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Background <p>Childhood emotional abuse (EA) and emotional neglect (EN) are frequent in patients with schizophrenia and may worsen illness course and complicate management. However, evidence from North African outpatient settings remains limited. We aimed to estimate the frequency of EA and EN among outpatients with schizophrenia in southern Tunisia and to examine their associations with clinical characteristics and suicidal risk.</p> Methods <p>We conducted a cross-sectional study among outpatients with schizophrenia at Gabes University Hospital between July and December 2024. EA and EN were assessed using the emotional subscales of the Childhood Trauma Questionnaire–Short Form (CTQ-SF). Suicidal risk was measured with the Suicidal Behaviors Questionnaire–Revised (SBQ-R); high suicidal risk was defined as SBQ-<i>R</i> ≥ 8. EA and EN were analyzed as severity categories and continuous scores, and were dichotomized into none-to-mild versus moderate-to-severe exposure. Clinical correlates of moderate-to-severe EA and EN, as well as associations with high suicidal risk and recurrence of attempts among attempters, were examined using modified Poisson regression with robust standard errors to estimate prevalence ratios (PRs). Given the limited number of high-risk cases, adjusted suicidality models were kept parsimonious and were considered exploratory. Discrimination for high suicidal risk was assessed using receiver operating characteristic (ROC) analyses.</p> Results <p>Seventy-six participants were included (mean age 44.7 years; 64.5% men, <i>n</i> = 49). Moderate-to-severe EN was reported by 19.7% (<i>n</i> = 15) and moderate-to-severe EA by 14.5% (<i>n</i> = 11). In multivariable models, both EA and EN were independently associated with older age, current psychoactive substance use, the presence of psychiatric comorbidity, and greater treatment burden, including longer cumulative hospitalization and more frequent admissions; EA was additionally associated with earlier symptom onset (PR 1.05 per year earlier; 95% CI 1.01–1.11). High suicidal risk was present in 11.8% (<i>n</i> = 9), and 22.7% (<i>n</i> = 17) reported at least one lifetime suicide attempt. High suicidal risk was more frequent in the moderate-to-severe EA group than in the none-to-mild EA group, and EA scores were higher in the high-risk group than in the lower-risk group (mean 13.56 vs. 7.58; <i>p</i> = 0.0003). In robust Poisson models including both maltreatment dimensions, moderate-to-severe EA was associated with high suicidal risk (PR 5.26; 95% CI 1.51–18.34) and EA standardized scores were similarly associated (PR 2.03 per 1 SD; 95% CI 1.29–3.18), whereas EN was not. ROC analyses favored EA (AUC 0.864; cutoff 9) over EN (AUC 0.666; cutoff 11). Among attempters (<i>n</i> = 17), moderate-to-severe EA was associated with recurrent attempts (PR 5.77; 95% CI 1.68–19.81; <i>p</i> = 0.005), whereas EN was not.</p> Conclusion <p>In this outpatient schizophrenia sample in Tunisia, EA and EN were both linked to greater clinical burden, but only EA showed consistent associations with suicidal risk and recurrence of attempts. EA screening could contribute to risk stratification, pending validation in larger prospective samples.</p>

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Childhood emotional neglect and abuse and their clinical and suicidal correlates in schizophrenia: evidence from an outpatient Tunisian sample

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  • 发表日期：

    2026年1月23日

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  • Benali Jinen,
  • Kerkeni Ali,
  • Abbes Wafa,
  • Kerkeni Hajer,
  • Hajji Hazem,
  • Beji Mayssa,
  • Kolsi Safa,
  • Bouaziz Amal,
  • Medhaffar Khawla,
  • Zitoun Khalifa

摘要

Background

Childhood emotional abuse (EA) and emotional neglect (EN) are frequent in patients with schizophrenia and may worsen illness course and complicate management. However, evidence from North African outpatient settings remains limited. We aimed to estimate the frequency of EA and EN among outpatients with schizophrenia in southern Tunisia and to examine their associations with clinical characteristics and suicidal risk.

Methods

We conducted a cross-sectional study among outpatients with schizophrenia at Gabes University Hospital between July and December 2024. EA and EN were assessed using the emotional subscales of the Childhood Trauma Questionnaire–Short Form (CTQ-SF). Suicidal risk was measured with the Suicidal Behaviors Questionnaire–Revised (SBQ-R); high suicidal risk was defined as SBQ-R ≥ 8. EA and EN were analyzed as severity categories and continuous scores, and were dichotomized into none-to-mild versus moderate-to-severe exposure. Clinical correlates of moderate-to-severe EA and EN, as well as associations with high suicidal risk and recurrence of attempts among attempters, were examined using modified Poisson regression with robust standard errors to estimate prevalence ratios (PRs). Given the limited number of high-risk cases, adjusted suicidality models were kept parsimonious and were considered exploratory. Discrimination for high suicidal risk was assessed using receiver operating characteristic (ROC) analyses.

Results

Seventy-six participants were included (mean age 44.7 years; 64.5% men, n = 49). Moderate-to-severe EN was reported by 19.7% (n = 15) and moderate-to-severe EA by 14.5% (n = 11). In multivariable models, both EA and EN were independently associated with older age, current psychoactive substance use, the presence of psychiatric comorbidity, and greater treatment burden, including longer cumulative hospitalization and more frequent admissions; EA was additionally associated with earlier symptom onset (PR 1.05 per year earlier; 95% CI 1.01–1.11). High suicidal risk was present in 11.8% (n = 9), and 22.7% (n = 17) reported at least one lifetime suicide attempt. High suicidal risk was more frequent in the moderate-to-severe EA group than in the none-to-mild EA group, and EA scores were higher in the high-risk group than in the lower-risk group (mean 13.56 vs. 7.58; p = 0.0003). In robust Poisson models including both maltreatment dimensions, moderate-to-severe EA was associated with high suicidal risk (PR 5.26; 95% CI 1.51–18.34) and EA standardized scores were similarly associated (PR 2.03 per 1 SD; 95% CI 1.29–3.18), whereas EN was not. ROC analyses favored EA (AUC 0.864; cutoff 9) over EN (AUC 0.666; cutoff 11). Among attempters (n = 17), moderate-to-severe EA was associated with recurrent attempts (PR 5.77; 95% CI 1.68–19.81; p = 0.005), whereas EN was not.

Conclusion

In this outpatient schizophrenia sample in Tunisia, EA and EN were both linked to greater clinical burden, but only EA showed consistent associations with suicidal risk and recurrence of attempts. EA screening could contribute to risk stratification, pending validation in larger prospective samples.