Institut de Neurosciences de la Timone, UMR 7289, Aix Marseille Université, CNRS, Marseille, France.
IGF,Univ. Montpellier, CNRS, INSERM, Montpellier, France.
Eur Psychiatry. 2023 Sep 22;66(1):e79. doi: 10.1192/j.eurpsy.2023.2452.
Childhood trauma (CT), depression, and psychological pain are known predictors of suicidal ideation. Recent literature additionally highlights the importance of the attachment system.
We aimed to predict suicidal ideation through CT, attachment, and psychological and social pain by using mediation models aiming to predict suicidal ideation through CT (predictor) and attachment (mediator). In the same models, we introduced psychological or social pain as a moderator of the relationship between attachment, CT, and suicidal ideation. We included 161 depressed patients and assessed depression, attachment, CT, suicidal ideation, psychological pain, and social pain.
We found (1) a complete mediating effect of anxious attachment (ab = 0.0035, CI = [0.0010; 0.0069]) on the relationship between CT on suicidal ideation, and (2) a significant complete conditional mediating effect of anxious attachment and psychological pain (index of moderated mediation VAS: 0.0014; CI = [0.0002; 0.0032]) but not social pain on the relationship between CT and suicidal ideation. Both models were controlled for history of suicidal attempt, depression severity, and sex.
Our results suggest a developmental profile of suicidal ideation in mood disorder that is characterized by the presence of CT and insecure attachment, especially anxious attachment, that is sensitive to experiences of psychological pain. Nevertheless, we cannot conclude that avoidantly attached individuals do not present the same mechanism, as they may not disclose those ideas.
儿童期创伤（CT）、抑郁和心理痛苦是自杀意念的已知预测因素。最近的文献还强调了依恋系统的重要性。
我们旨在通过 CT、依恋以及心理和社会痛苦来预测自杀意念，使用中介模型来预测通过 CT（预测因子）和依恋（中介）来预测自杀意念。在相同的模型中，我们引入了心理或社会痛苦，作为依恋、CT 和自杀意念之间关系的调节因素。我们纳入了 161 名抑郁患者，并评估了抑郁、依恋、CT、自杀意念、心理痛苦和社会痛苦。
我们发现 (1) 焦虑依恋（ab=0.0035，CI=[0.0010；0.0069]）对 CT 与自杀意念之间关系的完全中介作用，以及 (2) 焦虑依恋和心理痛苦（VAS 调节中介指数：0.0014；CI=[0.0002；0.0032]）对 CT 与自杀意念之间关系的显著完全条件中介作用，但社会痛苦没有。两个模型均控制了自杀未遂史、抑郁严重程度和性别。
我们的结果表明，心境障碍中自杀意念存在一种发展模式，其特征是存在 CT 和不安全依恋，尤其是焦虑依恋，对心理痛苦的体验很敏感。然而，我们不能得出回避依恋个体不存在相同机制的结论，因为他们可能不会表达这些想法。
