Childhood trauma and suicide risk in schizophrenia inpatients: the sequential mediating roles of COVID-19 related psychological impact, sleep quality, and emotional distress

Purpose The stressful global situation due to the COVID-19 pandemic has had a tremendous impact on mental health in hospitalized patients with schizophrenia. The mediating roles of psychological impacts related to COVID-19 sleep quality and emotional distress were investigated in the association between childhood trauma and suicide risk in inpatients with schizophrenia. Methods A total of 270 participants, including 125 in-patients with schizophrenia and 145 healthy controls (HCs) were enrolled. Childhood trauma, psychological impact related to COVID-19, global sleep quality, and psychological distress were measured using the Childhood Trauma Questionnaires (CTQ), Impact of Event Scale-Revised (IES-R), Pittsburgh Sleep Quality Index (PSQI), and Depression, Anxiety and Stress Scale (DASS-21), respectively. Results The total score and subtype scores of CTQ and the mean scores of the IES-R, PSQI, and DASS-21 in patients with schizophrenia were higher than those in HCs (all p < 0.001). Hierarchical linear regression analyses showed that a history of childhood trauma or schizophrenia was a good predictor of psychological impact, global sleep quality, and emotional distress (all p < 0.01). Moreover, the chain mediation model showed that the effect of childhood trauma on suicide risk in hospitalized patients with schizophrenia was totally sequentially mediated by thepsychological impact of COVID-19, sleep quality, and emotional distress. Conclusions It is important for clinicians to recognize the increased suicide risk associated with COVID-19-related psychological distress in patients with schizophrenia with a history of childhood trauma.