Suicidality is a major public health concern, particularly for low-income, trauma-exposed patients with limited access to mental health providers. However, limited research has modeled pathways of suicidality in safety-net primary care samples. Patients (N = 207) in a safety-net primary care clinic completed measures of childhood and adult trauma exposure, depression, and suicidality. Participants (M age = 44.8 years, SD = 11.6), were 60.4% male, 63.8% Black/African American, and predominantly low-income (i.e., 69.1% reported an annual income less than $5,000 USD). Half of the sample reported at least four childhood traumatic events (M = 3.9 events, SD = 3.0) and approximately three adult traumatic events (M = 3.0 events, SD = 2.1). Most participants (82.1%) reported significant depressive symptoms, and 43.5% endorsed recent suicidality. Models showing the mediational effect of depression on the association between trauma exposure and suicidality, β = .20, B = 0.23, SE = 0.05, 95% CI [0.16, 0.32], and the moderational effect of trauma exposure on the association between depression and suicidality, β = .16, B = 0.20, SE = 0.08, p = .007, were both supported. These results underscore the high prevalence of trauma exposure, depression, and suicidality in a safety-net primary care sample. They also highlight the pervasiveness and complexity of suicidality in low-income primary care patients, emphasize the importance of trauma-informed suicide assessment, and identify trauma sequelae and depression as potential treatment targets to reduce suicidality.

中文翻译：

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安全网初级保健中的创伤暴露、抑郁和自杀模型

自杀是一个主要的公共卫生问题，特别是对于低收入、受过创伤的患者来说，他们接触心理健康服务提供者的机会有限。然而，有限的研究模拟了安全网初级保健样本中的自杀途径。安全网初级保健诊所的患者 ( N = 207) 完成了儿童和成人创伤暴露、抑郁和自杀的测量。参与者（M年龄 = 44.8 岁，SD = 11.6）为 60.4% 的男性，63.8% 的黑人/非裔美国人，并且主要是低收入人群（即 69.1% 的人报告年收入低于 5,000 美元）。一半的样本报告了至少四个儿童创伤事件（M = 3.9 事件，SD = 3.0）和大约三个成人创伤事件（M = 3.0 个事件，SD = 2.1）。大多数参与者 (82.1%) 报告有明显的抑郁症状，43.5% 的参与者表示最近有自杀倾向。模型显示抑郁对创伤暴露与自杀之间的关联有中介作用，β = .20，B = 0.23，SE = 0.05，95% CI [0.16, 0.32]，以及创伤暴露对抑郁之间关联的调节作用和自杀，β = .16，B = 0.20，SE = 0.08，p =.007，均受支持。这些结果强调了安全网初级保健样本中创伤暴露、抑郁和自杀的高流行率。他们还强调了低收入初级保健患者自杀的普遍性和复杂性，强调了创伤知情自杀评估的重要性，并将创伤后遗症和抑郁症确定为减少自杀的潜在治疗目标。