International Psychogeriatrics: Childhood Trauma is Associated with Early-Onset but not Late-Onset Suicidal Behavior in Late-Life Depression

Traumatic early-life experiences—emotional, physical, or sexual abuse and/or neglect in childhood—can have an impact on cognitive, emotional, and neurodevelopmental processes years after the events occur, potentially leading to depression and suicidal behavior into adolescence and young adulthood. However, it is unclear whether this same relationship extends into late life. As older adults, especially those 85 and older, remain at the highest risk for death by suicide of any age group, investigators led by Katalin Szanto, MD (Professor of Psychiatry), examined the relationship between various types of childhood trauma and early and late-onset suicidal behavior among depressed older adults.

The scientists recruited 224 individuals ages 50 and older into the Longitudinal Research Program for Late Life Suicide. Study participants were recruited into one of four groups: 1) depressed suicide attempters, 2) depressed suicide ideators, 3) a non-suicidal depressed comparison group, and 4) a non-psychiatric comparison group, and assessed for history of childhood trauma, cognitive dysfunction, and suicide history (including the age of first suicide attempt). Dr. Szanto and her team used univariate analyses to compare these attempter groups to each other and each comparison group on childhood trauma.

Results of the study, published in International Psychogeriatrics, revealed that early-onset attempters (older suicide attempters with their first incidence of suicidal behavior early in life whilst still being suicidal into late life) had higher levels of overall childhood trauma, and a higher likelihood of having at least one trauma and multiple traumas, than all other groups. Early-onset attempters also experienced more emotional abuse and neglect and physical neglect than late-onset attempters, whereas late-onset attempters (those who do not make their first attempt until late life) had similar levels of these forms of childhood trauma as non-attempter comparison groups. 

“Recently, our group has examined age of onset of suicidal behavior to tease apart the phenotypic heterogeneity in older attempters’ variable life trajectories. We found that early-onset attempters — even as older adults — display risk factors (familial/social exposure to suicidal behavior, childhood trauma, impulsivity, maladaptive personality traits, longstanding interpersonal difficulties, and legal problems), that are identified in younger attempters. They also have similar comorbidity, including higher prevalence of current and lifetime post-traumatic stress disorder, and earlier onset of depression than late-onset attempters. They were also more likely to have multiple suicide attempts,” said Dr. Szanto, the study’s senior author.

“Conversely, late-onset attempters show different personality traits and are largely indistinguishable from non-suicidal depressed participants with the exception of cognitive functioning, possibly marking a dementia prodrome. Age at first suicide attempt appears to be a promising way to subgroup participants given the consistent differential risk factors for attempt we are seeing in these populations. It can be considered a proxy for differences in life trajectories by enabling the differentiation of attempters who have experienced lifelong social hardships and mental health challenges from those whose suicide risk only arose later in life,” said Dr. Szanto.

Childhood trauma is associated with early-onset but not late-onset suicidal behavior in late-life depression
Chang Y, Buerke M, Galfalvy H, Szanto K. 
International Psychogeriatrics, 1-14. doi:10.1017/S1041610223000662