ابعاد کنترل روانشناختی والدین: ارتباطات با پرخاشگری فیزیکی و رابطه پیش دبستانی در روسیه

Background The aim of this study is to establish to what degree variation in lifetime experience of rhythmicity and manic-hypomanic features correlates with suicidality in individuals with mood disorders and other major psychiatric diagnoses and in a comparison group of controls. Method Suicidal ideation and attempts were investigated in a clinical sample, including 77 patients with schizophrenia, 60 with borderline personality disorder, 61 with bipolar disorder, 88 with unipolar depression, and 57 with panic disorder, and in a comparison group of 102 controls. Using information derived from the diagnostic interview and a self-report assessment of mood spectrum symptoms, subjects were assigned to 3 categories according to the maximum level of suicidality achieved in the lifetime (none, ideation/plans, and suicide attempts). The association of categorical and continuous variables with suicidality levels was investigated using multinomial logistic regression models. Results Suicidal ideation and plans were more common in unipolar depression (50%) and bipolar disorder (42.4%) than in borderline personality disorder (30%), whereas the reverse was true for suicidal attempts. In each of the study groups, the number and the type of mood spectrum items endorsed, including depressive and manic-hypomanic items and rhythmicity and vegetative symptoms, were associated with increased levels of suicidality. Conclusions Our results suggest that the assessment of lifetime rhythmicity and manic-hypomanic features may be clinically useful to identify potential suicide attempters in high-risk groups

Suicide has been associated with many risk factors, each documented by a large amount of evidence. However, most studies on suicide are usually restricted to one domain of possible risk factors, at a social, psychiatric, or psychologic level, resulting in a narrow view of a phenomenon that is in fact multifactorial. In recent years, comprehensive models have been formulated, which include a number of factors predisposing, protecting from, or precipitating suicide. The stress-diathesis model of suicide holds that the actual stress, that is, the factors temporarily and directly related to self-harm behavior, is equal or even less critical than the diathesis, that is, the vulnerability factors, in the genesis of suicide. The onset of a psychiatric disorder is a well-known stress-related factor. Research studies usually explore suicidality within one single diagnostic group, such as major depression [1], schizophrenia (SCHI) [2] and [3], cluster B personality disorder [4], bipolar disorder (BD) [5], [6], [7] and [8], panic disorder (PD) [9] and [10], posttraumatic stress disorder [11], and alcoholism [12]. As observed by Mann et al [13], such approach fails to determine whether risk factors are specific to a single diagnosis or allow generalizations across diagnostic boundaries. Among diathesis-related factors, a number of studies have highlighted the role of psychopathologic traits such as anger [14], impulsivity [14], [15] and [16], aggression [17] and [18], hopelessness [15], [19] and [20], and rhythmicity [21], [22], [23], [24] and [25]. Such studies in general fail to complement their data with information on psychiatric disorders (the stressor). Furthermore, the stress-diathesis model can be integrated with the model of suicidal process [26]. According to this model, suicidal ideation precedes planning, which may result in an attempt leading to death. In retrospective studies, an in-depth investigation of patients attempting or completing suicide attempters or completers can demonstrate a gradually increasing seriousness in suicidal behavior, from weariness of life to death wishes, suicidal thoughts, suicide attempts, and suicide [27]. Unfortunately, most studies focus their investigation only on suicidal attempters, with the consequence that evidence on suicidal ideation is scanty, and it is usually restricted to analyses that explore depressive symptoms. A close investigation of the entire suicide process is, on the contrary, not common [26]. In recent years, a structured interview was developed, which explores the lifetime spectrum of mood disorders (Structured Clinical Interview for Mood Spectrum) [28], conceptualized as 3 broad components exploring signs, symptoms, behaviors, and functioning: the rhythmicity and vegetative symptoms, the manic-hypomanic component, and the depressive component. Each component is obtained by counting up the items endorsed. The mood spectrum underlies a dimensional approach to psychopathology implying that the endorsement of an increasing number of lifetime depressive, manic, or rhythmicity features is indicative of higher severity. The experience of mood spectrum features is assumed to shape the personality of the individual and his/her ability to adjust to life circumstances and may establish a vulnerability to full-fledged Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, disorders. The manic-hypomanic component proved to be associated with suicidality in unipolar as well as bipolar patients [29]. Using the self-report version of the interview (Mood Spectrum–Self-Report [MOODS-SR]), in the present article, we extended our investigation of the impact of mood spectrum (the diathesis) on suicidal ideation and attempts across different psychiatric diagnoses (stressors) and in a control group to establish the relevance of this dimensional approach to the evaluation of suicidal risk. Anger/overreactivity [30] was also analyzed as a correlate of suicidality. The aims of this article are, first, to compare the lifetime prevalence of suicidal ideation and attempts across psychiatric diagnoses and a comparison group of controls and, second, to establish to what degree variation in mood spectrum symptoms, such as rhythmicity and manic-hypomanic components, and in anger/overreactivity symptoms correlates with increasing levels of suicidality.