Trauma-related shame and depression moderate the relationship between complex posttraumatic stress and suicidal ideation in a treatment-seeking adult sample

<b>Background & Objective:</b> There has been a dearth of empirical research examining suicidality in the context of the new diagnosis of the ICD-11 Complex posttraumatic stress disorder (CPTSD). The main aim of the current cross-sectional study was to test the moderating role of trauma-related shame and depression on the relationship between CPTSD symptoms and suicidal ideation.<b>Method:</b> In total, 300 treatment-seeking trauma-exposed adults were included in the study. The mean age was 39.25 (<i>SD</i> = 12.77), ranging from 18 to 72 years. The majority of the sample (90.3%) were female and had a university degree (67%). Self-report measures for assessing complex posttraumatic stress disorder and depression symptoms, suicidal ideation and trauma-related shame were used.<b>Results:</b> In the study sample, 22.7% of the participants met the criteria for probable PTSD, 45.7% probable CPTSD, and 45% reported suicidal ideation. The levels of trauma-related shame and CPTSD symptoms were the highest in the high suicidal ideation group. Moderation analysis revealed that the association between CPTSD symptom severity and suicidal ideation intensified with increasing levels of trauma-related shame. The findings of the moderated moderation analysis showed that with increasing levels of shame, the effects of interaction between CPTSD and depression symptoms on suicidal ideation were getting stronger.<b>Conclusions:</b> Results demonstrated that the relationship between CPTSD symptoms and suicidal ideation depends on the levels of trauma-related shame and comorbid depressive symptoms. Such findings provide insights for the assessment and management of suicide risk after trauma exposure and suggest that the relationship between complex posttraumatic stress and suicidal ideation depends on other post-traumatic reactions, comorbid conditions, and on how they interact.