The role of psychopathology in the relationship between history of maltreatment and suicide attempts among children and adolescent inpatients Baptiste Barbot 1,2 , Henry Eff 3 , Shira R. Weiss 4 & James B. McCarthy 3,5 1 Psychological Sciences Research Institute, Catholic University of Louvain, Louvain-la-Neuve, Belgium 2 Child Study Center, Yale University, New Haven, CT, USA 3 Department of Psychology, Pace University, New York City, NY, USA 4 Sagamore Children’s Psychiatric Center, Dix Hills, NY, USA 5 School of Psychology, Adelphi University, Garden City, NY, USA Background: This retrospective chart review study investigates the relationship between the history of various forms of abuse and the presence of mood disorders and psychotic symptoms in predicting suicide attempts among psychiatrically hospitalized children and adolescents. Method: A multi-mediation analysis was con- ducted with an archival dataset of 101 children and adolescents hospitalized predominantly for mood disor- ders and bipolar disorders with and without history of psychotic symptoms. Results: Results showed that history of suicide attempts was directly associated with physical abuse and indirectly associated with sexual abuse (mediated by bipolar disorders). Emotional abuse was also indirectly related to history of suicide attempts, mediated by mood disorders for boys, and by psychotic symptoms for girls. Conclusions: This study is among the first to differentiate the unique effects of different types of early maltreatment on psychopathol- ogy, particularly mood disorders and psychotic symptoms, and histories of suicide attempts in psychiatrically hospitalized children and youth. Key Practitioner Message • Little is known about the relationships between histories of maltreatment, psychopathology, and suicide (considered simultaneously) among hospitalized children and adolescents. • Different forms of abuse are associated with distinct psychopathology symptoms, and in turn, risk for sui- cide attempts. • Only physical abuse is directly related to a history of suicide attempts, while sexual and emotional abuse are indirectly related (mediated by mood disorders and psychotic symptoms). • These risk pathways are partly distinct for girls and boys. • Identifying unique and cumulated risk factors can help prevent suicidality among hospitalized youth. Keywords: Maltreatment; suicide; mood disorder; bipolar disorder; adolescence Introduction Suicide is one of the leading causes of death for children and adolescents (Cunningham, Walton, & Carter, 2018). Histories of suicide attempts—defined as a ‘nonfatal, self-directed, potentially injurious behavior with an intent to die as a result of the behavior even if the behav- ior does not result in injury’ (Klonsky, May, & Saffer, 2016; p. 309)—are strongly predictive of suicide deaths, and prevalent among samples of child and adolescent inpatients (e.g., Bromet et al., 2017). Although relation- ships between psychopathology and suicide attempts (Kelleher et al., 2012), maltreatment and psychopathol- ogy (Maniglio, 2013), and maltreatment and suicide attempts (Sachs-Ericsson, Stanley, Sheffler, Selby, & Joiner, 2017) are well documented, the contribution of both psychopathology and history of maltreatment in relation to suicide attempts has not been extensively explored, especially within child and adolescent clinical samples (Joiner et al., 2007). Psychopathology and suicidality Though there are multiple risk factors for suicide attempts in youth, the presence of psychiatric disorders, particu- larly mood disorders, appears to be a leading factor. An increased risk of suicidality is associated with depression, mixed mood states, mania, substance abuse, and anxiety disorders in children and adolescents (Halfon, Labelle, Cohen, Guil e, & Breton, 2013) while youth with psychotic symptoms have an even higher risk of suicidal ideation than those without psychotic symptoms (Ulloa et al., 2000). Both depressed adolescents and those with bipolar disorder are also more likely to attempt suicide if they experience psychotic symptoms (Caetano et al., 2006; Kelleher et al., 2012). Additionally, psychotic episodes can be highly associated with suicide attempts regardless of © 2020 Association for Child and Adolescent Mental Health Published by John Wiley & Sons Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main St, Malden, MA 02148, USA Child and Adolescent Mental Health Volume **, No. *, 2020, pp. **–** doi:10.1111/camh.12393