Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
Depress Anxiety. 2021 Sep;38(9):940-949. doi: 10.1002/da.23151. Epub 2021 Mar 23.
Clinical guidelines suggest that psychological interventions specifically aimed at reducing suicidality may be beneficial. We examined the impact of two depression treatments, cognitive therapy (CT) and interpersonal psychotherapy (IPT) on suicidal ideation (SI) and explored the temporal associations between depression and SI over the course of therapy.
Ninety-one adult (18-65) depressed outpatients from a large randomized controlled trial who were treated with CT (n = 37) and IPT (n = 54) and scored at least ≥1 on the Beck Depression Inventory II (BDI-II) suicide item were included. Linear (two-level) mixed effects models were used to evaluate the impact of depression treatments on SI. Mixed-effects time-lagged models were applied to examine temporal relations between the change in depressive symptoms and the change in SI.
SI decreased significantly during treatment and there were no differential effects between the two intervention groups (B = -0.007, p = .35). Depressive symptoms at the previous session did not predict higher levels of SI at the current session (B = 0.016, p = .16). However, SI measured at the previous session significantly predicted depressive symptoms at the current session (B = 2.06, p < .001).
Both depression treatments seemed to have a direct association with SI. The temporal association between SI and depression was unidirectional with SI predicting future depressive symptoms during treatment. Our findings suggest that it may be most beneficial to treat SI first.
临床指南表明，专门针对降低自杀意念的心理干预可能是有益的。我们研究了两种抑郁治疗方法，认知疗法（CT）和人际心理治疗（IPT）对自杀意念（SI）的影响，并探讨了治疗过程中抑郁和 SI 之间的时间关联。
91 名来自大型随机对照试验的成年（18-65 岁）抑郁门诊患者，他们接受了 CT（n=37）和 IPT（n=54）治疗，贝克抑郁量表第二版（BDI-II）自杀项目得分至少≥1。采用线性（两级）混合效应模型评估抑郁治疗对 SI 的影响。应用混合效应时滞模型来检验抑郁症状变化与 SI 变化之间的时间关系。
SI 在治疗期间显著下降，两种干预组之间没有差异效应（B=-0.007，p=.35）。前一次就诊时的抑郁症状并不能预测当前就诊时更高水平的 SI（B=0.016，p=.16）。然而，前一次就诊时的 SI 显著预测了当前就诊时的抑郁症状（B=2.06，p<.001）。
两种抑郁治疗方法似乎都与 SI 有直接关联。SI 和抑郁之间的时间关联是单向的，即 SI 在治疗期间预测未来的抑郁症状。我们的研究结果表明，首先治疗 SI 可能是最有益的。
