Trauma Exposure Moderates the Link Between Cognitive Flexibility and Suicide Risk in Pre-Adolescent Children

Abstract

Objectives

Trauma exposure (TE) and cognitive flexibility (CF) are risk factors for self-injurious thoughts and behaviors (SITBs). However, it is unknown whether these risk factors contribute to mechanisms associated with distinct categories of SITBs. The current study examined the potential moderating role of TE in the relationships between CF and multiple SITBs, including active suicidal ideation (SI), passive SI, non-suicidal self-injury (NSSI), and history of suicide attempt (SA), among pre-adolescent children.

Methods

A total of 11,326 children from the Adolescent Brain Cognitive Development study were included in the present study. SITBs and TE were measured by the Kiddy Schedule for Affective Disorder and Schizophrenia (KSADS). CF was measured using the NIH Cognitive Toolbox.

Results

Cumulative TE moderated the relationship of CF to active SI. Higher CF was associated with lower odds of current SI in children with a single lifetime TE, but not in children without trauma or with two or more TE. As a main effect, two or more TE predicted higher odds of active SI, passive SI, and lifetime SA, but not NSSI. Higher CF was associated with lower odds of passive SI, with effects not moderated by trauma exposure.

Conclusion

The current results clarify previously inconsistent findings about the relationship of CF to SI by identifying cumulative TE as a moderator. CF served as a protective factor against SI, but only in children with a single lifetime trauma. Implications for screening and treatment targets of children at risk for distinct categories of SITBs are discussed.

Keywords:

• Children
• cognitive flexibility
• non-suicidal self-injury
• suicidal ideation
• trauma exposure

ACKNOWLEDGMENTS

Preparation of this article was supported by a Focused Projects Award for Junior Investigators from the American Academy of Sleep Medicine Foundation (to CFC) and a Trainee Innovator Grant from the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Data used in the preparation of this article were obtained from the Adolescent Brain Cognitive Development (ABCD) Study (https://abcdstudy.org) from the NIMH Data Archive (NDA).

A listing of participating sites and a complete listing of the study investigators can be found at https://abcdstudy.org/consortium_members/. ABCD consortium investigators designed and implemented the study and/or provided data but did not participate in the analysis or writing of this study. This manuscript reflects the views of the authors and may not reflect the opinions or views of the NIH or ABCD consortium investigators.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The ABCD Study is supported by the National Institutes of Health and additional federal partners under award numbers U01DA041048, U01DA050989, U01DA051016, U01DA041022, U01DA051018, U01DA051037, U01DA050987, U01DA041174, U01DA041106, U01DA041117, U01DA041028, U01DA041134, U01DA050988, U01DA051039, U01DA041156, U01DA041025, U01DA041120, U01DA051038, U01DA041148, U01DA041093, U01DA041089, U24DA041123, and U24DA041147.

Notes on contributors

Shou En Chen

Shou En Chen, M.A., Christina F. Chick, and Ruth O’Hara, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.

Christina F. Chick

Shou En Chen, M.A., Christina F. Chick, and Ruth O’Hara, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.

Ruth O’Hara

Shou En Chen, M.A., Christina F. Chick, and Ruth O’Hara, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.