Models of Trauma Exposure, Depression, and Suicidality in Safety‐Net Primary Care

Suicidality is a major public health concern, particularly for low‐income, trauma‐exposed patients with limited access to mental health providers. However, limited research has modeled pathways of suicidality in safety‐net primary care samples. Patients (N = 207) in a safety‐net primary care clinic...

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Bibliographic Details
Published in:Journal of traumatic stress 2021-12, Vol.34 (6), p.1139-1148
Main Authors: Mladen, Samantha N., Williams, Allison B., Griffin, Sarah C., Perrin, Paul B., Rybarczyk, Bruce D.
Format: Article
Language:English
Subjects:
Adult
Depression - epidemiology
Female
Humans
Male
Mental depression
Primary care
Primary Health Care
Stress Disorders, Post-Traumatic - epidemiology
Suicidal Ideation
Suicide
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Summary:Suicidality is a major public health concern, particularly for low‐income, trauma‐exposed patients with limited access to mental health providers. However, limited research has modeled pathways of suicidality in safety‐net primary care samples. Patients (N = 207) in a safety‐net primary care clinic completed measures of childhood and adult trauma exposure, depression, and suicidality. Participants (M age = 44.8 years, SD = 11.6), were 60.4% male, 63.8% Black/African American, and predominantly low‐income (i.e., 69.1% reported an annual income less than $5,000 USD). Half of the sample reported at least four childhood traumatic events (M = 3.9 events, SD = 3.0) and approximately three adult traumatic events (M = 3.0 events, SD = 2.1). Most participants (82.1%) reported significant depressive symptoms, and 43.5% endorsed recent suicidality. Models showing the mediational effect of depression on the association between trauma exposure and suicidality, β = .20, B = 0.23, SE = 0.05, 95% CI [0.16, 0.32], and the moderational effect of trauma exposure on the association between depression and suicidality, β = .16, B = 0.20, SE = 0.08, p = .007, were both supported. These results underscore the high prevalence of trauma exposure, depression, and suicidality in a safety‐net primary care sample. They also highlight the pervasiveness and complexity of suicidality in low‐income primary care patients, emphasize the importance of trauma‐informed suicide assessment, and identify trauma sequelae and depression as potential treatment targets to reduce suicidality.
ISSN:0894-9867
1573-6598
DOI:10.1002/jts.22658