Rugo Kelsi F, Tabares Jeffrey V, Crowell Sheila E, Baucom Brian R, Rudd M David, Bryan Craig J
National Center for Veterans Studies, The University of Utah, Salt Lake City, UT, USA; Department of Psychology, The University of Utah, Salt Lake City, UT, USA.
National Center for Veterans Studies, The University of Utah, Salt Lake City, UT, USA; Department of Psychology, The University of Utah, Salt Lake City, UT, USA.
J Affect Disord. 2020 Mar 15;265:333-341. doi: 10.1016/j.jad.2020.01.095. Epub 2020 Jan 23.
Military suicide rates have risen across all service branches, with the overall rate surpassing that of the general population for the first time in history in 2008. Service members with posttraumatic stress disorder (PTSD) are at a substantially higher risk for suicidal ideation, suicide attempts, and death by suicide than their peers without PTSD. While the link between PTSD and suicide is well established in the literature, less is known about the precise nature of that connection. Several constructs have been implicated as potential mediators of this relation, such as depression, alcohol use, suicidal cognitions, and sleep disturbance. Yet, to our knowledge, these constructs have never been examined simultaneously in a single model to determine mediational influence for suicide risk among soldiers with PTSD.
A sample of 172 active duty Army soldiers completed a series of measures targeting the aforementioned constructs. Data were analyzed using mediation model analyses.
Suicidal cognitions fully mediated the relation between PTSD symptoms and current suicide risk severity. The indirect effect for suicidal cognitions was significantly larger than indirect effects for alcohol use, depression, and sleep disturbance. Exploratory analyses suggest serial mediation of the relation between PTSD and current suicide risk by depression and suicidal cognitions.
These results should be interpreted within the context of study limitations, to include use of self-report data and inability to firmly establish temporal sequencing assumed in mediation.
Implications of this study include the improvement of suicide risk assessment and individualized treatment planning for suicidal military personnel with PTSD.
所有军种的军人自杀率均有所上升，2008年总体自杀率有史以来首次超过普通人群。患有创伤后应激障碍（PTSD）的军人出现自杀意念、自杀未遂及自杀死亡的风险比未患PTSD的同龄人高得多。虽然PTSD与自杀之间的联系在文献中已有充分记载，但这种联系的确切性质却鲜为人知。有几种因素被认为是这种关系的潜在中介因素，如抑郁、饮酒、自杀认知和睡眠障碍。然而，据我们所知，这些因素从未在单一模型中同时进行检验，以确定其对患有PTSD的士兵自杀风险的中介影响。
对172名现役陆军士兵进行抽样，让他们完成一系列针对上述因素的测量。使用中介模型分析对数据进行分析。
自杀认知完全中介了PTSD症状与当前自杀风险严重程度之间的关系。自杀认知的间接效应显著大于饮酒、抑郁和睡眠障碍的间接效应。探索性分析表明，抑郁和自杀认知对PTSD与当前自杀风险之间的关系起到了连续中介作用。
这些结果应在研究局限性的背景下进行解读，包括使用自我报告数据以及无法确定中介作用中假设的时间顺序。
本研究的意义包括改进对患有PTSD的自杀军人的自杀风险评估和个性化治疗计划。
