Distress partially links childhood maltreatment to suicide risk in Mexican medical students

A cross-sectional study of 670 second-year medical students at the National Autonomous University of Mexico found that 26.0% met the study’s threshold for high suicide risk, while depression, anxiety and perceived academic stress each statistically mediated part of the association between childhood maltreatment and suicide risk. The analysis did not establish that any factor caused another, but it identified current psychological distress as a measurable bridge between early adversity and elevated risk among students in medical training.

Researchers recruited students during classroom sessions between February and March 2025 and analyzed those who provided complete questionnaire data, leaving a sample with a mean age of 20.0 years. Sixty-nine point four percent were women and 97.9% were single. Participants completed self-administered assessments of childhood maltreatment, depressive symptoms, anxiety symptoms, perceived academic stress and suicide risk under the supervision of trained research staff. The final group represented about 30% of the approximately 2,215 eligible second-year students, and the single-school, single-stage sample limits how broadly the results can be generalized.

Childhood adversity was measured retrospectively with the 28-item Childhood Trauma Questionnaire–Short Form, which assesses emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect for experiences before age 18. The main statistical models combined emotional abuse and emotional neglect into an emotional-maltreatment score, and physical abuse and physical neglect into a physical-maltreatment score. Sexual abuse was reported descriptively but excluded from the mediation models because the researchers regarded it as conceptually distinct. Depressive symptoms were measured with the nine-item Patient Health Questionnaire-9, anxiety with the seven-item Generalized Anxiety Disorder-7, academic stress with the SISCO Academic Stress Inventory and suicide risk with the 15-item Plutchik Suicide Risk Scale.

The instruments were internally consistent in this cohort, with Cronbach’s alpha values of 0.90 for the total Childhood Trauma Questionnaire–Short Form, 0.87 for the PHQ-9, 0.90 for the GAD-7, 0.80 for SISCO and 0.78 for the Plutchik scale. Using a Plutchik score of at least 6, investigators classified 174 students as being at high risk and 496 as being at low risk. The average total score was 4.4, with a standard deviation of 3.0 and a range of 0 to 14. Because the mediation analyses treated suicide risk as a continuous variable, the models did not depend only on the binary high-versus-low classification.

Students classified as being at high risk reported substantially more psychological distress than their low-risk peers. Mean PHQ-9 scores were 15.2 versus 7.7, a difference with a large effect size of Cohen’s d = 1.5, and 84.5% of the high-risk group met the study’s threshold for moderate or severe depressive symptoms, compared with 33.1% of the low-risk group. Mean GAD-7 scores were 11.6 versus 6.3, with d = 1.1, while 65.5% of high-risk students had moderate or severe anxiety symptoms compared with 22.6% of low-risk students. Academic stress was also higher among high-risk students, whose mean SISCO score was 3.7 rather than 2.9, a difference with d = 0.6.

Childhood maltreatment likewise differed between the suicide-risk groups. Mean emotional-maltreatment scores were 24.3 in the high-risk group and 16.6 in the low-risk group, with d = 1.0. Moderate or severe emotional maltreatment was reported by 56.9% of high-risk students, compared with 16.1% of low-risk students. Physical-maltreatment scores averaged 15.5 and 12.7, respectively, with d = 0.7, and moderate or severe physical maltreatment was reported by 42.0% of high-risk students versus 14.3% of low-risk students. Sexual abuse, although not entered into the mediation models, was also more common at the moderate or severe level among high-risk students: 28.2% compared with 9.1%.

The researchers tested two separate parallel multiple-mediation models using PROCESS Model 4 in SPSS. Emotional or physical maltreatment was the predictor, continuous suicide risk was the outcome, and depressive symptoms, anxiety symptoms and academic stress were entered simultaneously as mediators. Indirect effects were estimated with 5,000 bias-corrected bootstrap resamples and considered significant when their 95% percentile confidence interval excluded zero. The emotional-maltreatment model explained 53.6% of the variance in suicide risk, while the physical-maltreatment model explained 50.1%. All three specific indirect pathways were significant in both models, but their magnitudes differed.

Depressive symptoms produced the largest specific indirect effect in each model. For emotional maltreatment, the effect was B = 0.08 with a 95% bootstrap confidence interval of 0.06 to 0.10; for physical maltreatment, it was B = 0.12 with a 95% interval of 0.08 to 0.16. The indirect effects through academic stress and anxiety were each B = 0.005 and B = 0.01, respectively, in both models, and their confidence intervals also excluded zero. Maltreatment retained significant direct associations with suicide risk after the mediators were included: the standardized direct effect was β = 0.26 for emotional maltreatment and β = 0.14 for physical maltreatment. The researchers therefore interpreted the results as partial rather than complete mediation.

That pattern separates an early developmental vulnerability from more proximal psychological conditions. In statistical mediation, a significant indirect effect means that the association between exposure and outcome is attenuated when the proposed mediator is included; it does not by itself establish a causal sequence. Because all measures were collected at one point and childhood experiences were recalled retrospectively, the study cannot determine whether maltreatment preceded distress, whether distress contributed to later risk or whether other processes produced all three. Self-report may also introduce recall bias and underreporting, while the classroom recruitment, incomplete participation and restriction to one Mexican medical school may have introduced selection bias. The authors also did not formally test whether the two maltreatment models differed from one another, making direct comparisons of their overall indirect magnitudes uncertain.

The findings nevertheless offer a technically specific account of how developmental history and medical-training conditions can appear together in students’ mental-health profiles. Depressive symptoms had the strongest specific mediating association with suicide risk, academic stress was the mediator most directly associated with the outcome, and anxiety supplied another statistically significant pathway. These overlapping processes may reinforce one another: academic strain can accompany depression and anxiety, anxiety can intensify the perception of demands, and depression can erode coping resources. The analysis was not designed to estimate that feedback cycle, however. Its clearest result is that depression, anxiety and perceived academic stress account for part, but not all, of the statistical association linking early emotional and physical maltreatment to elevated suicide risk in this group of second-year medical students.

Subject of Research: Mediation of childhood maltreatment and suicide risk by psychological distress in Mexican medical students

Article Title: Early wounds, minds in training: childhood adversity and the mediating effect of psychological distress in suicidal risk among medical students

Article References: Martínez-Levy, G. A., Fresán-Orellana, A., Briones-Velasco, M., Romero-Silva, P. G., & Guizar-Sánchez, D. P. (2026). Early wounds, minds in training: childhood adversity and the mediating effect of psychological distress in suicidal risk among medical students. Frontiers in Psychology, 17, Article 1970728. https://doi.org/10.3389/fpsyg.2026.1970728

Image Credits: AI Generated

DOI: 10.3389/fpsyg.2026.1970728

Keywords: medical students, suicide risk, childhood maltreatment, depressive symptoms, anxiety symptoms, academic stress, mediation analysis, Mexico, Early, wounds, minds, training