边缘型人格障碍特质在童年期虐待对心境障碍患者自杀行为影响中的中介作用。
Mediating role of borderline personality disorder traits in the effects of childhood maltreatment on suicidal behaviour among mood disorder patients.
作者信息
Aaltonen K I, Rosenström T, Baryshnikov I, Karpov B, Melartin T, Suominen K, Heikkinen M, Näätänen P, Koivisto M, Joffe G, Isometsä E
机构信息
Department of Psychiatry, University of Helsinki and Helsinki University Hospital, PO Box 22, 00014 Helsinki, Finland; Department of Health, Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland; Department of Social Services and Health Care, PO Box 6000, 00099 Helsinki, Finland.
Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, PO Box 9, 00014 Helsinki, Finland.
出版信息
Eur Psychiatry. 2017 Jul;44:53-60. doi: 10.1016/j.eurpsy.2017.03.011. Epub 2017 Apr 8.
BACKGROUND
Substantial evidence supports an association between childhood maltreatment and suicidal behaviour. However, few studies have examined factors mediating this relationship among patients with unipolar or bipolar mood disorders.
METHODS
Depressive disorder and bipolar disorder (ICD-10-DCR) patients (n=287) from the Helsinki University Psychiatric Consortium (HUPC) Study were surveyed on self-reported childhood experiences, current depressive symptoms, borderline personality disorder traits, and lifetime suicidal behaviour. Psychiatric records served to complement the information on suicide attempts. We examined by formal mediation analyses whether (1) the effect of childhood maltreatment on suicidal behaviour is mediated through borderline personality disorder traits and (2) the mediation effect differs between lifetime suicidal ideation and lifetime suicide attempts.
RESULTS
The impact of childhood maltreatment in multivariate models on either lifetime suicidal ideation or lifetime suicide attempts showed comparable total effects. In formal mediation analyses, borderline personality disorder traits mediated all of the total effect of childhood maltreatment on lifetime suicide attempts, but only one fifth of the total effect on lifetime suicidal ideation. The mediation effect was stronger for lifetime suicide attempts than for lifetime suicidal ideation (P=0.002) and independent of current depressive symptoms.
CONCLUSIONS
The mechanisms of the effect of childhood maltreatment on suicidal ideation versus suicide attempts may diverge among psychiatric patients with mood disorders. Borderline personality disorder traits may contribute to these mechanisms, although the influence appears considerably stronger for suicide attempts than for suicidal ideation.
背景
大量证据支持童年期受虐与自杀行为之间存在关联。然而，很少有研究探讨单相或双相情感障碍患者中调节这种关系的因素。
方法
对来自赫尔辛基大学精神病学联盟（HUPC）研究的287名抑郁症和双相情感障碍（ICD-10-DCR）患者进行了关于自我报告的童年经历、当前抑郁症状、边缘型人格障碍特征和终生自杀行为的调查。精神病学记录用于补充自杀未遂的信息。我们通过正式的中介分析来检验：（1）童年期受虐对自杀行为的影响是否通过边缘型人格障碍特征介导；（2）终生自杀意念和终生自杀未遂之间的中介效应是否不同。
结果
在多变量模型中，童年期受虐对终生自杀意念或终生自杀未遂的影响显示出相当的总效应。在正式的中介分析中，边缘型人格障碍特征介导了童年期受虐对终生自杀未遂的所有总效应，但仅介导了对终生自杀意念总效应的五分之一。终生自杀未遂的中介效应比终生自杀意念更强（P=0.002），且独立于当前的抑郁症状。
结论
童年期受虐对自杀意念和自杀未遂的影响机制在患有情绪障碍的精神病患者中可能不同。边缘型人格障碍特征可能促成了这些机制，尽管其影响在自杀未遂方面似乎比对自杀意念的影响要强得多。
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