How do distal and proximal risk factors combine to predict suicidal ideation and behaviors? A prospective study of the narrative crisis model of suicide
How do distal and proximal risk factors combine to predict suicidal ideation and behaviors? A prospective study of the narrative crisis model of suicide
复制标题
DOI：
10.1016/j.jad.2020.08.088
复制
发表时间：
2020-12-01
影响因子：
6.6
通讯作者：
Galynker, Igor
中科院分区：
文献类型：
--
作者：
Bloch-Elkouby, Sarah;Gorman, Bernard;Galynker, Igor
目的：自杀的叙事危机模型假设，当有自杀倾向的特质个体面对紧张的生活事件时，他们可能会对自己和社会产生扭曲的看法，最终导致没有未来的感觉。这些认知被称为自杀叙事，使他们更有可能经历自杀危机综合症，这是一种急性情感疾病，会增加从事自杀意念行为的风险。本研究的目的是评估该模型的阶段构成。方法：对年龄在18-65岁且有自杀意念或自杀企图的成年精神科住院患者(N=223；列表N=85)进行NCM的阶段构成评估。在一个月的随访中评估自杀结果。采用结构方程模型对模型及其对自杀结果的预测进行评估。结果：该模型得到结构方程模型的支持，并与数据进行了较好的拟合。模型中的先例阶段显著地预测了每个时间阶段，并解释了自杀意念和行为(当联合评估时)的13%的变异。当分别评估自杀意念和自杀企图时，自杀意念和自杀企图的解释变异量分别为10.8%和40.7%。讨论：NCM提出的从特质易感性到自杀结果的过程得到了我们的研究结果的支持。这些发现对自杀风险的评估和治疗具有临床意义，需要在更大的样本中复制。
Aim: : The Narrative Crisis Model of suicide posits that when individuals with trait vulnerabilities for suicide face stressful life events, they may develop distorted perceptions of themselves and society that culminate in a sense of no future. Referred to as the suicide narrative, these perceptions makes them more likely to experience the Suicidal Crisis Syndrome, an acute affective condition that increases the risk of engaging in suicidal ideation behaviors. The goal of this study was to assess the stage components of this model.Methods: : The stage components of the NCM were assessed among adult psychiatric inpatients (N = 223; listwise N = 85) aged 18-65 years old and admitted for suicidal ideation or attempts. Suicidal outcomes were assessed at one month follow-up. Structural equation modeling (SEM) was used to assess the model and its prediction of prospective suicidal outcomes.Results: : The model was supported by the SEM and proved to be a good fit for the data. Each temporal stage was significantly predicted by the precedent stage in the model and 13% of the variance in suicidal ideation and behaviors (when assessed conjointly) were explained by the model. When suicidal ideation and attempts were assessed separately, the amount of variance explained was 10.8% for suicidal ideation and 40.7% for suicidal attempts.Discussion: : The progression from trait vulnerabilities to suicidal outcomes proposed by the NCM was supported by our findings. These findings have clinical implications in the assessment and treatment of suicide risk and will need replication with larger samples.