Department of Psychology, Edward Hines Jr. VA Hospital.
Psychol Serv. 2019 May;16(2):321-328. doi: 10.1037/ser0000215. Epub 2018 Oct 25.
Posttraumatic stress disorder (PTSD) rates are higher in military veterans than in the civilian population. Meta-analyses have found strong and consistent associations between PTSD and suicide risk. Several studies have demonstrated a concurrent reduction in suicidal ideation (SI) with reduction of PTSD symptoms during trauma-focused treatment. However, it is unclear whether changes in specific PTSD symptom clusters are most strongly associated with these changes in SI. This study prospectively examined associations between PTSD symptom clusters and SI to better specify mechanisms of change during treatment. Participants were 160 veterans (87% male, 63% Caucasian, 64% combat trauma) who completed a course of evidence-based trauma-focused therapy at a VA hospital. The Patient Health Questionnaire-9 and Posttraumatic Stress Disorder Checklist-5 were used to assess depression, SI frequency, and PTSD symptoms. Binary logistic regression analyses found that the cognitive/mood alteration cluster was the only significant independent predictor of SI at termination. Post hoc analysis of variance Bonferroni tests indicated those who decreased SI frequency had a greater reduction in intrusive, cognitive/mood alteration, and hyperarousal symptoms relative to those who increased or had no change in SI. A within-cluster item analysis revealed that baseline symptom D3 (blame self/others) was the only significant independent predictor for baseline SI, whereas baseline symptom D6 (detachment) was the only significant independent predictor for SI at termination. This discrepancy may be explained by reductions in guilt during treatment, as 79% of the sample elected to receive cognitive processing therapy. Given these associations, PTSD patients with SI may benefit from a treatment emphasis on reducing cognitive/mood alteration symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
创伤后应激障碍（PTSD）在退伍军人中的发病率高于普通人群。荟萃分析发现，PTSD 与自杀风险之间存在强烈而一致的关联。几项研究表明，在创伤聚焦治疗中，随着 PTSD 症状的减轻，自杀意念（SI）也会同时减少。然而，目前尚不清楚 PTSD 症状群的变化是否与 SI 的变化最密切相关。本研究前瞻性地考察了 PTSD 症状群与 SI 之间的关系，以更好地明确治疗过程中的变化机制。参与者为 160 名退伍军人（87%为男性，63%为白种人，64%经历过战斗创伤），他们在退伍军人事务部医院完成了一疗程基于证据的创伤聚焦治疗。使用患者健康问卷-9 和创伤后应激障碍检查表-5 评估抑郁、SI 频率和 PTSD 症状。二元逻辑回归分析发现，认知/情绪改变群是终止时 SI 的唯一显著独立预测因子。事后方差分析 Bonferroni 检验表明，与 SI 增加或无变化的患者相比，降低 SI 频率的患者在侵入性、认知/情绪改变和过度警觉症状方面的缓解程度更大。群内项目分析表明，基线症状 D3（自责/他人）是基线 SI 的唯一显著独立预测因子，而基线症状 D6（分离）是终止时 SI 的唯一显著独立预测因子。这种差异可能是由于治疗过程中内疚感的减轻所致，因为样本中有 79%的人选择接受认知加工治疗。鉴于这些关联，有 SI 的 PTSD 患者可能受益于强调减轻认知/情绪改变症状的治疗。（PsycINFO 数据库记录（c）2019 APA，保留所有权利）。
