Understanding suicidal ideation in Cambodia: the roles of PTSD, shame, and guilt

Introduction: Suicide is a major public health burden globally, and cultural and social factors have been found to substantially impact how suicidal ideation manifests. However, little research on these impacts has been conducted, particularly in low-and-middle income countries, which often face higher mental health burdens and limited access to care. In Cambodia, trauma exposure is high and cultural beliefs, particularly stemming from religious views of trauma, may increase experiences of shame and guilt. This research seeks to identify how trauma and cultural variables may interact with each other and serve as mechanisms of risk for the development of negative outcomes like suicidal ideation in Cambodia. Methods: This secondary analysis of cross-sectional data used the PCL-5 and the shame and guilt subsections of the DES-IV to examine contributions of PTSD severity, shame, and guilt as individual and interactive determinants of suicidal ideation in a sample of 191 Cambodian individuals. A series of ordinal logistic regressions were conducted to identify how these variables contribute to increased severity of suicidal ideation. Results: Forty percent of the sample endorsed severe suicidal ideation and suicidal ideation was significantly related to PTSD severity (r = 0.65, p < .001), shame (r = 0.64, p < .001), and guilt (r = 0.65, p < .001). The best-fitting ordinal logistic regression model found that shame and guilt were significantly related to suicidal ideation, but PTSD severity was not. Conclusion: These results suggest guilt and shame are important cultural and religious factors associated with trauma exposure and subsequent symptoms. Future research should investigate these mechanisms further, particularly with a focus on the development or refinement of existing trauma interventions to emphasize the constructs of shame and guilt within a culturally sensitive framework in Khmer individuals.