Early trauma and lifetime suicidal behavior in a nationwide sample of Korean medical students

Abstract

Background: No previous study has investigated the association between early trauma and suicidal behavior in medical students. We evaluated the types of early trauma which are the most strongly associated with a lifetime history of suicidal behavior in medical students. Method: A total of 6986 medical students completed a self-administered questionnaire (response rates: 49.6% of the entire medical student body in Korea) which included lifetime suicidal behavior, stressors, and the Early Trauma Inventory Self Report-Short Form (ETISR-SF). This was used to evaluate the most serious forms of trauma experienced before the age of 18, including general trauma, physical, emotional and sexual abuse. Results: Among medical students, lifetime prevalence of suicidal behavior was 34.0% for those who experienced early trauma and 18.1% in those without a history of trauma (chi(2) = 215.7, p<0.0001). Emotional abuse exhibited a higher odds ratio for lifetime suicidal behavior (OR = 3.6, 95%CI = 2.9-4.4) than other traumas including general trauma (OR = 2.1,95%CI = 1.8-2.4), sexual (OR = 2.0, 95%CI = 1.5-2.8) or physical (OR = 1.8, 95%CI = 1.5-2.1) abuse, and current stressors including heavy stress (OR = 1.5, 95%CI = 1.4-1.8), poor physical health (OR = 1.3, 95%CI = 1.2-1.5), and poor economic status (OR = 1.2, 95%CI = 1.0-1.3). Emotional abuse also showed a higher odds ratio for lifetime suicidal ideation (OR = 3.5, 95%CI = 2.8-4.4), plan (OR = 3.9, 95%CI = 2.4-6.2), and attempt (OR = 4.1, 95%CI = 2.4-6.8) than other early traumas or stressors. In emotional abuse, a continuously cold or uncaring parental attitude exhibited a stronger association with lifetime suicidal behavior (OR = 4.5, 95%CI = 2.7-7.7) than other emotional abuse. Conclusion: Emotional abuse, especially continuous parental emotional abuse in childhood, is significantly associated with lifetime suicidal behavior in Korean medical students. (C) 2009 Elsevier B.V. All rights reserved.