Nocturnal cognitive arousal is associated with objective sleep disturbance and indicators of physiologic hyperarousal in good sleepers and individuals with insomnia disorder

BackgroundCognitive arousal is central to models of sleep disturbance and insomnia, but findings remain mixed regarding whether cognitive arousal is associated with objective sleep disturbance and physiologic hyperarousal. This study explored associations of objective nocturnal wakefulness and indicators of physiologic hyperarousal with cognitive arousal in healthy sleepers and individuals with insomnia.MethodsIn sum, 52 adults (51.9% women; 18 with insomnia disorder, 34 healthy sleepers) underwent two overnight polysomnography (PSG) studies (adaptation + baseline nights) and a multiple sleep latency test (MSLT). Baseline depression was assessed and presleep cognitive arousal and somatic arousal were recorded for each night. Multivariate regression was used to evaluate associations of PSG sleep parameters with insomnia, cognitive arousal, and somatic arousal.ResultsAnalyses showed that high levels of nocturnal cognitive arousal were associated with prolonged sleep latency, lower sleep efficiency, and shorter total sleep time by PSG on both nights. An association between nocturnal cognitive arousal and wake after sleep onset was observed on night one only. Moreover, greater nocturnal cognitive arousal was associated with greater likelihood of obtaining short sleep and with longer MSLT sleep latencies. Insomnia diagnosis, depression, and somatic arousal were not associated with PSG sleep parameters or MSLT latency.ConclusionsHeightened cognitive arousal at night is linked to objective sleep disturbances and indicators of physiologic hyperarousal at night and during the day. For patients with insomnia, cognitive arousal may contribute to the 24-hr physiologic hyperarousal. Cognitive arousal may be a critical therapeutic target for severe or treatment-resistant sleep disturbance.     

Sleep problems, suicidal ideation, and self-harm behaviors in adolescence

Objective

Previous research has found an association between sleep problems and suicidal behavior. However, it is still unclear whether the association can be largely explained by depression. In this study, we prospectively examined relationships between sleep problems when participants were 12-14 years old and subsequent suicidal thoughts and self-harm behaviors—including suicide attempts—at ages 15-17 while controlling for depressive symptoms at baseline.

Methods

Study participants were 280 boys and 112 girls from a community sample of high-risk alcoholic families and controls in an ongoing longitudinal study.

Results

Controlling for gender, parental alcoholism and parental suicidal thoughts, and prior suicidal thoughts or self-harm behaviors when participants were 12-14 years old, having trouble sleeping at 12-14 significantly predicted suicidal thoughts and self-harm behaviors at ages 15-17. Depressive symptoms, nightmares, aggressive behavior, and substance-related problems at ages 12-14 were not significant predictors when other variables were in the model.

Conclusions

Having trouble sleeping was a strong predictor of subsequent suicidal thoughts and self-harm behaviors in adolescence. Sleep problems may be an early and important marker for suicidal behavior in adolescence. Parents and primary care physicians are encouraged to be vigilant and screen for sleep problems in young adolescents. Future research should determine if early intervention with sleep disturbances reduces the risk for suicidality in adolescents.     

低血清胆固醇与女性抑郁症的自杀行为

目的　本文对女性抑郁症患者的血清胆固醇水平与自杀行为的关系进行了探讨。方法　对 116例样本进行血清胆固醇水平测定 ,其中抑郁症伴自杀行为的 40例 ,抑郁症不伴自杀行为的 3 6例 ,正常人 40例。结果　抑郁症伴有自杀行为组血清胆固醇水平明显低于无自杀行为组和正常对照组。血清胆固醇水平与自杀的严重程度呈明显相关。结论　我们认为低血清胆固醇水平可增加女性抑郁症自杀的风险。推测低血清胆固醇导致的自杀行为可能与中枢 5 羟色胺 ( 5 HT)功能降低有关。     

Depression and suicidal ideation in pregnancy: exploring relationships with insomnia,short sleep,and nocturnal rumination

BackgroundSleep problems and depression are highly prevalent in pregnancy. Nocturnal rumination has been linked to insomnia and depression in non-pregnant samples, but remains poorly characterized in pregnancy. This study explored relationships of depression and suicidal ideation with insomnia, short sleep, and nocturnal rumination in mid-to-late pregnancy.MethodsIn this study, 267 pregnant women were recruited from obstetric clinics and completed online surveys on sleep, depression, and nocturnal rumination.ResultsOver half (58.4%) of the sample reported clinical insomnia on the Insomnia Severity Index, 16.1% screened positive for major depression on the Edinburgh Postnatal Depression Scale (EPDS), and 10.1% endorsed suicidal ideation. Nocturnal rumination was more robustly associated with sleep onset difficulties than with sleep maintenance issues. Depressed women were at greater odds of sleep onset insomnia (OR = 2.80), sleep maintenance insomnia (OR = 6.50), high nocturnal rumination (OR = 6.50), and negative perinatal-focused rumination (OR = 2.70). Suicidal ideation was associated with depression (OR = 3.64) and negative perinatal-focused rumination (OR = 3.50). A four-group comparison based on insomnia status and high/low rumination revealed that pregnant women with insomnia and high rumination endorsed higher rates of depression (35.6%) and suicidal ideation (17.3%) than good-sleeping women with low rumination (1.2% depressed, 4.9% suicidal). Women with insomnia alone (depression: 3.9%, suicidal: 5.9%) or high rumination alone (depression: 10.7%, suicidal: 7.1%) did not differ from good-sleeping women with low rumination.ConclusionsHigh rumination and insomnia are highly common in mid-to-late pregnancy and both are associated with depression and suicidal ideation. Depression and suicidal ideation are most prevalent in pregnant women with both insomnia and high rumination.ClinicalTrials.gov identifierNCT03596879.     

Work-related rumination and worry at bedtime are associated with worse sleep indicators in schoolteachers: a study based on actigraphy and sleep diaries

Objective/backgroundWork-related rumination and worry are indicators of occupational stress which can impact sleep when they occur close to bedtime. This study examined the relationship between these repetitive thoughts before sleep with objective and subjective sleep parameters.MethodsA microlongitudinal study was carried out with schoolteachers who answered questions on rumination and worry before sleep, wore a wrist actigraph, and completed a sleep diary for 5 to 7 consecutive days. Analysis used mixed-effects repeated measures linear models adjusted for sociodemographic, lifestyle, and health status.ResultsAmong the 134 schoolteachers studied, 64.9% were women and were aged 41.9 ± 9.5 years. In the fully adjusted analysis, actigraphy indicated that a wake-up time <6:30 a.m. was associated with both rumination (relative risk (RR) = 1.67; 95% confidence interval (CI) = 1.21–2.31) and worry (RR = 2.44; 95%CI = 1.63–3.64). Moreover, actigraphy-measured nighttime sleep duration <7 h (RR = 1.23; 95%CI = 1.03–1.47) and self-reported sleep latency >15 min (RR = 1.43; 95%CI = 1.02–2.02) were associated with work-related worry.ConclusionsThe occurrence of work-related repetitive thoughts before sleep, particularly worry about next-day issues, is associated with an increased risk of impaired objective and subjective sleep indicators. These findings suggest that these cognitive processes related to work should be addressed in strategies aimed at preventing and treating sleep disturbances and their individual and occupational consequences.     

Past suicidal ideation as an independent risk factor for suicide behaviours in patients with depression

Objectives: As South Korea has the highest incidence of completed suicides, the present study aimed to investigate the predictive power of the variables that have been associated with suicide attempts in Korean patients diagnosed with depression.

Methods: Hundred participants were divided into two groups: suicide attempters (31%) and suicide non-attempters (69%). Participants with a history of more than one suicidal attempt were assigned to the suicide attempter group. A hierarchical logistic regression analysis was performed to determine the predictive strengths of the variables that were likely to be associated with suicide attempts.

Results: After controlling for the effects of such variables as the severity of depressive symptoms, life stress events and impulsivity, the severity of past suicidal ideation was the most important predictive factor for discriminating suicide attempters from suicide non-attempters. The odds ratio for attempting suicide relative to not attempting suicide increased by a factor of 4.408 for each unit of increase in suicidal ideation.

Conclusions: The present study suggests that the most severe suicidal ideation throughout one’s entire life should not be overlooked and may be a major predictor of the risk of suicide.     

Correlations between interpersonal and cognitive difficulties: Relationship to suicidal ideation in military suicide attempters

BackgroundUnderstanding suicidal ideation may help develop more effective suicide screening and intervention programs. The interpersonal and the cognitive-deficit theories seek to describe the factors leading to suicidal behavior. In the military setting it is common to find over- and under-reporting of suicidal ideation. This study sought to determine the relationship between these two models and determine to what degree their components can indirectly predict suicidal ideation.MethodsSuicide attempters (n = 32) were compared with non-suicidal psychologically treated peers (n = 38) and controls (n = 33), matched for sex and age (mean 19.7 years). Pearson's analysis was used to quantify the relationship between the variables from the two models and hierarchal regression analysis was used to determine the explanation of suicidal ideation variance by these variables.ResultsSuicide attempters have more difficulties in problem-solving, negative emotion regulation and burdensomeness compared with their peers (P < .001). These variables are all closely correlated with each other and to suicide ideation (r > ± 0.5; P < .001). Prior suicide attempt, loneliness and burdensomeness together explain 65% (P < .001) of the variance in suicidal ideation.ConclusionsSuicidal ideation is strongly correlated with components of interpersonal and cognitive difficulties. In addition to assessing current suicidal ideation, clinicians should assess past suicide attempt, loneliness and burdensomeness.     

Psychotic-like experiences and their relationship to suicidal ideation in adolescents

Studies have suggested that psychotic-like experiences (PLEs) are associated with behavioral problems in adolescents. The aim of this study was to investigate relationships between domains of PLEs, suicidal ideation, and depression in a large community sample of adolescents. The sample consisted of 8096 Korean subjects (3184 boys and 4912 girls) aged 14 to 19 years. The level of PLEs, depression, and suicidal ideation were assessed by the Eppendorf schizophrenia inventory (ESI), Beck's depression inventory, and Beck's scale for suicidal ideation, respectively. Both the level of depression and suicidal ideation were significantly associated with PLEs. Among the four domains of the ESI, the deviant perception, ideas of reference, and auditory uncertainty were associated with the suicidal ideation. Additionally, subjects with more PLEs had significantly more suicidal ideation and depressive symptoms. PLEs in adolescents are associated with potential risk of suicide and depressive symptoms significantly mediated the association between suicidal ideation and PLEs. The presence of perceptual disturbances, ideas of reference, and depression may be regarded as warning signs for suicide-related behaviors.     

Objective sleep disturbance is associated with poor response to cognitive and behavioral treatments for insomnia in postmenopausal women

Study objectivesTo determine whether insomnia patients with objective sleep disturbance are less responsive to cognitive and behavioral treatments than those without objective sleep disturbance, characterize effects of insomnia therapy on objective sleep, and determine whether reductions in nocturnal cognitive arousal correspond to changes in objective sleep.MethodsSecondary analysis of a single-site, randomized controlled trial. 113 postmenopausal women (56.40 ± 5.34 years) with menopause-related insomnia disorder were randomized to three treatment conditions: cognitive-behavioral therapy for insomnia (CBTI), sleep restriction therapy (SRT), or sleep education control. Primary outcomes were the Insomnia Severity Index (ISI) and polysomnography (PSG) sleep parameters and were collected at pretreatment, posttreatment, and six-month follow-up.ResultsPatients with lower pretreatment PSG sleep efficiency had lower rates of insomnia remission after active treatment relative to those with higher sleep efficiency (37.8% vs 61.8%). Neither CBTI and SRT produced clinically meaningful effects on PSG sleep. Exploratory analyses revealed that reductions in nocturnal cognitive arousal were associated with decreases in PSG sleep latency, but not wake after sleep onset.ConclusionsOur findings support an emerging literature suggesting that insomnia patients with objective sleep disturbance may have blunted response to insomnia therapy. Research is needed to enhance treatments to better improve insomnia in patients with objective sleep disturbance. A lack of observed CBTI and SRT effects on PSG sleep suggests that these therapies may be presently ill-designed to improve objective sleep. Nocturnal cognitive arousal may represent an entry point to improve objective sleep latency in insomnia.NameBehavioral Treatment of Menopausal Insomnia: Sleep and Daytime Outcomes. URL: clinicaltrials.gov. Registration: NCT01933295.     

失眠伴抑郁与单纯失眠患者失眠认知行为治疗的疗效分析

目的分析失眠认知行为疗法(cognitive behavioral therapy on insomnia,CBT-i)对失眠伴抑郁患者以及单纯失眠患者的疗效。方法71例符合失眠症诊断的患者,根据贝克抑郁量表(Beck Depression Inventory,BDI)得分分为单纯失眠组(<14分,33例)和失眠伴抑郁组(≥14分,38例)。2组患者每天填写睡眠日记,并给予8周标准的CBT-i治疗,在治疗前(基线)、治疗第4周、治疗第8周、治疗结束后4周(第3个月)、治疗结束后16周(第6个月)采用匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)、失眠严重程度指数(Insomnia Severity Index,ISI)、BDI、贝克焦虑量表(Beck Anxiety Inventory,BAI)、SF-36健康调查简表对2组患者睡眠质量、抑郁焦虑程度、个人健康状况等进行评估,采用独立样本t检验进行组间比较,采用重复测量方差分析进行各时间点组内比较。结果与基线时比较,单纯失眠组和失眠伴抑郁组第8周、第3个月和6个月随访时入睡潜伏期、睡眠效率、PSQI、ISI、BDI、BAI、SF-36组内比较差异均有统计学意义。失眠伴抑郁组较单纯失眠组在基线、第8周、第3个月和6个月随访时BAI(t=-6.340、-3.301、-3.511、-2.982)、SF-36(t=4.162、3.195、2.022、3.629)评分差异有统计学意义(P<0.01或0.05),2组ISI评分在第6个月随访时差异有统计学意义[(7.3±4.6)分与(4.7±3.4)分,t=-2.044,P=0.048]。2组入睡潜伏期和睡眠效率以及PSQI的评分在第8周、第3个月和6个月随访时与基线的变化量差异均无统计学意义;而2组BAI、BDI评分在第8周与第3个月和6个月随访时与基线的变化量差异有统计学意义。结论CBT-i对失眠伴抑郁患者和单纯失眠患者均有效,且可以缓解失眠伴抑郁患者的抑郁症状以及改善患者生活质量。     

Suicidal ideation in depressed postpartum women: Associations with childhood trauma,sleep disturbance and anxiety

BackgroundSuicide is one of the leading causes of death in postpartum women. Identifying modifiable factors related to suicide risk in mothers after delivery is a public health priority. Our study aim was to examine associations between suicidal ideation (SI) and plausible risk factors (experience of abuse in childhood or as an adult, sleep disturbance, and anxiety symptoms) in depressed postpartum women.MethodsThis secondary analysis included 628 depressed mothers at 4–6 weeks postpartum. Diagnosis was confirmed with the Structured Clinical Interview for DSM-IV. We examined SI from responses to the Edinburgh Postnatal Depression Scale-EPDS item 10; depression levels on the Structured Interview Guide for the Hamilton Depression Rating Scale, Atypical Depression Symptoms (SIGH-ADS); plus sleep disturbance and anxiety levels with subscales from the EPDS and SIGH-ADS items on sleep and anxiety symptoms.ResultsOf the depressed mothers, 496 (79%) ‘never’ had thoughts of self-harm; 98 (15.6%) ‘hardly ever’; and 34 (5.4%) ‘sometimes’ or ‘quite often’. Logistic regression models indicated that having frequent thoughts of self-harm was related to childhood physical abuse (odds ratio-OR = 1.68, 95% CI = 1.00, 2.81); in mothers without childhood physical abuse, having frequent self-harm thoughts was related to sleep disturbance (OR = 1.15, 95% CI = 1.02, 1.29) and anxiety symptoms (OR = 1.11, 95% CI = 1.01, 1.23).DiscussionBecause women with postpartum depression can present with frequent thoughts of self-harm and a high level of clinical complexity, conducting a detailed safety assessment, that includes evaluation of childhood abuse history and current symptoms of sleep disturbance and anxiety, is a key component in the management of depressed mothers.     

伴失眠的缓解期抑郁症患者客观睡眠质量与认知功能的关系

目的 探讨伴失眠的缓解期抑郁症患者客观睡眠质量与认知功能的关系。方法 在北京回龙观医院筛选缓解期抑郁症患者47例,采用失眠严重程度指数量表（ISI）和匹兹堡睡眠质量指数量表（PSQI）前四项计算的睡眠效率对患者进行分组,最终伴失眠组22例,不伴失眠组25例。通过多导睡眠监测（PSG）评定患者客观睡眠情况,采用重复性成套神经心理状态测验（RBANS）评定患者认知功能。建立回归模型探究伴失眠的缓解期抑郁症患者客观睡眠质量与认知功能的关系。结果伴失眠与不伴失眠的缓解期抑郁症患者RBANS即刻记忆因子评分差异有统计学意义（t=-2.102,P<0.05）。伴失眠组的睡眠效率（Z=-2.113,P<0.05）、N3期占比（Z=-3.175,P<0.01）和N3期持续时间（Z=-3.196,P<0.01）均小于不伴失眠组,夜间总清醒时间（Z=-2.058,P<0.05）、N1期占比（Z=-2.399,P<0.05）和N1期持续时间（Z=-2.463,P<0.05）均多于不伴失眠组。伴失眠组REM期占比增加与注意功能的改善相关（β=0.953,95%CI:0...     

Killing in combat, mental health symptoms, and suicidal ideation in Iraq war veterans

This study examined combat and mental health as risk factors of suicidal ideation among 2854 U.S. soldiers returning from deployment in support of Operation Iraqi Freedom. Data were collected as part of a postdeployment screening program at a large Army medical facility. Overall, 2.8% of soldiers reported suicidal ideation. Postdeployment depression symptoms were associated with suicidal thoughts, while postdeployment PTSD symptoms were associated with current desire for self harm. Postdeployment depression and PTSD symptoms mediated the association between killing in combat and suicidal thinking, while postdeployment PTSD symptoms mediated the association between killing in combat and desire for self harm. These results provide preliminary evidence that suicidal thinking and the desire for self-harm are associated with different mental health predictors, and that the impact of killing on suicidal ideation may be important to consider in the evaluation and care of our newly returning veterans.     

Alterations in platelet serotonin transporter binding in women with postpartum onset major depression

There is considerable debate as to whether postpartum depression (PPD) is biologically distinct from other depressive syndromes. Although abnormalities in serotonergic neural systems have repeatedly been reported in depression, few such studies have been conducted in PPD. In the present study, platelet serotonin transporter (SERT) binding was assessed using [(3)H]paroxetine in 14 depressed pregnant women, 31 normal healthy pregnant women, 39 depressed postpartum women, and 27 normal healthy postpartum women; all of the subjects were drug-free. Significant differences were detected among the 4 groups with respect to the dissociation constant (Kd) of platelet binding sites for [(3)H]paroxetine with the highest Kd values among those with PPD. The density (Bmax) of platelet binding sites for [(3)H]paroxetine did not differ between the study groups. These data suggest that PPD may be associated with unique alterations in serotonergic function that are specific to the puerperium.     

Primary care clinician responses to positive suicidal ideation risk assessments in veterans of Iraq and Afghanistan

Objective

To examine primary care clinician actions following positive suicide risk assessments administered to Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans.

Methods

We identified OEF/OIF veterans with positive templated suicide risk assessments administered in primary care settings of three Veterans Affairs (VA) Medical Centers. National VA datasets and manual record review were used to identify and code clinician discussions and actions following positive assessments. Bivariate analyses were used to examine relationships between patient characteristics and discussions of firearms access and alcohol/drug use.

Results

Primary care clinicians documented awareness of suicide risk assessment results for 157 of 199 (79%) patients with positive assessments. Most patients were assessed for mental health conditions and referred for mental health follow-up. Clinicians documented discussions about firearms access for only 15% of patients. Among patients whose clinicians assessed for substance abuse, 34% received recommendations to reduce alcohol or drug use. Depression diagnoses and suicidal ideation/behavior severity were significantly associated with firearms access discussions, while patient sex, military service branch, and substance abuse diagnoses were significantly associated with recommendations to reduce substance use.

Conclusion

Greater efforts are needed to understand barriers to clinicians' assessing, documenting and counseling once suicidal ideation is detected, and to develop training programs and systems changes to address these barriers.     

Predictors of posttraumatic stress disorder, depression, and suicidal ideation among Canadian Forces personnel in a National Canadian Military Health Survey

Despite efforts to elucidate the relationship between traumatic event exposure and adverse mental health outcomes, our ability to understand why only some trauma-exposed individuals become emotionally affected remains challenged. The aim of the current study is to determine the relations between social support, religiosity, and number of lifetime traumatic events experienced on past-12 month posttraumatic stress disorder (PTSD), depression, and suicidal ideation (SI) in a nationally representative sample of Canadian Forces personnel. The current study used data from the Canadian Community Health Survey Cycle 1.2 - Canadian Forces Supplement. The impact of a number of predictive and mediating factors was assessed using structural equation modeling. Social support and number of lifetime traumatic events experienced were significant predictors of past-year PTSD, depression, and SI; however PTSD did not mediate the relationship between number of traumatic events and SI nor between social support and SI. Conversely, depression mediated the relationship between number of traumatic events and SI. Possible mechanisms for these findings and their implications are discussed.     

Vasopressin-neurophysin and DST in major depression: relationship with suicidal behavior

The purpose of the present study was to assess if AVP-neurophysin is associated with hypercortisolemia and suicidal behaviour in depressed patients. The study included 28 patients subgrouped into suicide attempters (n=13) and nonattempters (n=15). We assessed basal AVP-neurophysins concentrations and post-dexamethasone (DST) cortisol levels. Concentrations of AVP-neurophysins did not differ between DST suppressors and nonsuppressors: 0.29+/-0.13 ng/ml vs 0.36+/-0.21 ng/ml, (F=1.1, df=1, 27, p=0.30). Suicide attempters did not differ from nonattempters for AVP-neurophysins levels. Our results fail to support a role of AVP in the early cortisol escape.     

A clinical measure of suicidal ideation,suicidal behavior,and associated symptoms in bipolar disorder: Psychometric properties of the Concise Health Risk Tracking Self-Report (CHRT-SR)

ObjectivePeople with bipolar disorder are at high risk of suicide, but no clinically useful scale has been validated in this population. The aim of this study was to evaluate the psychometric properties in bipolar disorder of the 7- and 12-item versions of the Concise Health Risk Tracking Self-Report (CHRT-SR), a scale measuring suicidal ideation, suicidal behavior, and associated symptoms.MethodsThe CHRT was administered to 283 symptomatic outpatients with bipolar I or II disorder who were randomized to receive lithium plus optimized personalized treatment (OPT), or OPT without lithium in a six month longitudinal comparative effectiveness trial. Participants were assessed using structured diagnostic interviews, clinician-rated assessments, and self-report questionnaires.ResultsThe internal consistency (Cronbach α) was 0.80 for the 7-item CHRT-SR and 0.90 for the 12-item CHRT-SR with a consistent factor structure, and three independent factors (current suicidal thoughts and plans, hopelessness, and perceived lack of social support) for the 7-item version. CHRT-SR scores are correlated with measures of depression, functioning, and quality of life, but not with mania scores.ConclusionsThe 7- and 12-item CHRT-SR both had excellent psychometric properties in a sample of symptomatic subjects with bipolar disorder. The scale is highly correlated with depression, functioning, and quality of life, but not with mania. Future research is needed to determine whether the CHRT-SR will be able to predict suicide attempts in clinical practice.     

认知治疗联合帕罗西汀对首发轻中度抑郁症患者沉思的干预

目的探讨首发轻中度抑郁症患者接受认知治疗联合帕罗西汀治疗前后沉思的变化。方法将70例符合《精神障碍诊断与统计手册(第4版)》(DSM-IV)诊断标准的首发轻中度抑郁症患者,采用随机抽签法分为实验组和对照组各35例,实验组接受认知治疗联合帕罗西汀治疗,对照组接受帕罗西汀治疗与一般支持心理治疗,观察12周,于治疗前后对所有患者进行沉思反应量表(RRS)测验和汉密尔顿抑郁量表24项版(HAMD-24)评定。结果 1治疗后,实验组HAMD-24总评分、RRS总评分及各分量表评分与治疗前比较差异均有统计学意义(P均0.05);2治疗后,两组的强迫性冥想分量表评分差异有统计学意义(t=2.28,P=0.02),HAMD-24总评分、RRS总评分、与抑郁相关和反思分量表评分差异均无统计学意义(P均0.05)。结论认知治疗联合帕罗西汀治疗对缓解轻中度抑郁症患者强迫性冥想的疗效可能较一般支持心理治疗联合帕罗西汀更好。     

Specific coping behaviors in relation to adolescent depression and suicidal ideation

The coping strategies used by adolescents to deal with stress may have implications for the development of depression and suicidal ideation. This study examined coping categories and specific coping behaviors used by adolescents to assess the relation of coping to depression and suicidal ideation. In hierarchical regression models, the specific coping behaviors of behavioral disengagement and self-blame were predictive of higher levels of depression; depression and using emotional support were predictive of suicidal ideation. Results suggest that specific behaviors within the broad coping categories of emotion-focused coping (e.g., self-blame) and avoidant coping (e.g., behavioral disengagement) account for these categories’ associations with depression and suicidal ideation. Specific problem-focused coping strategies did not independently predict lower levels of depression or suicidal ideation. It may be beneficial for interventions to focus on eliminating maladaptive coping behaviors in addition to introducing or enhancing positive coping behaviors.