Naoki Hayashi1, Miyabi Igarashi2, Atsushi Imai3, Yuka Yoshizawa4, Kaori Asamura, Yoichi Ishikawa5, Taro Tokunaga3, Kayo Ishimoto3, Yoshitaka Tatebayashi6, Naoki Kumagai7, Hidetoki Ishii8, Yuji Okazaki3,9. 1. Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan. 2. Tokyo Metropolitan Chubu Comprehensive Center for Mental Health and Welfare, Tokyo, Japan. 3. Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan. 4. Osaka Prefectural Tondabayashi Health Center, Osaka, Japan. 5. Kitanomaru Clinic, Tokyo, Japan. 6. Affective Disorders Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan. 7. Tokyo Government Bureau of Social Welfare and Public Health, Tokyo, Japan. 8. Graduate School of Education and Human Development, Nagoya University, Nagoya, Japan. 9. Michinoo Hospital, Nagasaki, Japan.
Abstract
AIMS: Suicidal behavior (SB) is a major mental health problem. The research has identified many factors related to SB, such as problems in the developmental period and psychiatric and personality disorders. However, the interrelation of these factors has not been clearly delineated. METHODS: The subjects were 155 patients consecutively admitted with SB to a psychiatric center in Tokyo. Structured interviews, including the Structured Clinical Interview for DSM-IV (SCID)-I and SCID-II, were conducted to determine characteristics of the SB-related factors. To illustrate their interrelation, this study applied the technique of structural equation modeling. The latent constructs of life-historical events, borderline personality disorder (BPD) features and three symptomatic disorders (depression, anxiety disorders and substance dependence) were aligned in the chronological order of their manifestation, and connected one another within the model. Indicator variables of life-historical events were maltreatment in the developmental period and early onset of problematic behaviors. Indicators of BPD features and symptomatic disorders included the scales composed of the items in the SCID-I and II. RESULTS: The constructed model with favorable goodness-of-fit indices confirmed that BPD features had a mediating role in which they were influenced by life-historical events, and exerted an influence on the symptomatic disorders. Outside the BPD-mediating paths, the model suggested three clinically interpretable links between life-historical events and symptomatic disorders. CONCLUSIONS: The model of this study demonstrated the pathways from life-historical events and BPD to symptomatic disorders, and indicated a generating process of psychiatric comorbidity among suicidal patients. The wide-range view this study portrayed has important clinical implications, and deserves further substantiation by future studies.
AIMS: Suicidal behavior (SB) is a major mental health problem. The research has identified many factors related to SB, such as problems in the developmental period and psychiatric and personality disorders. However, the interrelation of these factors has not been clearly delineated. METHODS: The subjects were 155 patients consecutively admitted with SB to a psychiatric center in Tokyo. Structured interviews, including the Structured Clinical Interview for DSM-IV (SCID)-I and SCID-II, were conducted to determine characteristics of the SB-related factors. To illustrate their interrelation, this study applied the technique of structural equation modeling. The latent constructs of life-historical events, borderline personality disorder (BPD) features and three symptomatic disorders (depression, anxiety disorders and substance dependence) were aligned in the chronological order of their manifestation, and connected one another within the model. Indicator variables of life-historical events were maltreatment in the developmental period and early onset of problematic behaviors. Indicators of BPD features and symptomatic disorders included the scales composed of the items in the SCID-I and II. RESULTS: The constructed model with favorable goodness-of-fit indices confirmed that BPD features had a mediating role in which they were influenced by life-historical events, and exerted an influence on the symptomatic disorders. Outside the BPD-mediating paths, the model suggested three clinically interpretable links between life-historical events and symptomatic disorders. CONCLUSIONS: The model of this study demonstrated the pathways from life-historical events and BPD to symptomatic disorders, and indicated a generating process of psychiatric comorbidity among suicidal patients. The wide-range view this study portrayed has important clinical implications, and deserves further substantiation by future studies.
Authors: Tommy H Ng; Taylor A Burke; Jonathan P Stange; Patricia D Walshaw; Rachel B Weiss; Snezana Urosevic; Lyn Y Abramson; Lauren B Alloy Journal: J Abnorm Psychol Date: 2017-04