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Journal Article

Citation

Infrasca R. Ital. J. Psychopathol. 2009; 15(2): 186-192.

Copyright

(Copyright © 2009, Pacini editore)

DOI

unavailable

PMID

unavailable

Abstract

OBJECTIVE: One of the most complex problems in clinical psychiatry concerns the prediction and prevention of suicidal behavior. An important aspect of clinical interest is suicidal ideation, which is a stable phenomenon. Many studies stated that this condition is the basis of suicidal behavior in psychiatric patients. Numerous studies have shown an association between negative parental styles and family conditions in childhood and high risk of serious interpersonal difficulties during adolescence and maturity, indicating that these difficulties may have a central role in the development of suicidal ideation and suicidal behavior. Many reports have identified in depressive symptoms, low self-esteem, and "psychotic style or psychoticism" the suicidal dynamics involved in both mental (ideation) and behavioral (attempted suicide and completed suicide) aspects of this problem. Research has examined the link between parenting and family characteristics and suicidal ideation in psychiatric patients. Moreover, assuming that suicidal ideation is a multidimensional phenomenon involving many variables, work was directed to developing a "suicidal indicator" (SI) that can aggregate a large number of these variables.

METHODS: The sample consisted of 710 adult outpatients with DSM-IV diagnosis of depressive disorders, anxiety disorders, somatoform disorders, personality disorders, and psychotic disorders (515 women and 195 men). All subjects were required to fill-out the MMPI test. Analyzed were the MMPI scales for depression (D), and special scales for psychoticism (PS), and low self-esteem (Lse), which are all known pathologic traits associated with suicidal ideation. The total score of the three scales (D+ SP + Lse/3) was described as the SI. The score was subjected to binary coding, which takes the values 0 (≤ 139) or 1 (≥ 140). Two Indices were also obtained from the MMPI to measure suicidal ideation: the "Threat suicide" (TS) scale, and the response to the item 339. Data on personality traits of the mother and father (depression and other psychiatric disorders, relational skills, violent behavior, affectivity), and the family environment (separation, death of a parent, economic problems, alcoholism, family climate), were obtained, retrospectively, using a structured questionnaire. Each significant negative trait or condition reported by a subject was assigned one point (1), and the lack of an event was assigned no points (0). The childhood adversity scores were then aggregated into three categories, the Maternal Marker (MM), the Paternal Marker (MP), and the Family Marker (MF), obtained from the sum of the number of stressful childhood characterizations referring to the mother, father, and family. Using this method, we aimed also to examine the joint effects (interactive model) of negative childhood conditions on suicidal ideation in adult psychiatric patients. Finally, we also aimed to determine if an increase in the marker scores was associated with an increase in the risk of suicidal Ideation.

RESULTS: D, PS, and Lse MMPI scales, which make up the SI, showed good internal consistency (Cronbach alpha = 0.87). The cut-off of 140 points for the SI shows a remarkable ability to recognize the presence of suicidal thoughts (sensitivity = 0.93, specificity = 0.61). The data show the relationship between the presence of negative characterizations of parental personality and family conditions and the risk of suicidal ideation in psychiatric patients, particularly marked in relation to the negativity of the family (Table II). Furthermore, the increase in the number of positive markers also Increases the risk of suicidal thoughts (Table III).

RESULTS indicated that the risk of suicidal ideation (OR) is different based on the characteristics of an individual's two parents. In particular, the lack of maternal affection is stronger than the paternal one, and authoritarianism increases the risk unless manifested by the father, whereas depression is significant only for the maternal figure (Table I).

CONCLUSIONS: The SI proved able to detect the presence of suicidal thoughts, suggesting the need for more effective therapy to reduce the likelihood of such psychopathologic dynamics (mainly the serotonin and dopamine system). SI precedes suicidal ideation and is not secondary to it. It is able to detect also potential (not communicated) suicidal ideation, which is often tenuous and definitely affects the vast majority of serious psychiatric disorders (depressive, psychotic, borderline, etc.). In this regard, the SI as reliable as investigative measure with different psychopathologic symptoms. In the second scenario, research has shown a statistical link between certain stressful conditions of childhood (characterizations of negative parenting and family) and suicidality, as represented in the SI. In fact, the results indicate that specific, objective, and identifiable dimensions are present and could assist in creating possible preventive interventions during childhood in some psycho-behavioral parenting and family conditions.


Language: it

Keywords

adult; human; female; male; alcoholism; suicidal ideation; depression; Suicidal ideation; psychosis; suicidal behavior; risk factor; article; major clinical study; mental disease; controlled study; personality disorder; family violence; anxiety disorder; child parent relation; self esteem; Psychiatric disorders; structured questionnaire; somatoform disorder; family relation; parental attitude; family assessment; Parental style; Suicidal indicator

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