Objective: This study aims to explore the relationships of childhood trauma and suicide attempts in adolescents with depressive disorders, and the serial mediating role of alexithymia and psychological inflexibility between them. Methods: A total of 1,426 adolescents with depressive disorders were included in this study. We used Childhood Trauma Questionnaire (CTQ), Mini International Neuropsychiatric Interview (MINI), Toronto Alexithymia Scale (TAS-20), Action Questionnaire-2nd edition (AAQ-Ⅱ), and Cognitive Fusion Questionnaire (CFQ) to evaluate childhood trauma, suicide attempts, alexithymia, and psychological inflexibility, respectively. Results: The incidence of suicide attempts in adolescents with depressive disorders was 51.68%, with females (74.90%) having a rate 2.98 times higher than that of males (25.10%). In addition, compared with the non-suicide attempts group, the suicide attempts group had significantly higher scores in childhood trauma [48 (39, 57) vs. 54 (43, 65), Z = -6.87, p < 0.001], alexithymia [63 (55, 68) vs. 63 (58, 71), Z = -5.22, p < 0.001], and psychological inflexibility [72 (48, 85) vs. 74 (62, 93), Z = -6.07, p < 0.001]. Furthermore, childhood trauma, alexithymia and psychological inflexibility were all positively correlated with suicide attempts (r = 0.18, 0.14, 0.16, all p < 0.001). The results of the mediation analysis indicate that childhood trauma has a significant direct effect on suicide attempts (β= 0.019, p < 0.001, 95% CI: 0.011, 0.026), psychological inflexibility significantly simple mediates the relationship between childhood trauma and suicide attempts (β= 0.002, p < 0.001, 95% CI: 0.001, 0.004). Importantly, the serial mediation effect of alexithymia and psychological inflexibility on the relationship between childhood trauma and suicide attempts is also significant (β= 0.002, p < 0.001, 95% CI: 0.001, 0.003). Conclusion: Childhood trauma not only directly predicts suicide attempts among adolescents with depressive disorders, but also indirectly increases the risk of suicide attempts through the independent mediating effect of psychological inflexibility and the serial mediating effect of alexithymia and psychological inflexibility.

Childhood Trauma, Suicide Attempts, Alexithymia, Psychological Inflexibility, Depressive Disorders