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A 6-month supported online program for the treatment of persecutory delusions: Feeling Safer.
BACKGROUND: Based on an efficacious face-to-face theory-driven psychological therapy for persecutory delusions in the context of psychosis, we set out to develop a scalable guided 6-month online program. The aim was an intervention that patients can easily access and use, produces large clinical effects, and can be supported by a range of mental health professionals in less contact time than face-to-face therapy. We report here the proof-of-concept testing. At least moderate-sized clinical effects were required to progress to a randomized controlled trial (RCT). METHODS: In the 6-month Feeling Safer online program, a certified medical device, patients complete a brief assessment and then are provided with up to 10 modules that match their difficulties. Regular remote meetings with a mental health professional also take place. These may be supplemented by in-person visits. A pre- to post-treatment cohort trial was conducted with 14 patients with persistent persecutory delusions. The primary outcome was the Psychotic Symptoms Rating Scale (PSYRATS)-Delusions. RESULTS: Satisfaction and usability ratings of the program were high. Very large reductions in persecutory delusions were observed (PSYRATS mean reduction = 7.1, 95% C.I. = 3.4, 10.8, n = 13, Cohen's d = 3.0). There were large improvements in paranoia, anxiety, depression, agoraphobic distress, psychological wellbeing, meaningful activity, personal recovery, recovering quality of life, and moderate improvements in insomnia, agoraphobic avoidance, and quality of life. CONCLUSIONS: The clinical effects associated with Feeling Safer were very high, comparable to those seen in the evaluations of the face-to-face therapy, and enable progression to an RCT.
Interoceptive and exteroceptive pregnant bodily experiences and postnatal well-being: A network analysis
Objectives: Pregnancy involves rapid physical and physiological changes that may affect feelings towards the bodily experience. This experience, including body dissatisfaction and interoceptive sensibility, is linked to antenatal attachment and maternal mental health. However, the long-term relationships between pregnant bodily experiences and postnatal outcomes remain unknown. This study aimed to explore the complex relationships between the perinatal bodily experience and postnatal variables. Design: Longitudinal observational study using online surveys at three time points. Methods: Longitudinal data were collected at three time points, during pregnancy (N = 253), and 3 (N = 137) and 6 (N = 107) months postpartum. Pregnancy-validated measures assessed body dissatisfaction and interoception, alongside measures of postnatal bonding, maternal anxiety and depression, breastfeeding behaviours, and infant birth weight and development. A partial correlation graphical lasso network analysis was used to explore the relationships between the bodily experience and these postnatal variables. Results: Antenatal bodily experiences linked to postnatal anxiety, body dissatisfaction and interoceptive trust, with poorer postnatal experiences going on to correlate with higher anxiety, depression and breastfeeding rates at 3 months. Antenatal body weight dissatisfaction was linked to increased breastfeeding and depression, less trust in bodily signals and a lower quality mother-infant bond at 6 months postpartum. Conclusions: The findings underscore the importance of pregnant bodily experiences for maternal postnatal health and mother-infant bonding, helping to identify mothers at risk of poorer postnatal outcomes.
Single neurons and networks in the mouse claustrum integrate input from widespread cortical sources.
The claustrum is thought to be one of the most highly interconnected forebrain structures, but its organizing principles have yet to be fully explored at the level of single neurons. Here, we investigated the identity, connectivity, and activity of identified claustrum neurons in Mus musculus to understand how the structure's unique convergence of input and divergence of output support binding information streams. We found that neurons in the claustrum communicate with each other across efferent projection-defined modules which were differentially innervated by sensory and frontal cortical areas. Individual claustrum neurons were responsive to inputs from more than one cortical region in a cell-type and projection-specific manner, particularly between areas of frontal cortex. In vivo imaging of claustrum axons revealed responses to both unimodal and multimodal sensory stimuli. Finally, chronic claustrum silencing specifically reduced animals' sensitivity to multimodal stimuli. These findings support the view that the claustrum is a fundamentally integrative structure, consolidating information from around the cortex and redistributing it following local computations.
Temporal Network of Depressive Symptoms across College Students with Distinct Depressive Trajectories during the COVID-19 Pandemic.
BACKGROUND: There are marked differences in how individuals respond and adapt to depressive symptoms over time during the strain of public health emergencies; however, few studies have examined the interrelations between depressive symptoms in distinct depressive trajectories from the COVID-19 outbreak period to the COVID-19 control period. Therefore, this study conducted cross-lagged panel networks to investigate the temporal relationships between depressive symptoms across distinct depressive trajectories from the COVID-19 outbreak period (T1) to the COVID-19 control period (T2). METHODS: A total of 35,516 young participants from the College Students' Behavior and Health Cohort during the COVID-19 pandemic were included in the current study. Depressive symptoms were self-reported using the nine-item Patient Health Questionnaire. Unique longitudinal relationships between symptoms during the COVID-19 pandemic were estimated using a cross-lagged panel network. RESULTS: Longitudinal relationships across distinct depressive trajectories were unique during the COVID-19 pandemic. Specifically, suicidal ideation at T1 in the chronic- and delayed-dysfunction groups was most predictive of other symptoms at T2, whereas "sleep" at T1 in the recovery group and "lack of energy" at T1 in the resistance group may be strongly related to the remission of other depressive symptoms at T2. CONCLUSIONS: These exploratory findings demonstrate the directionality of relationships underlying individual symptoms in the youth and highlight suicidal ideation, sleep, and energy as potential influencers of other depressive symptoms across distinct depressive trajectories. Targeting those symptoms during the outbreak period of COVID 19 would theoretically have been beneficial in preventing and/or reducing the likelihood of spontaneous depression during the subsequent control period.
A comparative study of mental health status among left-behind, migrant, and local adolescents in China.
OBJECTIVE: Influence of migration on mental impairments among adolescents has been well assessed. However, there lack empirical data on multiple mental health problems and comparisons of children who suffer from different parental migration. This study aims to compare the mental health status among left-behind adolescents (LBA), migrant adolescents (MA), and local adolescents (LA). METHODS: A total of 67,532 adolescents were investigated on depression, anxiety, sleep disturbance, and psychotic-like experiences (PLEs). The LBA were registered in Shenzhen's hukou (household register system) and are living in Shenzhen while their parent(s) has/have migrated to work elsewhere for over 6 months. MA, defined as adolescents who immigrated with parents from other places, are living but not registered in Shenzhen hukou. LA referred to adolescents who were registered in Shenzhen hukou and are living with their parents. Social-demographics, family function, and school climate were also evaluated as influential factors. RESULTS: The prevalence of overall mental health problems was 37.4 % for LBA, which was higher than that of MA (27.9 %) and LA (27.1 %). Females, adolescents with chronic physical illness, and with family history of mental disorders are all contributed to the increased occurrence of mental health issues. Poorer family function and school climate were also negatively associated with mental health among the three types of adolescents. CONCLUSION: LBA is at a higher risk for poor mental health than other adolescents. Interventions that promoting family function and improving school climate may be helpful, especially for girls with chronic physical illness, or with family history of mental disorders.
Psychological resilience and posttraumatic growth in adolescent survivors of earthquake: A 10-year cohort study
This 10-year cohort study explored whether individual differences in resilience during early stages post-earthquake could have diverse impacts on future PTG and whether the impacts varied by sex. 1357 Chinese adolescent survivors of the Wenchuan earthquake were assessed on their resilience at 6-, 12-, 18-, and 24-months post-earthquake. 799 participants responded to an online survey 10 years later, and 744 of which provided useable data for subsequent analysis. Resilience trajectories were modeled using the latent class growth analysis. Linear regressions were used to test the predictive effects of different resilience trajectories on subsequent PTG. Of 744 samples (Mage=15.44, SD = 0.66 at baseline), 59.1% were females. Three trajectories of resilience were identified, including low resilience (19.8%), moderate resilience (58.7%), and high resilience (21.5%). Highly resilient participants reported greater PTG 10 years later (β = 0.12, 95%CI 0.60–6.08) after adjusting for demographic variables, earthquake exposure, negative life events, and mental health problems. Moreover, the same findings only existed in males (β = 0.22, 95%CI 1.26–11.01). Our findings highlight the importance of classifying survivors by resilience trajectories in order to better account for different implications on future PTG. Moreover, sex-specific programs are needed to provide tailored intervention.
Trajectories of mental health status during the early phase pandemic in China: A longitudinal study on adolescents living in the community with confirmed cases
Sufficient research reports that individuals living in the community with confirmed COVID-19 cases are more likely to exhibit poor mental health condition. However, little is known about the longitudinal trajectories of mental health status among these people who are exposed to increased risk of contracting COVID-19. Using a 3-wave longitudinal survey between February and June 2020, data has been collected from 2,352 adolescents living in the community with confirmed cases. Depressive/anxiety symptoms, soc-demographic, and other psychological factors of interest (e.g., social support) were measured. Using latent growth mixture modeling, we identified two subgroups (Resistance vs. Dysfunction) of adolescents based on their depressive and anxiety symptoms. More social support and positive coping are identified as protective factors for mental health, whereas higher level of negative coping predicts unfavorable outcomes. These findings suggested that adolescents living in the community with confirmed cases of COVID-19 are a group to which researchers should pay more attention when studying the impacts of quarantine on mental health. It is also crucial to emphasize the role of social support and positive coping in planning psychological interventions for adolescents.
Changes in suicidal ideation and related influential factors in college students during the COVID-19 lockdown in China
This study aims to investigate the patterns and predictors of suicidal ideation (SI) trajectories among college students during extended lockdowns in China. A three-wave survey was conducted during the outbreak period, remission period, and prevention period of COVID-19. Distinct patterns of SI trajectories were established by grouping respondents based on temporal changes in SI. Multivariate logistic regressions were performed to examine predictors for delay-occurrence and persistent SI. From a total of 35,516 college students included in the study, rates of SI increased significantly from T1 to T2 (7.3% v. 9.4%) and from T2 to T3 (9.4% v. 12.6%). Five SI trajectories were observed: resilient (80.5% of the sample), recovery (3.6%), relapsing/remitting (4.8%), persistent dysfunction (2.3%) and delayed dysfunction (8.7%). Further, junior-year undergraduates, postgraduates, only-child families, mental health history, confirmed cases in the community of residence, depressive symptoms, and negative coping strategies were significant predictors of distinct SI trajectories, whereas greater social support, more positive coping strategies, and better family functioning were associated with a lower probability of developing delayed or persistent dysfunction during the lockdown period. These findings suggest that continuous preventive and intervening measures for college students during COVID-19 lockdowns are of global importance, particularly among vulnerable groups who experience the most distress.
Resilience buffers the association between sleep disturbance and psychotic-like experiences in adolescents
Background: Sleep disturbance may cause psychotic-like experiences (PLEs). The present study aimed to exam their rate of co-occurrence and investigate whether resilience buffers the association. Methods: A total of 50,625 junior high school students were assessed using the self-compiled socio-demographics and sleep questionnaires, 8-item Positive Subscale of the Community Assessment of Psychic Experiences, 10-item Connor-Davidson Resilience Scale, Patient Health Questionnaire and Generalized Anxiety Disorder Questionnaire. Results: In this sample, 15.8% participants had frequent PLEs in the past month, where 40.1% exhibited comorbid sleep disturbance. Sleep disturbance positively associated with the onset of frequent PLEs, after adjusting for socio-demographics, depression and anxiety. Moderation analysis showed resilience buffers the association between sleep disturbance and PLEs, with a higher level of resilience, the positive effect of sleep disturbance on PLEs would be diminished to a greater extent. Conclusions: These findings suggested that early attention should be drawn to adolescents with sleep disturbance. Intervention strategies should be enhancing resilience, increasing sleep duration and improving sleep quality.
Current psychotic-like experiences among adolescents in China: Identifying risk and protective factors
Objective: This study aim to explore the prevalence of current PLEs over past month and relevant influential factors among adolescents. Methods: A total of 67,538 students completed one online survey between April 21st and May 12th, 2021. Current PLEs were assessed using the 8-item Positive Subscale of the Community Assessment of Psychic Experiences (CAPE-P8). Participants were defined as having frequent PLEs if they selected “often” or “nearly always” on one or more items of CAPE-P8. Family function, school climate and a series of socio-demographic were also evaluated. Results: In this sample, 49.3% adolescents reported having at least one PLE over the past month, while 15.4% experienced high frequent PLEs. Alcohol intake was positively associated with high frequent PLEs (OR = 2.61, 95% CI = 2.37–2.88). Adolescents with chronic physical illness (OR = 1.94, 95% CI = 1.73–2.18) or family history of psychiatric illness (OR = 2.61, 95% CI = 2.22–2.77) were more likely to suffer from high frequent PLEs. Dysfunction family function (OR moderate = 1.98, 95% CI = 1.98–2.09; OR severe = 6.98, 95% CI = 6.48–7.53) or poor school climate (OR = 3.14, 95% CI = 2.93–3.37) was associated with elevated high frequent PLEs. Conclusions: Several factors of socio-demographics, unhealthy lifestyle, family and school environments are found to be related to frequent PLEs. These factors should also be taken into consideration for effective psychosocial intervention in adolescents.
Cognitive processes in autism: Repetitive thinking in autistic versus non-autistic adults
Repetitive and restricted behaviours are a core feature of autism, and cognition in autistic individuals may also be repetitive and restricted. We aimed to investigate the relationship between repetitive behaviours and repetitive thinking. We predicted that autistic people would experience more repetitive, perseverative, visual and negative cognition than controls. We predicted that repetitive thinking would be associated with repetitive behaviours in the autistic participants. We recruited autistic (n = 54) and control (n = 66) participants who completed measures of insistence on sameness and obsessive-compulsive behaviours. Participants then took part in 5 days of descriptive experiencing sampling, recording their thoughts when a random alarm sounded. Consistent with our hypothesis, autistic participants reported more repetitive thinking. Contrary with our other hypotheses, autistic participants reported equivalent frequency of perseveration, visual thoughts and negative thoughts to non-autistic participants. Moreover, participants who reported more obsessive thinking reported more repetitive behaviour (insistence on sameness), but there was no such relationship between repetitive thinking and behaviour. Autistic participants who reported more repeated thoughts in the descriptive experience sampling had significantly lower obsessive thinking scores. We conclude that anxiety focused cognitions may drive insistence on sameness behaviours, and that the relationship between repetitive cognition and behaviour is complex and warrants further investigation. Lay abstract: A core feature of autism is the tendency to do the same activity or behaviour repetitively. We wanted to find out if autistic people also experience repetitive thinking, for example, having the same thoughts repeatedly. We thought that there would be a link between repetitive behaviour and repetitive thinking. We asked 54 autistic people and 66 non-autistic people to complete questionnaires measuring repetitive behaviours and obsessive thinking. Next, participants were trained by a researcher to record their thoughts using a structured paper form. They then completed 5 days of thought recording, which they did each time a random alarm sounded on their mobile phone. We found that autistic people had more repetitive thoughts than non-autistic people, but they did not report having more negative or visual thoughts compared with non-autistic people. Autistic people who had more repetitive thoughts during the 5 days of thought recording did not report more repetitive behaviour. However, autistic people who reported more obsessive thinking, for example, more negative and unwanted thoughts, also reported higher levels of repetitive behaviour. We conclude that some repetitive behaviours may be linked to anxiety and that more research is needed to better understand repetitive behaviours in autism.
The Moderating Role of Lifestyle on Insomnia in Home Quarantine College Students During the COVID-19 Epidemic
There has been sufficient evidence for the relationship between lifestyle and insomnia in the general population, but for individuals who already suffer from insomnia, it is not clear whether a healthy lifestyle can also pose similar benefits. The present study investigated the roles of different aspects of lifestyle in the development of individual insomnia by tracking insomnia symptoms of college students during the COVID-19 lock-down. Two surveys were conducted on 65,200 college students in the process of home isolation in Guangdong Province of China, at the pandemic outbreak period (T1) and the initial remission period (T2), respectively. Given the objectives of the present study, a total of 1,702 college students with clinical insomnia from T1 were selected as subjects. Insomnia symptoms were assessed using the Youth Self Rating Insomnia Scale (YSIS), while demographic information, epidemic exposure, and lifestyle were all measured by self-developed questionnaire, through network survey. The 1,702 college students (mean age ± standard deviation, 20.06 ± 1.46, range 16–25; 71.9% females) with insomnia symptoms were divided into three trajectory groups: recovery group, remission group, and chronic insomnia group according to their insomnia scores in T2 phase. The results showed that there was no significant difference in demographic backgrounds or epidemic exposure among the three groups, however, there were significant differences in food intake, exercise, and Internet use. The regression results further showed that both the recovery group and the remission group adopted more regular food intake than the chronic group. The recovery group exhibited better daily exercise habits than both the remission group and the chronic group. The duration of Internet use was significantly shorter for the recovery group than for the chronic group. These findings indicate a strong relationship between the lifestyle and the recovery of insomnia for college students isolated at home during the epidemic period. Significance of the different aspects of lifestyle on the recovery of insomnia are discussed.
An Exploration of Self-Reported Sleep Inertia Symptoms Using Network Analysis
Purpose: Sleep inertia (SI) is the transitional state accompanied by compromised cognitive and physical performance and sleepiness. Network analysis offers a potential new framework to conceptualize a complex network of symptom–symptom interactions, and the network structure is analyzed to reveal the core characteristics. However, no previous study examined the network structure of SI symptoms. Thus, this study aimed to elucidate characteristics and compare sex differences of SI symptom networks in the general population. Materials and Methods: A total of 1491 participants from China were recruited from 30 May to 17 June, 2021. SI symptoms were assessed by using the Sleep Inertia Questionnaire (SIQ). The network structures were estimated and compared using network analytic methods in the R version 4.1.1. Results: Centrality properties analysis of the expected influence suggested that symptoms of “Feel sleepy”, “Groggy, fuzzy or hazy mind”, and “Dread starting your day” exerted greatest influences. The weighted adjacency matrix revealed that the “Dread starting your day” and “Anxious about the upcoming day” edge showed the strongest connection (edge weight value = 0.70). The network comparison test found no significant difference in network global strength (p=0.928), distribution of edge weights (p=0.194) and individual edge weights (all p values >0.05 after Holm–Bonferroni corrections) between males and females. Conclusion: Symptoms of “Feel sleepy”, “Groggy, fuzzy or hazy mind”, and “Dread starting your day” were central in the SI symptom network. Intervention, such as the artificial dawn and change in body temperature, for symptoms of “Feel sleepy”, “Groggy, fuzzy or hazy mind”, and “Dread starting your day” might be crucial to hasten the dissipation of SI in the general population who may need to perform tasks upon waking.
Application of the Chinese version of the 11-item circadian-type inventory (CTI-11) in a working sample
This study revised the Chinese version of 11-item circadian-type inventory (CTI-11) and examined its validity and reliability in textile workers. 3833 workers were recruited to complete the Chinese version of CTI-11. The Composite Scale of Morningness (CSM) was used as the concurrent validity instrument. The exploratory factor analysis revealed that the Chinese version of CTI-11 consists of two factors: flexibility/rigidity (FR) and languid/vigorous (LV). The results of confirmatory factor analysis showed that CTI-11 has a good construct validity. Measurement invariance test indicated that the factor structure of CTI-11 is quite stable across gender and work shifts. FR and LV are significantly correlated with CSM, and LV can significantly predict insomnia. The Cronbach’s alpha coefficient of the two subscales were satisfactory. These findings indicated satisfactory psychometric properties of the Chinese version of CTI-11 in a working sample, with the implication that this scale is potentially a reliable assessment tool on individuals’ adaptability to shift work.
Insomnia and other sleep-related problems during the remission period of the COVID-19 pandemic: A large-scale survey among college students in China
This study aimed to evaluate the sleep-related problems and predictors of probable clinical insomnia among college students during the COVID-19 remission period in China. 146,102 college students from 22 colleges/universities in Guangdong province participated in this study from 1th to 15th June, 2020. Self-administered questionnaires were used to assess demographic characteristics. Sleep-related problems, depression and anxiety symptoms were measured by Youth Self-Rating Insomnia Scale, Patient Health Questionnaire-9 and Generalized Anxiety Disorder Scale-7, respectively. The prevalence of difficulty in initiating sleep, difficulty in maintaining sleep, early morning awakening, sleep insufficiency, unrefreshing sleep and daytime functioning impairment were 7.2%, 3.4%, 3.5%, 9.6%, 14.6%, and 7.6%, respectively. 16.9% students had varying degrees of insomnia and 6.3% were considered as displaying probable clinical insomnia. Moreover, being urban residents, having a history of physical or mental illness, and probable clinical depression or anxiety were significant risk factors of probable clinical insomnia, while college senior degree and 7-8 hours’ sleep duration per day was the protective factor for probable clinical insomnia. Unrefreshing sleep was the most prominent sleep problem among college students during COVID-19 remission in China. Good sleep hygiene practices are strongly suggested to develop in the time of prolonged home isolation.
Change patterns of sleep problems predict mental health problems among adolescents: a 10-year cohort study of Chinese Wenchuan earthquake
Background: The predictive effects of change patterns of sleep problems on mental health after a long-term disaster remain poorly known. We examined the change patterns of sleep problems after the Wenchuan earthquake, and tested whether specific sleep-related change patterns could predict mental health problems (posttraumatic stress disorder [PTSD], anxiety, and depression) in the 10 years after Wenchuan earthquake. Methods: 1357 adolescents exposed to the Wenchuan earthquake were surveyed on potential sleep problems at 18 months (T18m) and 30 months (T30m) post-earthquake. Among them, 799 participants completed the followed-up survey online 10 years after the earthquake (T10y). Since some participants did not provide sleep problems data at both T18m and T30m, 707 samples were included in final analyses. Linear regression analysis was performed. Results: Four different patterns of sleep problems were identified: stable-low pattern (61.1%), stable-high pattern (15.3%), decreasing pattern (13.2%), and increasing pattern (10.5%). Additionally, we found that individuals in stable-high and increasing patterns were more likely to experience PTSD, anxiety, and depression at T10y in the crude model. After controlling for confounders (e.g., earthquake exposure), these patterns were strongly predictive of depression at T10y. Limitations: Only two waves of sleep problems were collected and subjective sleep outcomes methods were used to collect data instead of objective methods. Conclusions: Sleep problems had heterogeneity after a deadly earthquake. Individuals in stable-high and increasing patterns should be given more attention. Timely assessment and targeted interventions on specific sleep problems are necessary for preventing an escalation of adverse mental health outcomes.
Is returning to school during the COVID-19 pandemic stressful? A study on immediate mental health status of Chinese college students
Background: As the COVID-19 pandemic has posed substantial impacts on individual's daily routine and psychological state. For the first time at great scale, Chinese college students had their educational activities moved online in spring 2020. Due to this unexpected isolation and unconventional learning method, their mental health following returning to school is worth investigating. Methods: Between June 1 and June 15, 2020, a total of 8,921 returning college students’ mental health status were assessed using instruments designed for psychiatric disorders, namely the 9-Item Patient Heath Questionnaire (PHQ-9), 7-Item Generalized Anxiety Disorder Scale (GAD-7), 6-Item Impact of Event Scale (IES-6), Youth Self Rating Insomnia Scale (YSIS), and self-developed questionnaire. Results: Our results showed that 8.7%, 4.2%, 10.5%, and 6.1% of the participants experienced depression, anxiety, acute stress, and insomnia, respectively, with a total of 19.8% reporting having at least one psychiatric symptom following their return to school. Sophomore and Senior year, and presence of previous psychiatric conditions contribute to the increased occurrence of psychiatric issues. The level of impact by COVID-19 on one's daily functioning is also positively associated with poor mental health. Conclusions: Our findings suggested no significant increase in the prevalence of psychiatric symptoms, following the first batch of students’ return to school. These findings aim to complement the current understanding of the psychiatric impact of COVID-19 on students and assist school principals to plan their return-to-school approaches in a mental-health sensitive way.
Prevalences of and correlations between childhood trauma and depressive symptoms, anxiety symptoms, and suicidal behavior among institutionalized adolescents in Vietnam
Objectives: We investigated the prevalence rates of childhood trauma, depressive symptoms, anxiety symptoms and suicidal behaviors among Vietnamese adolescents and compared the differences between institutionalized adolescents (IAs) and noninstitutionalized adolescents (NIAs). In addition, we examined the multidimensional associations between childhood trauma and psychopathology among IAs. Methods: Five hundred forty-six participants were recruited into two groups (IAs and NIAs) matched by age, sex and grade. They completed a childhood trauma questionnaire, depression scale, anxiety scale, and 3 suicide-related questions. The chi-squared test and logistic regressions were performed. Results: The prevalences of anxiety symptoms and suicide attempts among IAs was higher than that among NIAs (25.6 % vs 14.7 %, p = 0.001 and 8.1 vs 3.7, p = 0.03, respectively), while the prevalences of other psychopathologies did not differ significantly. In the IA group, high prevalences of victimization through physical abuse (22.3 %), emotional neglect (57.9 %), and physical neglect (72.9 %) were found, and 58.6 % of the participants had experienced more than one type of trauma. These figures were significantly higher in IAs than in NIAs. Depression and suicidal ideation were more strongly correlated with emotional abuse and neglect than other types of maltreatment, while anxiety, suicide planning and suicide attempts were more strongly correlated with physical abuse. IAs who experienced more than two categories of trauma or greater intensity of trauma were more susceptible to developing depression, anxiety, and suicidal behaviors. Conclusions: Childhood trauma was multidimensionally associated with adverse psychological outcomes. We suggest that various aspects of childhood trauma, as well as psychopathologies, must be routinely assessed.