The effect of cumulative trauma load on suicide risk and thoughts in trauma-exposed youth over two years

Trauma exposure has been linked to increased risk for suicide, a leading cause of death among youth. To date, most research identifying trauma as a risk factor for suicidality has been based on cross-sectional studies. To understand if trauma confers prospective risk for suicidality, this study used two-year longitudinal data from youth with trauma histories enrolled in the Texas Childhood Trauma Research Network. We analyzed data from 2606 youth assessed at baseline, including 1252 with two-year follow-up data. Analyses included youth with and without Criterion A trauma. Linear mixed effect models were estimated to disentangle the effects of trauma on between- and within-subject changes in two dimensions of suicidality, Propensity for Suicide and Suicidal Thoughts. Results demonstrated evidence for small between-person effects of cumulative trauma load and Propensity for Suicide (Posterior Median [Mdn.] = 0.16, SD = 0.03, adjusted p < .001) and Suicidal Thoughts (Mdn. = 0.10, SD = 0.03, adjusted p < .001). Unexpectedly, there was also evidence for a negative within-person effect of cumulative trauma load changes on Propensity for Suicide, with the effect falling below the threshold for a small effect (Mdn. = -0.04, SD = 0.01, adjusted p = .012). Sensitivity analyses indicated that unintentional trauma exposure may have driven the within-person effect, whereas unintentional trauma and interpersonal trauma exposure consistently demonstrated positive between-person effects. These findings demonstrate the long-term impact of trauma exposure on increased risk for suicide and suicidal thoughts in youth. Clinical implications for reducing suicidality risk in trauma-exposed youth are discussed.