Association between adverse childhood experiences and suicidal behavior in schizophrenia spectrum disorders: A systematic review and meta-analysis

Valentina Baldini; Ramona Di Stefano; Lorenzo Vittorio Rindi; Anthony O Ahmed; Maju Mathew Koola; Marco Solmi; Davide Papola; Diana De Ronchi; Corrado Barbui; Giovanni Ostuzzi

doi:10.1016/j.psychres.2023.115488

Association between adverse childhood experiences and suicidal behavior in schizophrenia spectrum disorders: A systematic review and meta-analysis

Psychiatry Res. 2023 Nov:329:115488. doi: 10.1016/j.psychres.2023.115488. Epub 2023 Sep 18.

Authors

Affiliations

¹ Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Italy. Electronic address: valentina.baldini@unimore.it.
² Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy.
³ Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy.
⁴ Department of Psychiatry, Weill Cornell Medicine, White Plains, NY, United States.
⁵ Department of Psychiatry and Behavioral Health, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, United States.
⁶ Department of Psychiatry, University of Ottawa, Ontario, Canada; The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa Ontario; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
⁷ Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States; WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, Verona, Italy.
⁸ Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
⁹ WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, Verona, Italy.

PMID: 37769371
DOI: 10.1016/j.psychres.2023.115488

Abstract

Assessing and managing suicide behaviors is highly relevant to individuals with schizophrenia spectrum disorders. Our study aims to assess the association between adverse childhood experiences and suicidal behaviors in individuals with schizophrenia spectrum disorders. We included observational studies comparing the probability of suicide behaviors in adults with schizophrenia spectrum disorders exposed and unexposed to adverse childhood experiences. Odds ratio estimates were obtained by pooling data using a random-effects pairwise meta-analysis. Standardized criteria were used to assess the strength of the association of the pooled estimate. We found 21 eligible studies reporting outcomes for 6257 individuals from 11 countries. The primary outcome revealed an association between any suicidal behavior and adverse childhood experiences, which resulted "highly suggestive" according to validated Umbrella Criteria. Similarly, a positive association was confirmed for suicidal ideation and suicide attempt and for any subtype of adverse childhood experience. This meta-analysis showed that exposure to adverse childhood experiences strongly increases the probability of suicide behaviors in people with schizophrenia spectrum disorders.

Keywords: Childhood trauma; Schizophrenia; Suicide.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Adult
Adverse Childhood Experiences*
Humans
Probability
Schizophrenia*
Suicidal Ideation
Suicide, Attempted