Childhood trauma is a risk factor for suicidal ideation in patients with depressive disorder, and plasma vitamin D level is also related to suicidal ideation. However, there is still insufficient research on the relationship between them in adolescent patients with depressive disorder.

To explore the relationship between suicidal ideation and childhood trauma and to analyze the mediating role of depressive symptom severity and low vitamin D levels.

Adolescent patients with depressive disorder who attended Chaohu Hospital of Anhui Medical University and the Fourth People's Hospital of Hefei City in 2021 were used as the depressive disorder group (n=168), and adolescents with no history of mental illness recruited during the same period were used as the control group (n=89). Childhood trauma, depressive symptoms, and suicidal ideation were assessed using the Childhood Abuse Questionnaire (CTQ), the Current Evaluation of Depression Scale (CES-D), and the Suicidal Ideation Scale (PANSI), and plasma 25-hydroxyvitamin D[25 (OH) D] levels were also tested. Differences between adolescents with depressive disorders and control adolescents in suicidal ideation, depressive symptoms, childhood trauma, and vitamin D levels were compared; Pearson correlation analyses were used to test the correlation of scores on each scale, and the mediating roles of depression and vitamin D levels between childhood trauma and suicidal ideation were analyzed by the PROCESS macro program.

Adolescents in the depressive disorder group had higher PANSI scores, CTQ subscale scores, and total scores than those in the control group (P<0.05), and lower 25 (OH) D levels than those in the control group (P<0.5). Pearson correlation analyses showed that there were correlations between the PANSI scores and the CTQ total scores, the CES-D scores, and the 25 (OH) D levels of adolescents in the depressive disorder group (P< 0.05), and the PANSI scores of adolescents in the control group were correlated with total CTQ scores, CES-D scores (P<0.05), and no correlation with 25 (OH) D levels (P>0.05). The mediation benefit analysis showed that the CES-D score and 25 (OH) D level in the adolescent group with depressive disorder played a partial mediating role between the CTQ total score and PANSI score, with mediation effects accounting for 61.8% and 5.3%, respectively; and a partial mediating role between the CTQ affective abuse subscale score and PANSI score, with mediation effects accounting for 58.9% and 6.5%; a partial mediating role between CTQ emotional neglect subscale scores and PANSI scores, with mediating effect percentages of 67.2% and 5.6%, respectively; and a full mediating role between CTQ somatic neglect subscale scores and PANSI scores, with mediating effect percentages of 92.2% and 7.8%. None of the mediating effects of 25 (OH) D levels were significant for control adolescents; CES-D scores played a fully mediating role between CTQ total scores and PANSI scores, and between CTQ emotional maltreatment subscale scores and PANSI scores; and a partially mediating role between CTQ emotional maltreatment subscale scores and PANSI scores, with a direct effect percentage of 41.5% and a mediating effect accounted for 58.5%; the mediating effect between CTQ somatic neglect subscale scores and PANSI scores was not significant.

The severity of depressive symptoms and low vitamin D levels in patients with adolescent depressive disorder are potential mechanisms of childhood trauma leading to suicidal ideation. In view of the disorder of childhood trauma of adolescent depression in clinical should be timely and effective control and improvement of patient, improve their vitamin D levels and actively carry out mental health education, in order to reduce the occurrence of suicidal ideation, improve clinical outcomes.

童年创伤是抑郁障碍患者自杀意念的危险因素，血浆维生素D水平也与自杀意念相关，而目前在青少年抑郁障碍患者中关于其相互关系的探究尚不足。

探讨自杀意念与童年创伤的关系，并分析抑郁症状严重程度和低维生素D水平的中介作用。

以2021年在安徽医科大学附属巢湖医院和合肥市第四人民医院就诊的青少年抑郁障碍患者为抑郁障碍组（n=168），以同期招募的无精神疾病史青少年为对照组（n=89）。采用儿童期虐待问卷（CTQ）、流调抑郁量表（CES-D）、自杀意念量表（PANSI）评估童年创伤、抑郁症状、自杀意念，同时检测血浆25-羟维生素D[25（OH）D]水平。比较抑郁障碍组青少年和对照组青少年在自杀意念、抑郁症状、童年创伤及维生素D水平之间的差异；采用Pearson相关分析检验各量表得分的相关性，并通过PROCESS宏程序分析抑郁和维生素D水平在童年创伤与自杀意念之间的中介作用。

抑郁障碍组的PANSI得分、CTQ各分量表得分及总得分高于对照组（P<0.05），25（OH）D水平低于对照组（P<0.05）。Pearson相关分析显示，抑郁障碍组的PANSI得分与CTQ总分、CES-D得分、25（OH）D水平存在相关性（P<0.05），对照组的PANSI得分与CTQ总得分、CES-D得分存在相关性（P<0.05）；与25（OH）D水平无相关关系（P>0.05）。中介效应分析显示：抑郁障碍组的CES-D得分和25（OH）D水平在CTQ总得分和PANSI得分之间发挥部分中介作用，中介效应占比分别为61.8%和5.3%；在CTQ情感虐待分量表得分和PANSI得分之间发挥部分中介作用，中介效应占比分别为58.9%和6.5%；在CTQ情感忽视分量表得分和PANSI得分之间发挥部分中介作用，中介效应占比分别为67.2%和5.6%；在CTQ躯体忽视分量表得分和PANSI得分之间发挥完全中介作用，中介效应占比为92.2%和7.8%。对照组的25（OH）D水平中介效应均不显著；CES-D得分在CTQ总得分与PANSI得分之间、CTQ情感虐待分量表得分和PANSI得分之间发挥完全中介作用；在CTQ情感忽视分量表得分与PANSI得分之间发挥部分中介作用，直接效应占比为41.5%，中介效应占比为58.5%；在CTQ躯体忽视分量表得分和PANSI得分之间的中介效应不显著。

青少年抑郁障碍患者的抑郁症状严重程度和低维生素D水平是童年创伤导致自杀意念的潜在机制。临床中针对合并童年创伤的青少年抑郁障碍患者应及时、有效地控制和改善病情，提高其维生素D水平，并积极开展心理健康教育，以减少自杀意念的发生，提高临床预后。