采用贝叶斯多层次分析方法研究双相障碍青少年关系质量与自杀意念和自杀企图的纵向关联。
A Bayesian multilevel analysis of the longitudinal associations between relationship quality and suicidal ideation and attempts among youth with bipolar disorder.
机构信息
School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Psychology, University of Kansas, Lawrence, KS, USA.
出版信息
J Child Psychol Psychiatry. 2021 Jul;62(7):905-915. doi: 10.1111/jcpp.13343. Epub 2020 Oct 27.
BACKGROUND
Youth with bipolar disorder (BD) are at high risk for suicidal thoughts and behaviors and frequently experience interpersonal impairment, which is a risk factor for suicide. Yet, no study to date has examined the longitudinal associations between relationship quality in family/peer domains and suicidal thoughts and behaviors among youth with BD. Thus, we investigated how between-person differences - reflecting the average relationship quality across time - and within-person changes, reflecting recent fluctuations in relationship quality, act as distal and/or proximal risk factors for suicidal ideation (SI) and suicide attempts.
METHODS
We used longitudinal data from the Course and Outcome of Bipolar Youth Study (N = 413). Relationship quality variables were decomposed into stable (i.e., average) and varying (i.e., recent) components and entered, along with major clinical covariates, into separate Bayesian multilevel models predicting SI and suicide attempt. We also examined how the relationship quality effects interacted with age and sex.
RESULTS
Poorer average relationship quality with parents (β = -.33, 95% Bayesian highest density interval (HDI) [-0.54, -0.11]) or friends (β = -.33, 95% HDI [-0.55, -0.11]) was longitudinally associated with increased risk of SI but not suicide attempt. Worsening recent relationship quality with parents (β = -.10, 95% HDI [-0.19, -0.03]) and, to a lesser extent, friends (β = -.06, 95% HDI [-0.15, 0.03]) was longitudinally associated with increased risk of SI, but only worsening recent relationship quality with parents was also associated with increased risk of suicide attempt (β = -.15, 95% HDI [-0.31, 0.01]). The effects of certain relationship quality variables were moderated by gender but not age.
CONCLUSIONS
Among youth with BD, having poorer average relationship quality with peers and/or parents represents a distal risk factor for SI but not suicide attempts. Additionally, worsening recent relationship quality with parents may be a time-sensitive indicator of increased risk for SI or suicide attempt.
背景
患有双相情感障碍（BD）的年轻人有很高的自杀念头和行为风险，并且经常经历人际关系受损，这是自杀的一个风险因素。然而，迄今为止，没有研究探讨家庭/同伴关系质量与 BD 青少年自杀念头和行为之间的纵向关联。因此，我们调查了个体间差异——反映了随时间变化的平均关系质量——以及个体内变化，反映了最近关系质量的波动，如何作为自杀意念（SI）和自杀企图的远因和/或近因风险因素。
方法
我们使用了来自双相青年研究课程和结果研究（N=413）的纵向数据。关系质量变量被分解为稳定（即平均）和变化（即最近）成分，并与主要临床协变量一起，纳入单独的贝叶斯多层次模型，预测 SI 和自杀企图。我们还检查了关系质量的影响如何与年龄和性别相互作用。
结果
与父母（β=-.33，95%贝叶斯最高密度区间[HDI] [-0.54，-0.11]）或朋友（β=-.33，95%HDI [-0.55，-0.11]）的平均关系质量较差与 SI 风险增加有关，但与自杀企图无关。与父母（β=-.10，95%HDI [-0.19，-0.03]）和在较小程度上与朋友（β=-.06，95%HDI [-0.15，0.03]）的最近关系质量恶化与 SI 风险增加有关，但只有与父母的最近关系质量恶化与自杀企图风险增加有关（β=-.15，95%HDI [-0.31，0.01]）。某些关系质量变量的影响受到性别而不是年龄的调节。
结论
在患有 BD 的年轻人中，与同伴和/或父母的关系质量较差代表 SI 的远因风险因素，但不是自杀企图的风险因素。此外，与父母的最近关系质量恶化可能是 SI 或自杀企图风险增加的时间敏感指标。
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