The influence of childhood trauma on the onset and repetition of suicidal behavior: An investigation in a high risk sample of male prisoners Laura Mandelli a , Vladimir Carli b, c , Alec Roy d , Alessandro Serretti a , Marco Sarchiapone b, * a Institute of Psychiatry, University of Bologna, Bologna, Italy b Department of Health Sciences, University of Molise, Campobasso, Italy c National Prevention of Suicide and Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden d Veterans Affairs Medical Center, Psychiatry Service, East Orange, NJ 07018, USA article info Article history: Received 25 May 2010 Received in revised form 26 October 2010 Accepted 3 November 2010 Keywords: Childhood Trauma Suicide attempt Suicide onset Suicide repetition Prisoners abstract Background and Aims: Childhood trauma is a well recognized risk factor for attempting suicide. However, its relationship to the age of onset of first suicide attempt and the repetition of attempts has been little studied. Methods: One thousand five hundred and fifty-three prisoners underwent a psychiatric interview which included the Brown-Goodwin Lifetime History of Aggression (BGHA) interview. The prisoners completed the Childhood Trauma Questionnaire (CTQ) and the Buss-Durkee Hostility Inventory (BDHI). Results: Two hundred prisoners (12.9%) had a history of attempting suicide. Subjects who had attempted suicide had significantly higher CTQ scores than subjects who had never attempted. Childhood traumas were also significantly associated with the early onset of suicidal behavior, while repeated attempts were predicted by sexual abuse only. Early suicidal behavior was further associated with young age, psychiatric disease, aggressive traits and violent behavior. Early age at onset of suicidal behavior was also associated with repetition of suicide attempts. Repetition of suicide attempt was further associated with other self- injurious behaviors (self-harm). Conclusions: These results confirm that a history of attempting suicide is frequent among prisoners. Childhood trauma is a risk factor not only for suicidal behavior but also for its early onset as is having a psychiatric disorder and aggressive traits. Sexual abuse may increase the risk for multiple attempts, which strongly correlated with age at onset and other self-harm behaviors. Ó 2010 Published by Elsevier Ltd. 1. Introduction Childhood trauma has emerged as a strong and independent risk factor for suicidal behavior (Browne and Finkelhor, 1986; Santa Mina and Gallop, 1998; Sarchiapone et al., 2009b). The association between childhood trauma and increased risk of suicidal behavior has been observed in both general population and clinical samples. For example, results from both the Epidemiologic Catchment Area (ECA) Study and the US National Comorbidity Survey demonstrated a strong association between childhood sexual abuse and suicidal behavior (Davidson et al., 1996; Molnar et al., 2001). Similarly, an Australian community study of twins found that a history of childhood trauma significantly increased the risk of a suicide attempt (Nelson et al., 2002). Clinical studies have also reported that childhood trauma is associated with suicide attempt in patients with various psychiatric disorders (Brodsky and Stanley, 2008; Roy, 2005; Sarchiapone et al., 2007). The importance of childhood trauma as a risk factor for suicidal behavior is further shown by recent data from the US National Comorbidity Survey Replication (Afifi et al., 2008). From that study, Afifi et al. reported that exposure to childhood physical abuse, sexual abuse or wit- nessing domestic violence accounts for 16% and 50% of suicidal ideation and attempts, respectively, among women and 21% and 33% of ideation and attempts among men. In prisoners, high rates of childhood trauma have been reported (Collins and Bailey, 1990). For example, Driessen et al. (2006) administered the Childhood Trauma Questionnaire (CTQ) to 139 German prisoners and reported the presence of at least one type of moderate to severe childhood trauma in more than 50% of the prisoners. Prisoners also have a higher risk of attempting suicide, committing suicide and having suicidal ideation as compared to community individuals (Fazel and Danesh, 2002). Moreover, * Corresponding author. Tel.: þ39 320 4795630. E-mail address: marco.sarchiapone@gmail.com (M. Sarchiapone). Contents lists available at ScienceDirect Journal of Psychiatric Research journal homepage: www.elsevier.com/locate/psychires 0022-3956/$ e see front matter Ó 2010 Published by Elsevier Ltd. doi:10.1016/j.jpsychires.2010.11.005 Journal of Psychiatric Research 45 (2011) 742e747