陷阱作为自杀危机的中介。
Entrapment as a mediator of suicide crises.
机构信息
Department of Psychiatry, Beth Israel Medical Center NY, 1st Avenue and 15th Street, New York, NY, 10003, USA.
出版信息
BMC Psychiatry. 2018 Jan 8;18(1):4. doi: 10.1186/s12888-018-1587-0.
BACKGROUND
Prior research has validated the construct of a suicide crisis syndrome (SCS), a specific psychological state that precedes and may precipitate suicidal behavior. The feeling of entrapment is a central concept of the SCS as well as of several other recent models of suicide. However, its exact relationship with suicidality is not fully understood. In efforts to clarify the exact role of entrapment in the suicidal process, we have examined if entrapment mediates the relationship of other components of the SCS, including ruminative flooding, panic-dissociation, fear of dying and emotional pain, with suicidal ideation (SI) in recently hospitalized psychiatric inpatients.
METHODS
The Suicide Crisis Inventory (SCI) and Beck Scale for Suicidal Ideation (BSS) were administered to 200 high-risk adult psychiatric inpatients hospitalized following SI or suicide attempt, assessing SCS and SI levels at admission, respectively. The possible mediation effects of entrapment on the relationship between the other components of the SCS and SI at admission were evaluated.
RESULTS
Entrapment significantly and fully mediated the relationship of ruminative flooding, panic-dissociation, and fear of dying with SI, with no direct relationships between these variables and SI reaching statistical significance. Further, no reverse mediation relationships between these variables and SI were found, indicating that the mediation effects of entrapment were unidirectional. While entrapment did mediate the association between emotional pain and SI, the direct relationship between emotional pain and SI was also significant. Moreover, in reverse mediational analysis, emotional pain was a partial mediator of the relationship between entrapment and SI.
CONCLUSION
Entrapment and emotional pain may have a more direct association with SI than the other components of the SCS, including ruminative flooding, panic-dissociation, and fear of dying, the effects of which are mediated by the former. This suggests entrapment and emotional pain may represent key symptomatic targets for intervention in acutely suicidal individuals. Further research is needed to determine the relationship of these constructs to suicidal behavior.
背景
先前的研究已经验证了自杀危机综合征（SCS）的构建，这是一种特定的心理状态，先于并可能引发自杀行为。困境感是 SCS 的核心概念，也是最近几种自杀模型的核心概念。然而，它与自杀的具体关系尚未完全理解。为了阐明困境在自杀过程中的确切作用，我们研究了困境是否在 SCS 的其他组成部分（包括沉思泛滥、惊恐解离、对死亡的恐惧和情绪痛苦）与最近住院的精神病患者的自杀意念（SI）之间的关系中起中介作用。
方法
对 200 名因 SI 或自杀企图而住院的高危成年精神病患者进行自杀危机量表（SCI）和贝克自杀意念量表（BSS）评估，分别评估入院时的 SCS 和 SI 水平。评估困境在入院时 SCS 的其他组成部分与 SI 之间的关系中的中介作用。
结果
困境显著且完全中介了沉思泛滥、惊恐解离和对死亡的恐惧与 SI 之间的关系，这些变量与 SI 之间没有直接关系达到统计学意义。此外，这些变量与 SI 之间没有反向中介关系，表明困境的中介作用是单向的。虽然困境确实中介了情绪痛苦与 SI 之间的关系，但情绪痛苦与 SI 之间的直接关系也具有统计学意义。此外，在反向中介分析中，情绪痛苦是困境与 SI 之间关系的部分中介。
结论
与 SCS 的其他组成部分（包括沉思泛滥、惊恐解离和对死亡的恐惧）相比，困境和情绪痛苦可能与 SI 有更直接的关联，而后者的作用则是由前者介导的。这表明困境和情绪痛苦可能代表急性自杀个体干预的关键症状靶点。需要进一步研究这些结构与自杀行为的关系。
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