Department of Psychology, Florida State University, Tallahassee, FL, USA.
Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, USA.
Psychol Med. 2019 Oct;49(13):2237-2246. doi: 10.1017/S0033291718003124. Epub 2018 Oct 25.
Research is needed to identify the factors that explain the link between prior and future suicidality. This study evaluated possible mediators of the relationship between: (1) the severity of prior suicidality and (2) suicidal ideation severity at 3-month follow-up among a sample of high-risk military personnel.
US military service members referred to or seeking care for suicide risk (N = 624) completed self-report psychiatric domain measures and a clinician interview assessing prior suicidality severity at baseline. Three months later, participants completed a self-report measure of suicidal ideation severity. Three separate percentile bootstrap mediation models were used to examine psychiatric factors (i.e. alcohol abuse, anxiety sensitivity, hopelessness, insomnia, posttraumatic stress symptoms, suicidal ideation, and thwarted belongingness) as parallel mediators of the relationship between prior suicidality severity (specifically, suicidal ideation, suicide attempt, and overall suicidality - i.e. ideation/attempt severity combined) at baseline and suicidal ideation severity at follow-up.
Hopelessness, specifically, and the total effect of all mediators, each significantly accounted for the relationship between prior suicidality severity and subsequent ideation severity across models. In the models with attempt severity and overall suicidality severity as predictors, thwarted belongingness was also a significant mediator.
Hopelessness, thwarted belongingness, and overall severity of psychiatric indices may explain the relationship between prior suicidality severity and future suicidal ideation severity among service members at elevated suicide risk. Research is needed to replicate these findings and examine other possible mediators.
需要研究确定解释既往和未来自杀关联性的因素。本研究评估了以下两种情况之间关系的可能中介因素：（1）既往自杀严重性和（2）在高危军事人员样本中，随访 3 个月时的自杀意念严重程度。
美国军事人员因自杀风险被转诊或寻求治疗（N=624），在基线时完成了自我报告的精神病学领域测量和临床医生访谈，评估既往自杀严重性。三个月后，参与者完成了自杀意念严重程度的自我报告测量。使用三个单独的百分位 bootstrap 中介模型，考察了精神病学因素（即酒精滥用、焦虑敏感性、绝望感、失眠、创伤后应激症状、自杀意念和归属感受挫）作为基线时既往自杀严重性（具体而言，自杀意念、自杀企图和总体自杀性——即意念/企图严重程度的总和）与随访时自杀意念严重程度之间的平行中介。
绝望感，特别是所有中介的总效应，在所有模型中都显著解释了既往自杀严重性与随后的意念严重程度之间的关系。在以企图严重程度和总体自杀严重性为预测因素的模型中，归属感受挫也是一个显著的中介因素。
绝望感、归属感受挫和精神病学指标的总体严重程度可能解释了处于自杀风险升高的军人中既往自杀严重性与未来自杀意念严重程度之间的关系。需要开展研究来复制这些发现并研究其他可能的中介因素。
