Department of Psychiatry, Asan Medical Center, Seoul, Korea.
Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Korea.
J Korean Med Sci. 2021 Mar 15;36(10):e72. doi: 10.3346/jkms.2021.36.e72.
Evidence continues to accumulate that the presence or absence of early trauma (ET) implies unique characteristics in the relationships between suicidal ideation and its risk factors. We examined the relationships among recent stress, depressive symptoms, anxiety symptoms, and suicidal ideation in Korean suicidal women with or without such a history.
Using data on suicidal adult females, 217 victims and 134 non-victims of ET, from the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior, we performed structural equation modeling to investigate the contribution of recent stress, depressive symptoms, and anxiety symptoms on suicidal ideation within each group according to the presence or absence of a history of ET.
Structural equation modeling with anxiety and depressive symptoms as potential mediators showed a good fit. Recent stress had a direct effect on both depressive symptoms and anxiety symptoms in both groups. Only anxiety symptoms for victims of ET (standardized regression weight, 0.281; = 0.005) and depressive symptoms for non-victims of ET (standardized regression weight, 0.326; = 0.003) were full mediators that increased suicidal ideation. Thus, stress contributed to suicidal ideation by increasing the level of anxiety and depressive symptoms for victims and non-victims, respectively.
Tailored strategies to reduce suicidal ideation should be implemented according to group type, victims or non-victims of ET. Beyond educating suicidal women in stress-management techniques, it would be effective to decrease anxiety symptoms for those with a history of ET and decrease depressive symptoms for those without such a history.
越来越多的证据表明,早期创伤(ET)的存在或缺失意味着自杀意念及其风险因素之间的关系具有独特的特征。我们研究了韩国有或没有 ET 史的自杀女性中近期压力、抑郁症状、焦虑症状与自杀意念之间的关系。
利用韩国预测自杀和自杀相关行为模型的成年女性队列研究的数据,我们对 217 名 ET 创伤患者和 134 名非 ET 创伤患者进行了结构方程建模,根据是否存在 ET 史,在每个组中研究近期压力、抑郁症状和焦虑症状对自杀意念的贡献。
以焦虑和抑郁症状为潜在中介的结构方程模型拟合良好。近期压力对两组的抑郁症状和焦虑症状均有直接影响。仅 ET 创伤患者的焦虑症状(标准化回归权重 0.281;P = 0.005)和非 ET 创伤患者的抑郁症状(标准化回归权重 0.326;P = 0.003)是完全中介,增加了自杀意念。因此,压力通过增加 ET 创伤患者和非 ET 创伤患者的焦虑和抑郁症状水平,导致自杀意念的产生。
应该根据 ET 创伤患者和非患者的类型实施有针对性的策略来降低自杀意念。除了对自杀女性进行压力管理技巧的教育外,对于有 ET 史的患者降低焦虑症状,对于无 ET 史的患者降低抑郁症状,将会是有效的。