Early wounds, minds in training: childhood adversity and the mediating effect of psychological distress in suicidal risk among medical students
- 1Departamento de Genética, Dirección y Subdirección de Investigaciones Biomédicas en Salud Mental, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
- 2Laboratorio de Epidemiología Clínica, Dirección y Subdirección de Investigaciones Biomédicas en Salud Mental, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
- 3Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
Abstract
Background: Childhood adversity is a well-established distal determinant of suicide risk, yet the proximal psychological mechanisms linking it to suicidal vulnerability during medical training remain poorly understood.
Objective: To examine whether depressive symptoms, anxiety symptoms, and perceived academic stress mediate the association between childhood emotional and physical maltreatment with suicide risk among medical students.
Methods: This cross-sectional study included 670 second year medical students from a large public university in Mexico, assessed with validated measures of childhood maltreatment (CTQ-SF), depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), academic stress (SISCO Inventory), and suicide risk (Plutchik Suicide Risk Scale). Group comparisons used chi-square and independent-samples t tests; parallel multiple mediation analyses were conducted using PROCESS (Model 4) with 5,000 bias-corrected bootstrap resamples.
Results: Overall, 26.0% of students were classified at high suicide risk (Plutchik score ≥ 6). Compared with low-risk students, those at high risk reported greater childhood emotional and physical maltreatment, more severe depressive and anxiety symptoms, and higher academic stress. Parallel mediation analyses showed significant indirect effects of both emotional and physical maltreatment on suicide risk through psychological distress, with bootstrap 95% confidence intervals excluding zero. All three specific indirect pathways through depressive symptoms, anxiety symptoms, and academic stress were statistically significant in both models, with depressive symptoms showing the largest specific indirect effects [emotional: B = 0.08, 95% CI (0.06, 0.10); physical: B = 0.12, 95% CI (0.08, 0.16)].
Conclusions: Depressive symptoms, anxiety symptoms, and academic stress partially mediate the association between childhood maltreatment and suicide risk among medical students. These findings identify psychological distress as a clinically relevant and potentially modifiable pathway linking early adversity to suicide risk and support trauma-informed prevention strategies that integrate early detection and management of psychological distress within medical education.
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BibTeX
@article{martinezlevy2026early,
title = {{Early wounds, minds in training: childhood adversity and the mediating effect of psychological distress in suicidal risk among medical students}},
author = {Gabriela A. Martínez-Levy and Ana Fresán-Orellana and Magdalena Briones-Velasco and Pedro G. Romero-Silva and Diana P. Guizar-Sánchez},
journal = {Frontiers in Psychology},
year = {2026},
month = oct,
doi = {10.3389/fpsyg.2026.1970728},
url = {https://doi.org/10.3389/fpsyg.2026.1970728},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Early wounds, minds in training: childhood adversity and the mediating effect of psychological distress in suicidal risk among medical students
AU - Gabriela A. Martínez-Levy
AU - Ana Fresán-Orellana
AU - Magdalena Briones-Velasco
AU - Pedro G. Romero-Silva
AU - Diana P. Guizar-Sánchez
PY - 2026
DA - 2026/10/21
JO - Frontiers in Psychology
DO - 10.3389/fpsyg.2026.1970728
UR - https://doi.org/10.3389/fpsyg.2026.1970728
AB - Background: Childhood adversity is a well-established distal determinant of suicide risk, yet the proximal psychological mechanisms linking it to suicidal vulnerability during medical training remain poorly understood. Objective: To examine whether depressive symptoms, anxiety symptoms, and perceived academic stress mediate the association between childhood emotional and physical maltreatment with suicide risk among medical students. Methods: This cross-sectional study included 670 second year medical students from a large public university in Mexico, assessed with validated measures of childhood maltreatment (CTQ-SF), depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), academic stress (SISCO Inventory), and suicide risk (Plutchik Suicide Risk Scale). Group comparisons used chi-square and independent-samples t tests; parallel multiple mediation analyses were conducted using PROCESS (Model 4) with 5,000 bias-corrected bootstrap resamples. Results: Overall, 26.0% of students were classified at high suicide risk (Plutchik score ≥ 6). Compared with low-risk students, those at high risk reported greater childhood emotional and physical maltreatment, more severe depressive and anxiety symptoms, and higher academic stress. Parallel mediation analyses showed significant indirect effects of both emotional and physical maltreatment on suicide risk through psychological distress, with bootstrap 95% confidence intervals excluding zero. All three specific indirect pathways through depressive symptoms, anxiety symptoms, and academic stress were statistically significant in both models, with depressive symptoms showing the largest specific indirect effects [emotional: B = 0.08, 95% CI (0.06, 0.10); physical: B = 0.12, 95% CI (0.08, 0.16)]. Conclusions: Depressive symptoms, anxiety symptoms, and academic stress partially mediate the association between childhood maltreatment and suicide risk among medical students. These findings identify psychological distress as a clinically relevant and potentially modifiable pathway linking early adversity to suicide risk and support trauma-informed prevention strategies that integrate early detection and management of psychological distress within medical education.
SN - 1664-1078
ER -