[Childhood trauma and suicidality in bipolar disorder: The mediatory role of impulsivity].

Childhood trauma (CT) is correlated with suicidality among patients with bipolar disorder (BD). However, it has not been adequately investigated if a third factor, for instance impulsivity, mediates the effect of CT on suicidality in BD. This study aimed to explore potential mediatory effects of impulsivity in the pathway from CT to suicidality in BD. CT was assessed with the Early Trauma Inventory Self Report-Short Form (ETI-SR-SF), impulsivity with the Barratt Impulsivity Scale-11 (BIS-11) while lifetime suicidality was investigated with the Suicidal Behaviors Questionnaire-Revised (SBQ-R). The effect of childhood trauma on suicidality and impulsivity as well as the effect of impulsivity on suicidality were examined with multiple linear regressions, including gender, age and diagnosis (BD-I, BD-II) as covariates. Structural equation models were built and path analyses were performed (with AMOS 25 software and using bootstrapping in 1000 samples) for the examination of the mediatory role of BIS-11 and its subtypes in the effect of childhood trauma and its subtypes on suicidality. We included 78 BD euthymic patients (60.3% female, 67.9% BD-I). ETI-SR-SF significantly predicted SBQ-R (p=0.004) and BIS-11 (p<0.001), while BIS-11 significantly predicted SBQ-R (p=0.001). In a model including ETI-SR-SF and BIS dimensions, only ETISR-SF physical abuse (p=0.012) and BIS attentional (p<0.001) subscales significantly predicted SBQ-R. In structural equation models, the indirect effect of childhood trauma on suicidality via impulsivity was significant (p=0.003) while the direct effect of childhood trauma on suicidality was non-significant (complete mediation of the effect of childhood trauma on suicidality via impulsivity). In specific, both the indirect effect of physical abuse on suicidality via attentional impulsivity (p=0.002) and the direct effect of physical abuse on suicidality (p=0.013) were statistically significant (partial mediation of the effect of physical abuse on suicidality via attentional impulsivity). Childhood trauma predicts suicidality and impulsivity, while impulsivity predicts suicidality. More specifically, physical abuse and attentional impulsivity predict suicidality. The mediatory role of impulsivity completely explained the effect of childhood trauma on suicidality. Moreover, attentional impulsivity partially mediated the effect of physical abuse on suicidality. Therefore, management of impulsivity and especially of attentional impulsivity is crucial for the prevention and management of suicidality among BD patients with a history of childhood trauma.