Early wounds, minds in training: childhood adversity and the mediating effect of psychological distress in suicidal risk among medical students
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Childhood adversity is a well-established distal determinant of suicide risk, yet the proximal psychological mechanisms linking it to suicidal vulnerability during medical training remain poorly understood. Objective To examine whether depressive symptoms, anxiety symptoms, and perceived academic stress mediate the association between childhood emotional and physical maltreatment with suicide risk among medical students. Methods This cross-sectional study included 670 second year medical students from a large public university in Mexico, assessed with validated measures of childhood maltreatment (CTQ-SF), depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), academic stress (SISCO Inventory), and suicide risk (Plutchik Suicide Risk Scale). Group comparisons used chi-square and independent-samples t tests; parallel multiple mediation analyses were conducted using PROCESS (Model 4) with 5,000 bias-corrected bootstrap resamples. Results Overall, 26.0% of students were classified at high suicide risk (Plutchik score ≥ 6). Compared with low-risk students, those at high risk reported greater childhood emotional and physical maltreatment, more severe depressive and anxiety symptoms, and higher academic stress. Parallel mediation analyses showed significant indirect effects of both emotional and physical maltreatment on suicide risk through psychological distress, with bootstrap 95% confidence intervals excluding zero. All three specific indirect pathways through depressive symptoms, anxiety symptoms, and academic stress were statistically significant in both models, with depressive symptoms showing the largest specific indirect effects [emotional: B = 0.08, 95% CI (0.06, 0.10); physical: B = 0.12, 95% CI (0.08, 0.16)]. Conclusions Depressive symptoms, anxiety symptoms, and academic stress partially mediate the association between childhood maltreatment and suicide risk among medical students. These findings identify psychological distress as a clinically relevant and potentially modifiable pathway linking early adversity to suicide risk and support trauma-informed prevention strategies that integrate early detection and management of psychological distress within medical education.
Source: Frontiers in Psychology
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223133533