Yrondi Antoine, Vaiva Guillaume, Walter Michel, D Amato Thierry, Bellivier Frank, Bennabi Djamila, Bougerol Thierry, Camus Vincent, Doumy Olivier, Genty Jean-Baptiste, Haffen Emmanuel, Holtzmann Jérôme, Horn Mathilde, Lançon Christophe, Leboyer Marion, Llorca Pierre-Michel, Maruani Julia, Moirand Rémi, Molière Fanny, Petrucci Jean, Richieri Raphaelle, Samalin Ludovic, Schmitt Laurent, Stephan Florian, Courtet Philippe, El-Hage Wissam, Aouizerate Bruno
Fondation FondaMental, Creteil, France; Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, Toulouse, France.
Fondation FondaMental, Creteil, France; Centre National de Ressources et Résilience pour les psychotraumatisme, Lille, France; Service de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, CHRU de Lille, Hôpital Fontan 1, Lille, France.
J Psychiatr Res. 2021 Mar;135:20-27. doi: 10.1016/j.jpsychires.2020.12.055. Epub 2020 Dec 23.
In addition to heredity, exposure to early-life adversity is an important predisposing risk factor of suicidal behaviour. Although the association between Childhood Trauma (CT) and suicide risk is well documented, interactions between CT and suicidal behaviour in Treatment-Resistant Depression (TRD) populations have received little coverage. This study aimed to evaluate i) association between CT and suicidal behaviour in a TRD population, and ii) the role of personality traits and impulsiveness as potential factors of mediation in these associations.
Patients were recruited from a cohort of the French network of TRD expert centers. Depressive symptom severity, CT, suicidal behaviour, personality traits, and impulsiveness were assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS), the Childhood Trauma Questionnaire (CTQ), the Columbia Suicide Severity Rating Scale (CSSRS), the Structured Clinical Interview for DSM-IV, the Big Five Inventory, and the Barratt Impulsivness Scale (BIS) respectively.
Among the 256 patients with a baseline CTQ, in relation to suicide risk for the current depressive episode, we found an association with the total CTQ scores mediated by the intensity of the current episode in a model adjusted for age and sex (total effect: β = 0.171; p = 0.011, direct effect: β = 0.135; p = 0.043; indirect effect: β = 0.036; p = 0.048). Focusing on CT subtypes, we detected an association between suicide risk and physical neglect in a model adjusted for age and sex (β = 0.301; p = 0.002), without any mediation by the intensity of the current episode. There was no mediation effect from personality traits nor impulsiveness. With regards to CSSRS to assess suicidal ideation, we did not find any association with the total CTQ score and CT subtype scores.
We report a strong association between suicidal behaviour and CT (in particular childhood physical neglect) in a TRD population.
除遗传因素外，早年经历逆境是自杀行为的一个重要诱发风险因素。虽然童年创伤（CT）与自杀风险之间的关联已有充分记录，但在难治性抑郁症（TRD）人群中，CT与自杀行为之间的相互作用却鲜有报道。本研究旨在评估：i）TRD人群中CT与自杀行为之间的关联；ii）人格特质和冲动性作为这些关联中潜在中介因素的作用。
从法国TRD专家中心网络队列中招募患者。分别用蒙哥马利-Åsberg抑郁评定量表（MADRS）、儿童创伤问卷（CTQ）、哥伦比亚自杀严重程度评定量表（CSSRS）、DSM-IV结构化临床访谈、大五人格量表和巴拉特冲动性量表（BIS）评估抑郁症状严重程度、CT、自杀行为、人格特质和冲动性。
在256例基线CTQ患者中，就当前抑郁发作的自杀风险而言，在调整了年龄和性别的模型中，我们发现CTQ总分与自杀风险之间存在关联，且由当前发作强度介导（总效应：β = 0.171；p = 0.011，直接效应：β = 0.135；p = 0.043；间接效应：β = 0.036；p = 0.048）。聚焦于CT亚型，在调整了年龄和性别的模型中，我们检测到自杀风险与身体忽视之间存在关联（β = 0.301；p = 0.002），且不存在当前发作强度的介导作用。人格特质和冲动性均无中介效应。关于用CSSRS评估自杀观念，我们未发现其与CTQ总分及CT亚型分数之间存在任何关联。
我们报告了TRD人群中自杀行为与CT（尤其是童年期身体忽视）之间存在强关联。
