708305. Published 2021 Aug 3.
Zhaoyun X, Dongbo W, Xudong H, et al. Application of the Suicidal Ideation Self-Assessment Scale in college students. Chin J Psychiatry. 2007;40(02):94.
Fu WQ, Yao SHQ, Yu HH, et al. Reliability study of the Childhood Trauma Questionnaire in Chinese university students. Chinese Journal of Clinical Psychology, 2005, (01): 40–42. 36.
Cao XY, Ma ZF, Tian Miao, et al. The association between childhood abuse experiences and suicidal ideation among college students. Chin School Health. 2020;41(04):506–9.
Sahimi HMS, Mohd Daud TI, Chan LF, Shah SA, Rahman FHA, Nik Jaafar NR. Depression and Suicidal Ideation in a Sample of Malaysian Healthcare Workers: A Preliminary Study During the COVID-19 Pandemic. Front Psychiatry. 2021;12:658174. doi:10.3389/fpsyt.2021.658174. Published 2021 Apr 30.
Aijun Y, Shaobo SL, Ren C, et al. Suicidal ideation and its related factors among medical college graduate students. Chin J mental health. 2020;34(02):147–52.
Gao Q, Zhang Y, Jim YN, et al. Suicidal ideation and related factors among officers and soldiers in a naval department. Chin J Mental Health. 2021;35(03):208–12.
Rigucci S, Sarubbi S, Erbuto D, et al. Negative emotion dysregulation is linked to the intensity of suicidal ideation in a mixed inpatient sample. J Affect Disord. 2021;281:605–8. doi:10.1016/j.jad.2020.11.108.
Wang Wei L, Weili Z, Di, et al. A follow-up study on suicidal ideation of new recruits during their adaptation period. Chin J health Psychol. 2016;24(12):1796–8.
Knipe D, Padmanathan P, Newton-Howes G, Chan LF, Kapur N. Suicide and self-harm. Lancet. 2022;399(10338):1903–16. doi:10.1016/S0140-6736(22)00173-8.
Lai MH, Maniam T, Chan LF, Ravindran AV. Caught in the web: a review of web-based suicide prevention. J Med Internet Res. 2014;16(1):e30. Published 2014 Jan 28. doi:10.2196/jmir.2973.
Chan LF, Shamsul AS, Maniam T. Are predictors of future suicide attempts and the transition from suicidal ideation to suicide attempts shared or distinct: a 12-month prospective study among patients with depressive disorders. Psychiatry Res. 2014;220(3):867–73. doi:10.1016/j.psychres.2014.08.055.
Angelakis I, Gillespie EL, Panagioti M. Childhood maltreatment and adult suicidality: a comprehensive systematic review with meta-analysis. Psychol Med. 2019;49(7):1057–78. doi:10.1017/S0033291718003823.
Wang KUN-YAN, Lin BING-BING, Ma J-P, et al. Childhood emotional abuse and adolescent suicidal ideation: a mediated model with moderation. Chin J Clin Psychol. 2020;28(04):683–7.
Chan LF, Maniam T, Saini SM, et al. Sexual abuse and substance abuse increase risk of suicidal behavior in Malaysian youth. Asia Pac Psychiatry. 2013;5(Suppl 1):123–6. doi:10.1111/appy.12057.
DeCou CR, Lynch SM. Emotional reactivity, trauma-related distress, and suicidal ideation among adolescent inpatient survivors of sexual abuse. Child Abuse Negl. 2019;89:155–64. doi:10.1016/j.chiabu.2019.01.012.
Larson RW, Moneta G, Richards MH, et al. Continuity, stability, and change in daily emotional experience across adolescence[J]. Child Dev. 2002;73(4):1151–65.

No competing interests reported.

Download PDF

Journal Publication

published 06 Feb, 2023

Read the published version in BMC Psychiatry →

Editorial decision: Major revision
09 Dec, 2022
Reviews received at journal
05 Dec, 2022
Reviewers agreed at journal
20 Nov, 2022
Reviewers agreed at journal
17 Nov, 2022
Reviewers invited by journal
07 Nov, 2022
Editor assigned by journal
17 Oct, 2022
Editor invited by journal
14 Oct, 2022
Submission checks completed at journal
14 Oct, 2022
First submitted to journal
30 Sep, 2022

You are reading this latest preprint version

Longitudinal trajectories of suicidal ideation among Chinese medical students: the role of childhood trauma

Status:

Journal Publication

Version 1

Abstract

Background

Methods

Participants

Measures

Statistical analysis

Results

Traditional analysis of suicidal ideation

Results Of The Mixed Growth Model

Potential category for suicidal ideation

Trajectory Of Each Potential Category Of Suicidal Ideation

Analysis Of Factors Influencing Suicidal Ideation In Potential Category Groups

Discussion

Study Limitations

Conclusion

Declarations

References

Additional Declarations

Status:

Journal Publication

Version 1