مدل تقویت افسردگی اضطراب در نوجوانان: بررسی طولی نگرانی شناختی حساسیت اضطراب، افسردگی و افکار خودکشی
|کد مقاله||سال انتشار||تعداد صفحات مقاله انگلیسی||ترجمه فارسی|
|29721||2015||8 صفحه PDF||سفارش دهید|
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Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Journal of Adolescence, Volume 41, June 2015, Pages 17–24
Adolescents with comorbid anxiety and depression are at significantly increased risk of suicide. The recently proposed depression distress amplification model appears to have promise for explaining the relations between anxiety, depression, and suicidality, but it has not been tested in adolescents. Participants were 524 adolescents followed over two years. Baseline data for the current report were collected by trained interviewers while the adolescents were in eighth grade. Data were obtained in the same manner when the adolescents were in tenth grade. Baseline anxiety sensitivity cognitive concerns significantly predicted suicidal ideation two years later, above and beyond baseline suicidal ideation and depression. Further, consistent with the depression distress amplification model, anxiety sensitivity cognitive concerns interacted with depressive symptoms to predict suicidal ideation. This report extends the empirical and theoretical support for a relationship between anxiety sensitivity cognitive concerns and suicidality.
Completed and attempted adolescent suicides have a major impact on the public health care system (Burke et al., 2010 and Eaton et al., 2010). According to recent data reported by the Centers for Disease Control, suicide is the third leading cause of death in individuals 10–24 years of age and attempted suicides among adolescents increased 20% from 2009 to 2011 (CDC, 2013). Further, the rate of suicide increases drastically across adolescence, from .86 deaths per 100,000 in 12 year olds to 7.31 deaths per 100,000 in 17 year olds (CDC, 2013). Kessler, Borges, and Walters (1999) reported that age-of-onset for suicidal ideation and suicide attempts rapidly increase from about the age of 12 years, peaking around the age of 16 years. Given the consequences of suicide-related behavior in adolescents, the identification of risk factors for adolescent suicidal ideation is an important area for further research.
نتیجه گیری انگلیسی
Means, standard deviations, and bivariate correlations for the variables of interest are shown in Table 1. As expected, baseline suicidal ideation was the strongest predictor of prospective suicidal ideation. Suicidal ideation was observed in n = 19 (3.1%) of the sample at grade eight and n = 19 (3.4%) of the sample at grade 10. Table 1. Means, standard deviations and intercorrelations. Measure M SD 1 2 3 4 5 6 1. ASI physical – G8 18.99 8.15 – 2. ASI cognitive – G8 7.03 3.27 .60* – 3. ASI social – G8 12.04 3.55 .43* .35* – 4. HIF depression – G8 12.33 8.25 .29* .15* .38* – 5. HIF depression – G10 11.78 8.95 .13* .06 .19* .51* – 6. Suicidal ideation – G8 .03 .17 .13* .11* .12* .25* .17* – 7. Suicidal ideation – G10 .03 .18 .04 .02 .09* .20* .27* .24* *p < .05. ASI = Anxiety Sensitivity Index; G8 = Grade 8; G10 = Grade 10; HIF – How I Feel Scale. Table options A direct logistic regression was performed to assess the impact of baseline (grade eight) anxiety sensitivity subfactors on the likelihood that adolescents would report presence of suicidal ideation at grade 10. The model contained 5 predictor variables (baseline suicidal ideation, depressive symptoms, and Anxiety Sensitivity Index physical, cognitive, and social subfactors). Among covariates, baseline suicidal ideation (OR = 7.95, 95% CI = 1.94–32.54, p = .004) and baseline depressive symptoms (OR = 1.10, 95% CI = 1.04–1.17, p = .002) were significantly associated with Grade 10 suicidal ideation, whereas Anxiety Sensitivity Index physical (p = .213) and Anxiety Sensitivity Index social were not (p = .521). As predicted, baseline Anxiety Sensitivity Index cognitive concerns (OR = 1.19, 95% CI = 1.01–1.40, p = .046) were significantly associated with Grade 10 suicidal ideation. To test the depression distress amplification model in adolescents, another direct logistic regression was performed. The model contained 4 predictor variables (baseline suicidal ideation, baseline Anxiety Sensitivity Index cognitive concerns, grade 10 depressive symptoms, and the baseline Anxiety Sensitivity Index cognitive concerns X grade 10 depressive symptoms interaction). After covarying for the effects of baseline suicidal ideation (OR = 7.81, 95% CI = 1.72–35.57, p = .008), baseline anxiety sensitivity cognitive concerns (OR = .88, 95% CI = .66–1.17, p = .369), and grade 10 depressive symptoms (OR = 1.14, 95% CI = 1.01–1.49, p < .001), the Anxiety Sensitivity Index cognitive X depressive symptoms interaction (OR = 1.02, 95% CI = 1.01–1.04, p = .043), was a statistically significant predictor of grade 10 suicidal ideation. In the next step, we probed the hypothesized 2-way interaction between baseline anxiety sensitivity cognitive concerns and grade 10 depressive symptoms (See Fig. 1). As predicted by the depression distress amplification model, the effect of anxiety sensitivity cognitive concerns on suicidal ideation only exists among those with high levels of grade 10 depressive symptoms (OR = 1.22, 95% CI = 1.11–1.34, p < .001). In contrast, the effect of anxiety sensitivity cognitive concerns at low levels of depressive symptoms was not significantly associated with prospective suicidal ideation (p = .102). Full-size image (18 K) Fig. 1. Interaction of baseline (Grade 8) anxiety sensitivity cognitive concerns X grade 10 depressive symptoms predicting presence of grade 10 suicidal ideation. This analysis covaried for baseline suicidal ideation. ASI = Anxiety sensitivity index. Dep = depressive symptoms. **p < .01. Figure options Next, we tested the alternative hypothesis that suicidal ideation emerges via anxiety symptom amplification to determine whether the anxiety sensitivity amplification effects are specific to depressive symptoms (in line with the depression distress amplification model). In other words, we tested whether the interaction of anxiety sensitivity cognitive concerns X grade 10 anxiety symptoms would also predict the presence of grade 10 suicidal ideation. The model contained 4 predictor variables (baseline suicidal ideation, baseline Anxiety Sensitivity Index cognitive concerns, grade 10 anxiety symptoms, and the baseline Anxiety Sensitivity Index cognitive concerns X grade 10 anxiety symptoms interaction). As predicted, the anxiety sensitivity cognitive concerns X grade 10 anxiety symptoms interaction was not significantly associated with grade 10 suicidal ideation (OR = 1.01, p = .080).