(PS5-86) Pathways to Suicidal Ideation: PTSD, Depression, and Their Interplay in Cambodian Women

Abstract Text: Suicidal ideation is a significant public health concern globally, with rates of suicide in low- and middle-income countries (LMICs) far exceeding those in other areas of the world. Despite this, little research on factors contributing to suicidal ideation in these regions has been completed, including heightened rates of trauma exposure and PTSD and potential cultural and social factors that may influence suicide-related stigma. In Cambodia, exposure to traumatic events is high due to the historical context of the Khmer Rouge, leading to a need to better understand outcomes of these exposures. In this context, delineating how PTSD and depression may contribute to suicidal ideation in this population will allow for better identification of intervention targets and will improve understanding of the developmental pathway of suicidal ideation in this population.

This research examines whether depression mediates the effects of PTSD on suicidal ideation in a sample of 343 Cambodian women. PTSD severity was measured using the PCL-5, depression was assessed using the PHQ-8, and suicidal ideation is measured using question 9 of the PHQ-9. Individuals who endorsed any level of suicidal ideation on this question were dichotomized as experiencing suicidal ideation, with 45.5% of the total sample categorized as experiencing suicidal ideation. In a mediated logistic regression, PTSD had a significant direct effect (b = 0.011, p < .001) on likelihood of endorsing suicidal ideation. When adding depression into the model, there was also a significant indirect effect of PTSD on likelihood of endorsing suicidal ideation through depression (b = 0.005, p = .026). The proportion mediated was 29% [CI: 22% - 57%], p = .026, indicating that 71% of the likelihood of experiencing suicidal ideation in this sample is explained by PTSD severity.

These results suggest that while both PTSD severity and depression play a significant role in the development of suicidal ideation in Cambodian women, PTSD severity appears to play a larger role than depression. These results add to growing literature regarding the deleterious impact that trauma and PTSD has on suicide risk and expands our understanding of how PTSD and depression may interact to contribute to suicidality. Moreover, it expands our knowledge in global regions such as Cambodia where trauma and PTSD are significantly elevated and provide targets for intervention that can reduce suicidal ideation.