Emotional Responses to Suicidal Patients: Factor Structure, Construct, and Predictive Validity of the Therapist Response Questionnaire Suicide Form
Emotional Responses to Suicidal Patients: Factor Structure, Construct, and Predictive Validity of the Therapist Response Questionnaire Suicide Form
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DOI：
10.3389/fpsyt.2018.00104
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发表时间：
2018-04-05
影响因子：
4.7
通讯作者：
Galynker, Igor
中科院分区：
文献类型：
--
作者：
Barzilay, Shira;Yaseen, Zimri S.;Galynker, Igor
背景：心理健康专业人员在自杀预防中起着关键作用。然而，在遇到有自杀倾向的病人时，他们也经常有强烈的情绪反应，或反移情。治疗师反应问卷-自杀表（TRQ-SF）是一种简短的新颖的测量方法，旨在探索患者的一组独特的自杀相关情绪反应，先前的研究发现它可以预测高自杀风险住院患者的近期自杀行为。本研究的目的是验证TRQ-SF在普通门诊诊所设置。方法：成年精神科门诊患者（N = 346）及其治疗精神卫生专业人员（N = 48）在第一次门诊会议后完成自我报告评估。临床测量包括TRQ-SF、一般情绪状态和特征、治疗联盟和患者自杀风险评估。患者自杀结局和症状严重程度在摄入和一个月随访时进行评估。在对TRQ-SF进行验证性因素分析后，研究了因素得分与临床医生和患者措施以及自杀结果的关系。结果：TRQ-SF因子分析确定了三个维度：(1)隶属关系，(2)痛苦，(3)希望。这三个因素也加载到一个对患者表现出良好内在可靠性的负面情绪反应的一般因素上。TRQ-SF得分与临床医生状态愤怒、焦虑和治疗联盟的测量相关，在控制了状态和患者特异性测量后独立于临床医生人格特征。总分和三个分量表与患者自杀结局、抑郁严重程度和临床医生对患者自杀风险的判断同时相关和预测相关，但与整体症状严重程度无关，因此表明具体的自杀相关反应。结论：TRQ-SF是一种简便、可靠的三因子测量方法。本研究证明建构效度可用于评估精神科门诊病人自杀相关反移情行为。心理健康专业人员对病人的情绪反应同时是自杀想法和行为的指示性和前瞻性预测。因此，TRQ-SF是研究反移情在自杀患者治疗中的有用工具，可以帮助临床医生利用自己的反应进行诊断和治疗，以改进对个体自杀患者的评估和干预。
Background: Mental health professionals have a pivotal role in suicide prevention. However, they also often have intense emotional responses, or countertransference, during encounters with suicidal patients. Previous studies of the Therapist Response Questionnaire-Suicide Form (TRQ-SF), a brief novel measure aimed at probing a distinct set of suicide-related emotional responses to patients found it to be predictive of near-term suicidal behavior among high suicide-risk inpatients. The purpose of this study was to validate the TRQ-SF in a general outpatient clinic setting.Methods: Adult psychiatric outpatients (N = 346) and their treating mental health professionals (N = 48) completed self-report assessments following their first clinic meeting. Clinician measures included the TRQ-SF, general emotional states and traits, therapeutic alliance, and assessment of patient suicide risk. Patient suicidal outcomes and symptom severity were assessed at intake and one-month follow-up. Following confirmatory factor analysis of the TRQ-SF, factor scores were examined for relationships with clinician and patient measures and suicidal outcomes.Results: Factor analysis of the TRQ-SF confirmed three dimensions: (1) affiliation, (2) distress, and (3) hope. The three factors also loaded onto a single general factor of negative emotional response toward the patient that demonstrated good internal reliability. The TRQ-SF scores were associated with measures of clinician state anger and anxiety and therapeutic alliance, independently of clinician personality traits after controlling for the state-and patient-specific measures. The total score and three subscales were associated in both concurrent and predictive ways with patient suicidal outcomes, depression severity, and clinicians' judgment of patient suicide risk, but not with global symptom severity, thus indicating specifically suicide-related responses.Conclusion: The TRQ-SF is a brief and reliable measure with a 3-factor structure. It demonstrates construct validity for assessing distinct suicide-related countertransference to psychiatric outpatients. Mental health professionals' emotional responses to their patients are concurrently indicative and prospectively predictive of suicidal thoughts and behaviors. Thus, the TRQ-SF is a useful tool for the study of countertransference in the treatment of suicidal patients and may help clinicians make diagnostic and therapeutic use of their own responses to improve assessment and intervention for individual suicidal patients.