The association between traumatic experiences and suicide attempt in patients treated at the Hospital de Pronto Socorro in Porto Alegre, Brazil

A seven month comparative case-control study (28 subjects – patients with suicide attempt; 56 controls – patients without suicide attempt). The following instruments were used: Childhood Trauma Questionnaire (CTQ), Mini International Neuropsychiatric Interview (MINI), and Medical Outcomes Study (MOS).

Results

The group with suicide attempt had significantly higher scores for some variables: emotional abuse (p < 0.001), physical abuse (p < 0.001), emotional neglect (p < 0.001), and physical neglect (p < 0.001).

Conclusions

The results suggest that variables related to previous trauma may influence future suicide attempts. The adoption of preventive and therapeutic actions related to mistreatments during child development is a crucial factor in reduction of suicide risk.

Childhood trauma; suicide attempt; psychological suffering; abuse; neglect

Variable	Controls (n = 56)	Cases (n = 28)	p
Gender
Male	26 (46.4)	13 (46.4)	> 0.999
Female	30 (53.6)	15 (53.6)
Age, mean (SD) [min-max]*	35.6 (12.9) [19-66]	35.4 (12.8) [20-71]	0.933
Years in education, mean (SD) [min-max]*	10.1 (4.9) [1-25]	9.7 (4.0) [2-18]	0.707
Income, Q2 (Q1-Q3) [min-max] ^†	2.000 (1.250-3.650) [233-33.000]	2.000 (1.360-3.500) [0-5.000]	0.611
Marital status
Single	20 (35.7)	10 (35.7)	0.177
Long-term relationship	30 (53.6)	11 (39.3)
Widowed	1 (1.8)	0 (0)
Separated	5 (8.9)	7 (25)
Occupation
Unemployed	14 (25.0)	9 (32.1)	0.522
Employed	37 (66.1)	15 (53.6)
Retired or student	5 (8.9)	4 (14.3)
Prior psychiatric history	4 (7.1)	18 (64.3)	< 0.001
Family psychiatric history	27 (48.2)	18 (64.3)	0.246
History of significant loss in childhood	36 (64.3)	10 (35.7)	0.025
Commemorative date near hospitalization	29 (51.8)	10 (37)	0.305
Recent loss (death) of someone	24 (42.9)	15 (53.6)	0.486
Suicide attempt (in last 3 months), Q2 (Q1-Q3) [min-max]		1 (0-1) [0-3]

Type of trauma	Control n = 56	Case n = 28	Total n = 84	p _group	P _gender	p _interaçtion
Emotional abuse
Male	6.4 (5.7-7.1)	10.6 (7.9-13.4)	8.2 (7.1-9.3)
Female	9.0 (7.1-10.9)	15.6 (12.5-18.7)	11.8 (10.1-13.6)
Total	7.6 (6.7-8.5)	12.9 (10.8-15.0)
Physical abuse
Male	5.9 (5.4-6.4)	10.2 (7.2-13.3)	7.8 (6.6-9.0)	< 0.001	0.020	0.672
Female	7.9 (6.5-9.4)	12.5 (9.6-15.3)	9.9 (8.6-11.3)
Total	6.9 (6.2-7.5)	11.3 (9.2-13.4)
Sexual abuse
Male	5.3 (4.8-5.9)	7.0 (4.8-9.2)	6.1 (5.1-7.1)	0.067	0.037	0.927
Female	7.0 (5.7-8.3)	8.9 (5.8-12.1)	7.9 (6.5-9.3)
Total	6.1 (5.5-6.8)	7.9 (6.0-9.8)
Emotional neglect
Male	7.0 (5.8-8.1)	10.8 (9.0-12.5)	8.7 (7.5-9.8)	< 0.001	< 0.001	0.676
Female	10.1 (8.1-12.2)	17.0 (13.7-20.3)	13.1 (11.6-14.6)
Total	8.4 (7.3-9.5)	13.5 (11.8-15.3)
Physical neglect
Male	7.1 (6.7-7.5)	8.3 (6.6-10.0)	7.7 (6.9-8.5)	< 0.001	0.064	0.162
Female	7.5 (6.5-8.6)	10.8 (8.9-12.7)	9.0 (7.8-10.2)
Total	7.3 (6.8-7.9)	9.5 (8.2-10.8)
Total Score
Male	31.7 (29.9-33.7)	46.9 (39.7-55.4)	38.6 (35.2-42.3)	< 0.001	< 0.001	0.731
Female	41.6 (35.6-48.6)	64.8 (54.8-76.7)	51.9 (46.6-57.8)
Total	36.3 (33.4-39.5)	55.1 (49.0-62.1)

	Control Mean (95%CI)	Case Mean (95%CI)	p	Conditional logistic regression
	Control Mean (95%CI)	Case Mean (95%CI)	p	OR	95%CI	p
Family+Close friends	6.6 (5.2-8.0)	2.5 (1.4-3.7)	< 0.001	0.76	(0.64-0.91)	0.003
MOS_Tangible	4.6 (4.4-4.8)	3.4 (2.9-3.8)	< 0.001	0.20	(0.08-0.51)	< 0.001
MOS_Affection	4.6 (4.4-4.8)	3.4 (2.9-3.9)	< 0.001	0.31	(0.15-0.63)	< 0.001
MOS_Emotional	4.4 (4.2-4.6)	3.0 (2.4-3.5)	< 0.001	0.45	(0.29-0.69)	< 0.001
MOS_Informational	4.5 (4.3-4.7)	3.1 (2.6-3.5)	< 0.001	0.29	(0.15-0.57)	< 0.001
MOS_PositiveSocialInteraction	4.5 (4.3-4.7)	2.9 (2.4-3.4)	< 0.001	0.35	(0.20-0.62)	< 0.001
MOS_f1_Aff_PosSoc	4.5 (4.3-4.7)	3.1 (2.6-3.6)	< 0.001	0.30	(0.15-0.59)	< 0.001
MOS_f2_Em_Inf	4.5 (4.2-4.7)	3.0 (2.5-3.5)	< 0.001	0.37	(0.22-0.62)	< 0.001
MOS_f3_Tangible	4.6 (4.4-4.8)	3.4 (2.9-3.8)	< 0.001	0.20	(0.08-0.51)	< 0.001
Recent loss of someone	57.1 (45.3-69.0)	46.4 (28.0-64.9)	0.382	1.46	(0.62-3.45)	0.388
History of childhood loss	35.7 (23.7-47.7)	64.3 (46.5-82.0)	0.013	0.32	(0.12-0.84)	0.021
Childhood + Recent loss*	67.9 (57.7-78.0)	78.6 (63.4-93.8)	0.312	0.75	(0.42-1.34)	0.334

	Control	Case
Relationship
Mother	11 (29.7)	8 (28.6)
Father	10 (27.0)	8 (28.6)
Child	4 (10.8)	3 (10.7)
Sibling	12 (32.4)	9 (32.1)
Total responses	37 (100)	28 (100)
Total subjects	27	18
Type of disorder*
Depression	16 (8.7)	11 (10.8)
Suicide attempt	4 (2.2)	8 (7.8)
Suicide	2 (1.1)	0
Bipolar disorder	1 (0.5)	2 (2)
Alcohol problems	14 (7.6)	12 (11.8)
Drug problems	9 (4.9)	7 (6.9)
Psychiatric hospitalization	2 (1.1)	0
Psychiatric treatment	5 (2.7)	6 (5.9)
Total responses	184 (100)	102 (100)
Total subjects	56	28

Hospitalization reason	Birthdays	Traumatic memory/fight	Stressful event	Holidays*	Total ^†
SA	6 (60)	0 (0)	0 (0)	5 (50)	10
Accident (traffic/work/domestic)	12 (75)	0 (0)	1 (6.3)	5 (31.3)	16
Illness	6 (66.7)	2 (22.2)	2 (22.2)	0 (0)	9
Assault	4 (100)	0 (0)	0 (0)	0 (0)	4
Total ^‡	28	2	3	10	39

Associação de Psiquiatria do Rio Grande do Sul Av. Ipiranga, 5311/202, 90610-001 Porto Alegre RS/ Brasil, Tel./Fax: (55 51) 3024 4846 - Porto Alegre - RS - Brazil
E-mail: trends@aprs.org.br

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[1] Correspondence: Cleonice Zatti Rua Ramiro Barcelos, 2400, 2º andar, Bairro Santana 90035-003 - Porto Alegre, RS - Brazil E-mail: cleonice.zatti@outlook.com