Gooding Patricia, Harris Kamelia, Duxbury Paula, Pratt Daniel, Huggett Charlotte, Emsley Richard, Awenat Yvonne, Haddock Gillian
Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK.
Manchester Academic Health Science Centre, MAHSC, University of Manchester, Manchester, UK.
Psychol Med. 2024 Oct 4;54(12):1-11. doi: 10.1017/S0033291724001764.
The ways in which perceived harm due to substance use affects relationships between psychotic and suicidal experiences are poorly understood. The goal of the current study was to redress this gap by investigating the moderating effects of harm due to substance use on pathways involving positive psychotic symptoms, the perceived cognitive-emotional sequelae of those symptoms, and suicidal ideation.
The design was cross-sectional. Mediation and moderated mediation pathways were tested. The predictor was severity of positive psychotic symptoms. Cognitive interpretative and emotional characteristics of both auditory hallucinations and delusions were mediators. Suicidal ideation was the outcome variable. General symptoms associated with severe mental health problems were statistically controlled for.
There was evidence of an indirect pathway between positive psychotic symptom severity and suicidal ideation via cognitive interpretation and emotional characteristics of both auditory hallucinations and delusions. Harm due to drug use, but not alcohol use, moderated the indirect pathway involving delusions such that it was most prominent when harm due to drug use was at medium-to-high levels. The components of suicidal ideation that were most strongly affected by this moderated indirect pathway were active intent, passive desire, and lack of deterrents.
From both scientific and therapy development perspectives, it is important to understand the complex interplay between, not only the presence of auditory hallucinations and delusions, but the ensuing cognitive and emotional consequences of those experiences which, when combined with harm associated with substance use, in particular drug use, can escalate suicidal thoughts and acts.
物质使用所致的感知伤害如何影响精神病性体验与自杀体验之间的关系，目前尚不清楚。本研究的目的是通过调查物质使用所致伤害对涉及阳性精神病性症状、这些症状的感知认知 - 情感后遗症以及自杀意念的路径的调节作用来弥补这一差距。
采用横断面设计。测试了中介和调节中介路径。预测因素是阳性精神病性症状的严重程度。幻听和妄想的认知解释及情感特征为中介变量。自杀意念是结果变量。对与严重心理健康问题相关的一般症状进行了统计学控制。
有证据表明，通过幻听和妄想的认知解释及情感特征，阳性精神病性症状严重程度与自杀意念之间存在间接路径。药物使用而非酒精使用所致的伤害调节了涉及妄想的间接路径，使得当药物使用所致伤害处于中高水平时该路径最为显著。受这种调节后的间接路径影响最强烈的自杀意念成分是主动意图、被动愿望和缺乏威慑力。
从科学和治疗发展的角度来看，重要的是不仅要理解幻听和妄想的存在之间的复杂相互作用，还要理解这些体验所产生的认知和情感后果，当这些后果与物质使用，特别是药物使用相关的伤害相结合时，可能会加剧自杀念头和行为。
