Stanley Ian H, Joiner Thomas E, Bryan Craig J
Department of Psychology, Florida State University, Tallahassee, FL, USA.
Department of Psychology, Florida State University, Tallahassee, FL, USA.
J Psychiatr Res. 2017 Jan;84:161-168. doi: 10.1016/j.jpsychires.2016.10.004. Epub 2016 Oct 7.
Research has demonstrated a robust link between traumatic brain injuries (TBIs) and suicide risk. Yet, few studies have investigated factors that account for this link. Utilizing a clinical sample of deployed military personnel, this study aimed to examine a serial meditation model of anger and depression in the association of mild TBI and suicide risk. A total of 149 military service members referred for evaluation/treatment of a suspected head injury at a military hospital participated in the present study (92.6% male; M = 27.9y). Self-report measures included the Suicidal Behaviors Questionnaire-Revised (SBQ-R), Automated Neuropsychological Assessment Metrics (ANAM) anger and depression subscales, and Behavioral Health Measure-20 depression subscale. A current mild TBI diagnosis was confirmed by a licensed clinical psychologist/physician. Overall, 84.6% (126/149) of participants met diagnostic criteria for a current mild TBI. Bootstrapped serial mediation analyses indicated that the association of mild TBI and suicide risk is serially mediated by anger and depression symptoms (bias-corrected 95% confidence interval [CI] for the indirect effect = 0.044, 0.576). An alternate serial mediation model in which depression symptoms precede anger was not statistically significant (bias-corrected 95% CI for the indirect effect = -0.405, 0.050). Among a clinical sample of military personnel, increased anger and depression statistically mediated the association of mild TBI and suicide risk, and anger appears to precede depression in this pathway. Findings suggest that therapeutically targeting anger may serve to thwart the trajectory to suicide risk among military personnel who experience a mild TBI. Future research should investigate this conjecture within a prospective design to establish temporality.
研究表明，创伤性脑损伤（TBI）与自杀风险之间存在紧密联系。然而，很少有研究调查造成这种联系的因素。本研究以部署的军事人员为临床样本，旨在检验轻度TBI与自杀风险关联中愤怒和抑郁的序列中介模型。共有149名在军事医院因疑似头部受伤而被转介进行评估/治疗的军人参与了本研究（男性占92.6%；平均年龄M = 27.9岁）。自我报告测量工具包括修订版自杀行为问卷（SBQ-R）、自动神经心理评估指标（ANAM）愤怒和抑郁分量表以及行为健康测量-20抑郁分量表。当前轻度TBI诊断由持牌临床心理学家/医生确认。总体而言，84.6%（126/149）的参与者符合当前轻度TBI的诊断标准。自抽样的序列中介分析表明，轻度TBI与自杀风险之间的关联由愤怒和抑郁症状序列中介（间接效应的偏差校正95%置信区间[CI] = 0.044，0.576）。抑郁症状先于愤怒的替代序列中介模型无统计学意义（间接效应的偏差校正95%CI = -0.405, 0.050）。在军人临床样本中，愤怒和抑郁的增加在统计学上中介了轻度TBI与自杀风险之间的关联，并且在这条路径中愤怒似乎先于抑郁出现。研究结果表明，针对愤怒进行治疗可能有助于阻止经历轻度TBI的军人走向自杀风险的轨迹。未来研究应在前瞻性设计中调查这一推测以确定时间顺序。
