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Innovative Research Program on Suicide Countermeasures in FY2020: Report on Commissioned
Research Results

Field 3: Developing new policy areas
Topic number：3-2

Research topic:
Study on Enhancement and Improvement of Psychological Care/Support for People with TraumaticExperience of Disaster and/or Child Abuse

Principal Researcher:
Yoshiharu Kim
Director General, National Institute of Mental Health, National Center of Neurology and Psychiatry

Co-Researcher:
Hiroaki Hori
Section Chief, Department of Behavioral Medicine, National Center of Neurology and Psychiatry

Hitomi Kawanishi
Research Fellow, Department of Behavioral Medicine, National Center of Neurology and Psychiatry

Summary:Childhood adversity (maltreatment) has been shown to increase the risk of developing psychiatricdisorders such as depression and post-traumatic stress disorder (PTSD), as well as to increase therisk of suicide. Although there is a link between the two events of childhood adversity and suicide, little
has been done to study effective interventions including prevention and treatment, which may be due inpart to the time gap between the two events. The purpose of this study was to clarify the impact ofchildhood abuse on suicide risk in adult PTSD patients and to identify protective factors that reduce theimpact of abuse on suicide risk.
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To date, 69 patients with PTSD and 139 healthy controls have participated in the study. All participants
were female, and their average age was in their late 30s. Structured interviews by psychiatrists or clinicalpsychotherapists and validated self-administered questionnaires were used to confirm the diagnosis andto assess PTSD symptoms, childhood abuse experiences, depressive symptoms, coping strategies,
resilience, and suicide risk. Childhood maltreatment was assessed by the Childhood Trauma
Questionnaire (CTQ), and suicidal ideation was assessed by item 9 of the Beck Depression Inventory-II(BDI-II). Most of the patients developed PTSD as a result of interpersonal violence, and 43 of 69 (62%)
had major depressive disorder (MDD).
Statistical analysis revealed that PTSD patients had significantly more childhood maltreatment andhad significantly stronger suicidal ideation than healthy controls. The median total CTQ score forchildhood abuse in the patient group was 60.0 (25-75th percentile: 39.5-75.0), while the score for thehealthy control group was 34.0 (29.0-41.0). Regarding suicidal ideation assessed by item 9 of BDI-II (03, a four-point Likert scale), 24 of 69 patients (34.8%) responded that "2: I would like to kill myself' or"3: I would kill myself if l had the chance", which would indicate high-risk groups for suicide attempts.
In healthy controls, the number of those who selected "2: I would liketo kill myself" or "3: I would killmyself if l had the chance" was 0 out of 139.
Suicidal ideation was found to be significantly stronger in PTSD patients with MDD than in those
without (Mann­ Whitney U = 793 .0, p = 0.002). Suicidal ideation in PTSD patients was associatedwith emotional abuse (r = 0.313, p <0.01), sexual abuse (r = 0.335, p <0.01), emotional neglect (r =0.270, p <0.05), and physical neglect (r = 0.339, p <0.01).
Patients' suicidal ideation was significantly associated with lower resilience, social support (numberof people to consult), and less "positive interpretation" and "catharsis" as coping strategies. In addition,
childhood emotional abuse and emotional neglect were significantly associated with less social support
in PTSD patients.
The results of this study indicate that the experience of childhood abuse as well as the comorbidity ofdepression is an important risk factor for suicide in PTSD patients. Patients had low social support, and2

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low social support was associated with suicidal ideation. It has been reported that some percentage ofindividuals with childhood adversity may have weakened internal social support, such as lower selfesteem and feelings/habits of not being able to rely on others for reassurance. In addition, such people
often have weakened external social support, such as a lack of people around them to rely on due todifficulties in family and other interpersonal relationships. These results suggest the importance ofincreasing social support including the provision of social resources, which is diluted by the experienceof abuse. The results also indicate that interventions that help patients recover from difficulties, develop
resilience, and increase adaptive coping strategies may lead to a reduction in suicide risk. In this researchproject, we have also performed blood sampling from each participant to measure the levels of stresshormones and inflammatory markers; In the future, it is necessary to clarify the risk and protective factorsof suicide from a more comprehensive perspective, for example by using these biomarkers.

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