Stewart Jeremy G, Kim Judy C, Esposito Erika C, Gold Joseph, Nock Matthew K, Auerbach Randy P
Department of Psychiatry, Harvard Medical School; McLean Hospital, Center for Depression, Anxiety and Stress Research, Belmont, MA, USA.
Department of Psychiatry, Harvard Medical School; McLean Hospital, Center for Depression, Anxiety and Stress Research, Belmont, MA, USA.
J Affect Disord. 2015 Nov 15;187:27-34. doi: 10.1016/j.jad.2015.08.034. Epub 2015 Aug 19.
Suicide is the second leading cause of death among adolescents, and depressed youth are six times more likely to make suicide attempts as compared to non-depressed adolescents. The present study examined the unique and interactive effects of two well-established correlates of suicidality - childhood sexual abuse (CSA) and disinhibition - in predicting suicide attempts among depressed adolescents.
Participants were 163 adolescents (125 females) aged 13-18 (M=15.60, SD=1.27) diagnosed with Major Depressive Disorder (n=95, 58.3%) and/or Dysthymia (n=69, 42.3%) recruited from an acute residential treatment service. Participants completed interviews assessing psychopathology and suicidality, self-report measures of depressive symptoms and CSA, and a computerized disinhibition task.
Consistent with hypotheses, CSA moderated the association between disinhibition and adolescents' report of their past year and lifetime suicide attempts. Specifically, higher disinhibition was associated with a greater likelihood of having made a suicide attempt among adolescents with a history of CSA, but not among those without. The same pattern of results held in analyses of suicide attempt frequency.
Primary findings were based on observational, cross-sectional data, and therefore, causal relationships cannot be inferred. The gender imbalance in the sample precluded stratifying our analyses by gender. CSA was ascertained by self-report; replication of the results with more objective measures is warranted.
Our findings indicate that CSA and disinhibition may work together to predict elevated suicide risk, and these results have implications for early identification efforts in youth at high risk for suicide.
自杀是青少年死亡的第二大主要原因，与未患抑郁症的青少年相比，抑郁的青少年自杀未遂的可能性高出六倍。本研究考察了自杀倾向的两个既定相关因素——童年期性虐待（CSA）和行为抑制缺乏——在预测抑郁青少年自杀未遂方面的独特作用及交互作用。
参与者为163名年龄在13 - 18岁（M = 15.60，SD = 1.27）的青少年（125名女性），他们来自一家急性住院治疗机构，被诊断患有重度抑郁症（n = 95，58.3%）和/或心境恶劣障碍（n = 69，42.3%）。参与者完成了评估精神病理学和自杀倾向的访谈、抑郁症状和童年期性虐待的自我报告量表，以及一项计算机化的行为抑制缺乏任务。
与假设一致，童年期性虐待调节了行为抑制缺乏与青少年过去一年及终生自杀未遂报告之间的关联。具体而言，行为抑制缺乏程度较高与有童年期性虐待史的青少年自杀未遂的可能性更大相关，但在没有该病史的青少年中则不然。自杀未遂频率的分析也得出了相同的结果模式。
主要发现基于观察性横断面数据，因此无法推断因果关系。样本中的性别失衡使我们无法按性别分层进行分析。童年期性虐待是通过自我报告确定的；有必要用更客观的测量方法对结果进行重复验证。
我们的研究结果表明，童年期性虐待和行为抑制缺乏可能共同作用来预测自杀风险升高，这些结果对高危青少年自杀的早期识别工作具有启示意义。
