Jain Felipe A, Gutierrez-Ramirez Paulina, Zea Miranda, Okereke Olivia I, Van Orden Kimberly A, Pedrelli Paola, Vranceanu Ana-Maria, Dueck Kimberly, Pederson Aderonke, Ramirez Gomez Liliana A
Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Harvard-MIT Division of Health Sciences and Technology, Boston, MA.
Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
Res Sq. 2024 Sep 17:rs.3.rs-4803419. doi: 10.21203/rs.3.rs-4803419/v1.
Despite high rates of family caregiver suicidal ideation (SI), little is known about its relationship with childhood adversity. Those with a history of adverse childhood experiences (ACEs) have been shown to have higher neuroticism, lower self-compassion, and higher rates of late life mental health disorders. Caregiving for a family member with dementia may pose a particular challenge for those with ACEs.
In a secondary analysis of 81 family caregivers of people living with dementia enrolled in clinical trials, we undertook a cross-sectional baseline analysis of the association between childhood adversity, measured with the ACE questionnaire, and self-reported suicidal ideation (SI). We further assessed whether the relationship between ACE and SI was mediated by neuroticism and self-compassion.
18 caregivers self-reported SI (22%). 89% of caregivers with SI reported childhood adversity (ACE > 0), versus 63% of those without SI (p=.04). The relative risk of SI was 3.6x higher in those with childhood adversity than in those without (p=.04), and for those with a specific history childhood abuse, the relative risk of SI was 3.4x higher (p=.005). Neuroticism and self-compassion mediated the relationship between ACE and SI (p<.05), with neuroticism strengthening the association and self-compassion weakening it.
The association of SI with history of childhood adversity is high in family caregivers. Whereas elevated neuroticism might be one mechanism linking ACEs and SI, training self-compassion is a promising target for reducing SI. The phenotypic relationship between childhood adversity and SI in family caregivers should be further explored in larger samples, and could represent a new treatment target to improve the efficacy of therapies on caregiver emotional symptoms.
尽管家庭照顾者的自杀意念（SI）发生率很高，但对其与童年逆境之间的关系却知之甚少。有童年不良经历（ACEs）史的人已被证明具有更高的神经质、更低的自我同情，以及更高的晚年心理健康障碍发生率。为患有痴呆症的家庭成员提供照顾可能对有ACEs的人构成特殊挑战。
在对参与临床试验的81名痴呆症患者的家庭照顾者进行的二次分析中，我们对用ACE问卷测量的童年逆境与自我报告的自杀意念（SI）之间的关联进行了横断面基线分析。我们进一步评估了ACE与SI之间的关系是否由神经质和自我同情介导。
18名照顾者自我报告有SI（22%）。有SI的照顾者中有89%报告有童年逆境（ACE>0），而无SI的照顾者中这一比例为63%（p=0.04）。有童年逆境的人出现SI的相对风险比没有童年逆境的人高3.6倍（p=0.04），对于有特定童年虐待史的人，出现SI的相对风险高3.4倍（p=0.005）。神经质和自我同情介导了ACE与SI之间的关系（p<0.05），神经质增强了这种关联，而自我同情则削弱了这种关联。
在家庭照顾者中，SI与童年逆境史之间的关联度很高。虽然神经质升高可能是将ACEs与SI联系起来的一种机制，但培养自我同情是降低SI的一个有前景的目标。应在更大样本中进一步探索家庭照顾者中童年逆境与SI之间的表型关系，这可能代表一个新的治疗靶点，以提高治疗对照顾者情绪症状的疗效。
