Preisig Martina, Häberling Isabelle, Smigielski Lukasz, Emery Sophie, Baumgartner Noemi, Albermann Mona, Strumberger Michael, Schmeck Klaus, Wöckel Lars, Erb Suzanne, Rhiner Bruno, Contin-Waldvogel Brigitte, Walitza Susanne, Berger Gregor
Clinic for Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, Zurich, Switzerland.
Outpatient Psychology Wil, Psychiatric Hospital St. Gallen Nord, Wil, Switzerland.
Front Child Adolesc Psychiatry. 2025 Aug 14;4:1567387. doi: 10.3389/frcha.2025.1567387. eCollection 2025.
Adolescent suicidality is a significant public health issue. To develop effective interventions aimed at preventing suicide in this vulnerable population, it is essential to understand the complex interplay of health-related quality of life, depression and suicidal ideation.
For this purpose, we analyzed longitudinal data of 250 children and adolescents diagnosed with major depressive disorder (M = 15.7, SD = 1.6, range 8-18 years, 74% females). The main goal of the study was to examine whether the effect of health-related quality of life on individual trajectories of suicidal ideation is mediated by depression severity. A series of t-tests, Chi-squared-tests, Fisher's exact tests and a mediation analysis including three robust linear mixed-effects models were conducted.
Depressed adolescents with suicidal ideation reported lower health-related quality of life across physical, psychological, peer, and school domains compared to those without suicidal ideation, while no significant difference was observed in the family-related domain. Psychological well-being emerged as the sole domain of health-related quality of life with a direct influence on suicidal ideation. Notably, depression severity mediated the effect of physical, psychological, peer- and school-related quality of life on suicidal ideation.
Our findings suggest that improving health-related quality of life reduces depressive symptoms, which in turn leads to lower suicidal ideation. This highlights the importance of including health-related quality of life in the clinical assessment of suicide risk as well as targeting health-related quality of life in therapeutic interventions. In the light of the results of this study, interventions should not only focus on classical clinical criteria of psychiatric diagnoses such as major depressive disorder, but also on broader, more resource-oriented constructs such as health-related quality of life to better mitigate the risk of suicide in this vulnerable population.
www.ClinicalTrials.gov, identifier [NCT03167307].
青少年自杀行为是一个重大的公共卫生问题。为了制定有效的干预措施以预防这一弱势群体的自杀行为，了解与健康相关的生活质量、抑郁和自杀意念之间的复杂相互作用至关重要。
为此，我们分析了250名被诊断为重度抑郁症的儿童和青少年的纵向数据（M = 15.7，标准差 = 1.6，年龄范围8 - 18岁，74%为女性）。该研究的主要目的是检验与健康相关的生活质量对自杀意念个体轨迹的影响是否由抑郁严重程度介导。进行了一系列t检验、卡方检验、费舍尔精确检验以及包括三个稳健线性混合效应模型的中介分析。
与没有自杀意念的青少年相比，有自杀意念的抑郁青少年在身体、心理、同伴和学校领域的健康相关生活质量较低，而在家庭相关领域未观察到显著差异。心理健康是健康相关生活质量中对自杀意念有直接影响的唯一领域。值得注意的是，抑郁严重程度介导了身体、心理、同伴和学校相关生活质量对自杀意念的影响。
我们的研究结果表明，改善健康相关生活质量可减轻抑郁症状，进而降低自杀意念。这凸显了在自杀风险临床评估中纳入健康相关生活质量以及在治疗干预中针对健康相关生活质量的重要性。根据本研究结果，干预措施不仅应关注精神疾病诊断的经典临床标准，如重度抑郁症，还应关注更广泛、更注重资源的构念，如健康相关生活质量，以更好地降低这一弱势群体的自杀风险。
www.ClinicalTrials.gov，标识符 [NCT03167307]
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