Chou Po-Han, Ito Masaya, Horikoshi Masaru
Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan; Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung, Taiwan; Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan; Biological Optimal Imaging Lab, Department of Photonics, College of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan.
National Center for Cognitive-Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan.
J Psychiatr Res. 2020 Oct;129:47-52. doi: 10.1016/j.jpsychires.2020.06.004. Epub 2020 Jun 7.
While posttraumatic stress disorder (PTSD) symptoms in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are categorized into four clusters, emerging studies suggest the disorder is best characterized by seven symptom clusters: re-experiencing, avoidance, negative affect, anhedonia, externalizing behaviors, and anxious and dysphoric arousal symptoms. However, data are sparse regarding the relation between this novel model of DSM-5 PTSD symptoms and suicide risk.
Using data from the National Survey for Stress and Health, a sample of 6180 Japanese individuals, we evaluated the relationship between suicide ideation and PTSD symptoms using 4- and 7-factor models.
Different association patterns were observed between each model and suicidal ideation. In the 4-factor model, we found re-experiencing feelings (odds ratio [OR] = 1.03, 95% confidence interval [CI] = 1.01-1.06, p = 0.002), negative alterations in cognition and mood symptoms (OR = 1.08, 95%CI = 1.06-1.09, p < 0.001), and hyperarousal (OR = 1.03, 95% CI = 1.01-1.05, p = 0.014) were associated with increased suicide ideation. In the 7-factor model, we found re-experiencing feelings (OR = 1.04, 95%CI = 1.02-1.06, p = 0.001), negative affect (OR = 1.04, 95%CI = 1.01-1.07, p = 0.012), anhedonia (OR = 1.08-1.16, 95%CI, p < 0.001), and externalizing behavior (OR = 1.12, 95%CI = 1.07-1.17, p < 0.001) were associated with increased suicide risk.
A more refined 7-factor model of DSM-5 PTSD symptoms may help us understand their associations with comorbid psychopathology and suicide. Prevention and treatment efforts that target distinct aspects of the PTSD phenotype may be more effective in mitigating key clinical and functional outcomes in this population.
虽然《精神疾病诊断与统计手册》第五版（DSM - 5）中创伤后应激障碍（PTSD）症状分为四个集群，但新出现的研究表明，该障碍的最佳特征是七个症状集群：重新体验、回避、消极情绪、快感缺失、外化行为以及焦虑和烦躁性觉醒症状。然而，关于DSM - 5 PTSD症状的这种新模式与自杀风险之间的关系，数据却很稀少。
利用来自日本全国压力与健康调查的数据，对6180名日本个体的样本，我们使用4因素模型和7因素模型评估了自杀意念与PTSD症状之间的关系。
在每个模型与自杀意念之间观察到了不同的关联模式。在4因素模型中，我们发现重新体验情感（优势比[OR]=1.03，95%置信区间[CI]=1.01 - 1.06，p = 0.002）、认知和情绪症状的消极改变（OR = 1.08，95%CI = 1.06 - 1.09，p < 0.001）以及过度觉醒（OR = 1.03，95%CI = 1.01 - 1.05，p = 0.014）与自杀意念增加相关。在7因素模型中，我们发现重新体验情感（OR = 1.04，95%CI = 1.02 - 1.06，p = 0.001）、消极情绪（OR = 1.04，95%CI = 1.01 - 1.07，p = 0.012）、快感缺失（OR = 1.08 - 1.16，95%CI，p < 0.001）以及外化行为（OR = 1.12，95%CI = 1.07 - 1.17，p < 0.001）与自杀风险增加相关。
更精细的DSM - 5 PTSD症状7因素模型可能有助于我们理解它们与共病精神病理学和自杀之间的关联。针对PTSD表型不同方面的预防和治疗措施可能在减轻该人群的关键临床和功能结局方面更有效。
