Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan.
Tokyo Metropolitan Chubu Comprehensive Center for Mental Health and Welfare, Tokyo, Japan.
Psychiatry Clin Neurosci. 2015 Sep;69(9):563-71. doi: 10.1111/pcn.12280. Epub 2015 Feb 23.
Suicidal behavior (SB) is a major mental health problem. The research has identified many factors related to SB, such as problems in the developmental period and psychiatric and personality disorders. However, the interrelation of these factors has not been clearly delineated.
The subjects were 155 patients consecutively admitted with SB to a psychiatric center in Tokyo. Structured interviews, including the Structured Clinical Interview for DSM-IV (SCID)-I and SCID-II, were conducted to determine characteristics of the SB-related factors. To illustrate their interrelation, this study applied the technique of structural equation modeling. The latent constructs of life-historical events, borderline personality disorder (BPD) features and three symptomatic disorders (depression, anxiety disorders and substance dependence) were aligned in the chronological order of their manifestation, and connected one another within the model. Indicator variables of life-historical events were maltreatment in the developmental period and early onset of problematic behaviors. Indicators of BPD features and symptomatic disorders included the scales composed of the items in the SCID-I and II.
The constructed model with favorable goodness-of-fit indices confirmed that BPD features had a mediating role in which they were influenced by life-historical events, and exerted an influence on the symptomatic disorders. Outside the BPD-mediating paths, the model suggested three clinically interpretable links between life-historical events and symptomatic disorders.
The model of this study demonstrated the pathways from life-historical events and BPD to symptomatic disorders, and indicated a generating process of psychiatric comorbidity among suicidal patients. The wide-range view this study portrayed has important clinical implications, and deserves further substantiation by future studies.
自杀行为（SB）是一个主要的心理健康问题。研究已经确定了许多与 SB 相关的因素，例如发展期间的问题以及精神和人格障碍。然而，这些因素之间的相互关系尚未明确划定。
本研究的对象是 155 名连续因 SB 被收入东京一家精神科中心的患者。进行了结构化访谈，包括 DSM-IV 结构临床访谈（SCID）-I 和 SCID-II，以确定与 SB 相关因素的特征。为了说明它们的相互关系，本研究应用了结构方程建模技术。生命历史事件、边缘型人格障碍（BPD）特征和三种症状障碍（抑郁、焦虑障碍和物质依赖）的潜在结构按照表现的时间顺序排列，并在模型内彼此连接。生命历史事件的指标变量是发育期间的虐待和问题行为的早期发作。BPD 特征和症状障碍的指标包括由 SCID-I 和 II 中的项目组成的量表。
具有良好拟合指数的构建模型证实，BPD 特征具有中介作用，即它们受到生命历史事件的影响，并对症状障碍产生影响。在 BPD 中介路径之外，该模型还提示了生命历史事件和症状障碍之间三种临床可解释的联系。
本研究的模型展示了生命历史事件和 BPD 到症状障碍的途径，并表明自杀患者中精神共病的发生过程。该研究描绘的广泛视角具有重要的临床意义，值得未来研究进一步证实。
