Child maltreatment profiles differentially predict lifetime but not acute suicidality in high-risk disorders

Background

Child maltreatment (CM) is a major transdiagnostic risk factor for suicidal ideation and behaviour (SIB). However, CM is heterogeneous, which traditional severity scores insufficiently capture, and its differential relevance for lifetime versus acute suicidality remains poorly understood. While developmental models emphasize long-term vulnerability, it is unclear whether specific CM patterns also influence acute clinical states and treatment outcomes. We applied a data-driven CM profiling approach to examine associations with lifetime and acute SIB as well as symptom trajectories during inpatient psychotherapy in a high-risk clinical sample.

Methods

In this observational cohort study, 240 adults with persistent depressive disorder (PDD; 57.5%) or borderline personality disorder (BPD; 42.5%) underwent a standardized 10-week inpatient psychotherapy program (Cognitive Behavioural Analysis System of Psychotherapy, CBASP for PDD or Dialectical Behavioural Therapy, DBT for BPD). CM profiles were derived using hierarchical clustering of Childhood Trauma Questionnaire subscales, yielding seven distinct profiles. Lifetime and acute SIB were assessed using the Columbia–Suicide Severity Rating Scale. Associations between CM profiles and SIB were analysed using regression models, and symptom trajectories during treatment were examined using mixed-effects models.

Results

Seven CM profiles reflected heterogeneous patterns of adversity exposure. A profile characterized by combined emotional neglect and physical and emotional abuse (cluster type 6) showed markedly elevated lifetime suicidality. Specifically, 66.7% of individuals in this profile reported active suicidal ideation with plan and intent compared to 28.6% in a minimal CM profile, and 74.1% reported suicide attempts compared to 24.5% in minimal CM. This translated into substantially increased odds for potentially lethal suicide attempts (OR = 8.8, pFDR = .002) and active suicidal ideation with plan and intent (OR = 5.0, pFDR = .038). In contrast, CM profiles were not associated with acute SIB at baseline or post-treatment. Across psychotherapy, both CBASP and DBT were associated with significant reductions in SIB, with suicidal behaviour nearly absent post-treatment (97.4% without suicidal behaviours), and no differential effects across CM profiles. Differential symptom trajectories by CM profile were observed for depressive symptoms following CBASP (time × cluster interaction: F = 2.82, p = .013), whereas no such differences were found for borderline symptoms following DBT.

Discussion

These findings demonstrate a clear dissociation between distal developmental risk and proximal clinical states: CM profiles robustly stratified lifetime SIB risk but did not predict acute suicidality or their changes during treatment. This suggests that CM-informed risk stratification may be particularly relevant for identifying long-term vulnerability rather than guiding acute clinical decision-making. The observed heterogeneity in depressive symptom trajectories following CBASP further indicates potential relevance for treatment personalization in PDD. However, given the observational design, limited subgroup sizes, and data-driven clustering approach, findings should be interpreted as exploratory. Replication in larger and prospective samples is required to establish the clinical utility of CM profiling for precision psychiatry approaches in high-risk populations.

References

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