Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, United States.
Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, United States; Duke University Medical Center, Durham, NC, United States.
J Affect Disord. 2020 May 15;269:117-124. doi: 10.1016/j.jad.2020.03.053. Epub 2020 Mar 23.
Theoretical models and cross-sectional empirical studies of suicide indicate that anger is a factor that may help explain the association between posttraumatic stress disorder (PTSD) and suicide, but to date no longitudinal studies have examined this relationship. The current study used longitudinal data to examine whether changes in anger mediated the association between changes in PTSD symptomatology and suicidal ideation (SI).
Post 9/11-era veterans (N = 298) were assessed at baseline, 6-months, and 12-month time points on PTSD symptoms, anger, and SI. Analyses covaried for age, sex, and depressive symptoms. Multilevel structural equation modeling was used to examine the three waves of data.
The effect of change in PTSD symptoms on SI was reduced from B = 0.02 (p = .008) to B = -0.01 (p = .67) when change in anger was added to the model. Moreover, the indirect effect of changes in PTSD symptoms on suicidal ideation via changes in anger was significant, B = 0.02, p = .034. The model explained 31.1% of the within-person variance in SI.
Focus on predicting SI rather than suicidal behavior. Sample was primarily male.
Findings suggest that the association between PTSD and SI is accounted for, in part, by anger. This study further highlights the importance of anger as a risk factor for veteran suicide. Additional research on clinical interventions to reduce anger among veterans with PTSD may be useful in reducing suicide risk.
自杀的理论模型和横断面实证研究表明，愤怒是一个可能有助于解释创伤后应激障碍（PTSD）与自杀之间关联的因素，但迄今为止，尚无纵向研究检验过这种关系。本研究使用纵向数据来检验愤怒的变化是否在 PTSD 症状和自杀意念（SI）的变化之间的关联中起中介作用。
在 9/11 时代的退伍军人（N=298）中，在基线、6 个月和 12 个月时间点评估 PTSD 症状、愤怒和 SI。分析中考虑了年龄、性别和抑郁症状的协变量。使用多层次结构方程模型检验了三波数据。
当将愤怒的变化纳入模型时，PTSD 症状变化对 SI 的影响从 B=0.02（p=0.008）降低到 B=-0.01（p=0.67）。此外，愤怒变化对 PTSD 症状变化导致 SI 的间接影响是显著的，B=0.02，p=0.034。该模型解释了 SI 个体内方差的 31.1%。
专注于预测 SI 而不是自杀行为。样本主要是男性。
研究结果表明，PTSD 和 SI 之间的关联部分归因于愤怒。本研究进一步强调了愤怒作为退伍军人自杀风险因素的重要性。针对 PTSD 退伍军人愤怒的临床干预措施的进一步研究可能有助于降低自杀风险。
