Passive suicidal ideation is a predictor of subsequent suicidal behavior, and the predictive value of objective biomarkers for suicidal ideation is attracting increasing attention. The incidence of passive suicidal ideation is relative high in elderly patients with schizophrenia. However, studies on passive suicidal ideation and biomarkers in this population are lacking.
To investigate the correlation of passive suicidal ideation with thyroid stimulating hormone (TSH) and prolactin (PRL) among elderly schizophrenia inpatients.
A total of 248 schizophrenia inpatients aged 60 years and above from Shenzhen Kangning Hospital were retrospective included from January 2014 to October 2018 and divided into the passive suicidal ideation group (n=37) and non-passive suicidal ideation group (n=211) according to the first item of the Suicide Subscale of the Chinese Version of Mini-International Neuropsychiatric Interview. The sociodemographic characteristics, TSH, free triiodothyronine (FT3) , free total-thyroxine (FT4) and PRL levels in the two groups were collected separately.
Univariate analysis showed that the proportions of female patients, history of attempted suicide and PRL level inpassive suicidal ideation group were higher than non-passive suicidal ideation group, while the TSH level was lower than non-passive suicidal ideation group (P<0.05) . Multivariate Logistic regression analysis showed that TSH level (OR=0.654) , female (OR=10.950) , history of attempted suicide (OR=15.917) , PRL level (OR=1.018) were influencing factors of passive suicidal ideation in elderly schizophrenia inpatients (P<0.05) , PRL level (OR=1.035) was an influencing factor of passive suicidal ideation in schizophrenia inpatients aged 70 years and above (P<0.05) .
Elderly schizophrenia patients who are female, have a history of attempted suicide, have lower TSH level and higher PRL level were associated with a greater risk of passive suicide ideation. Elderly schizophrenia patients aged 70 years and above with higher PRL level may be more likely to have passive suicidal ideation, suggesting that more attention should be paid to these characteristics in clinical assessments of suicide risk.
Among people with various mental illnesses, those with schizophrenia have the highest incidence of aggressive behavior, which not only disturbs the medical environment, but also poses a great threat to family stability and social harmony. Previous regression analysis studies have shown that childhood trauma, self-esteem and resilience are influencing factors of aggressive behavior in schizophrenia patients, but few studies have explored the internal relationship between these four variables.
To explore the relationship between childhood trauma, self-esteem, resilience and aggressive behavior in schizophrenic patients using a self-constructed chain mediation model, and to clarify its internal mechanism.
A convenience sample of stable schizophrenia inpatients were selected from Daqing Third Hospital and Chifeng Anding Hospital from March 2021 to July 2022. A survey was conducted with them using a questionnaire consisting of general information questionnaire, Positive and Negative Symptom Scale (PANSS) , Childhood Trauma Questionnaire-Short Form (CTQ-SF) , Connor-Davidson Resilience Scale (CD-RISC) , Self-esteem Scale (SES) , and Aggressive Questionnaire (AQ) . Pearson correlation analysis was used to explore the correlation of AQ score with CTQ-SF, CD-RISC and SES scores. Multiple linear regression analysis was used to explore the influencing factors of aggressive behavior. AMOS 24.0 was used to construct the chain mediation model. The mediation effect of the chain mediation model was tested using Bootstrap method.
Three hundred and ten cases attended the survey, and 300 of them (96.8%) who responded effectively were finally included for analysis. The average scores of PANSS, CTQ-SF, SES, CD-RISC and AQ were (18.4±3.7) , (49.7±13.5) , (26.9±6.9) , (55.2±15.5) and (84.3±19.8) , respectively. Multiple linear regression analysis showed that childhood trauma〔B=0.551, 95%CI (0.421, 0.681) , P<0.001〕, self-esteem〔B=-0.661, 95%CI (-0.908, -0.413) , P<0.001〕and resilience〔B=-0.448, 95%CI (-0.561, -0.335) , P<0.001〕 were influencing factors of aggressive behavior. Pearson correlation analysis revealed that CTQ-SF scores were positively correlated with AQ scores (r=0.695, P<0.01) and negatively correlated with SES scores and CTQ-SF scores (r=-0.524, P<0.01; r=-0.565, P<0.01) ; SES scores were negatively correlated with AQ scores (r=-0.607, P<0.01) and positively correlated with CD-RISC scores (r= 0.522, P<0.01) ; the CD-RISC score was negatively correlated with the AQ scores (r=-0.681, P<0.01) . The chain mediation model test results showed that the goodness-of-fit of the model was good. Bootstrap test showed that the 95%CI of each mediation path did not include 0, and the mediation effect was significant. The overall effect of childhood trauma on aggressive behavior was significant〔β=0.810, 95%CI (0.743, 0.871) , P<0.001〕. The indirect effect of childhood trauma on aggressive behavior, that is, acting through the mediators of self-esteem and resilience, was significant〔β=0.473, 95%CI (0.362, 0.598) , P<0.001〕. The direct effect of childhood trauma on aggressive behavior was significant〔β=0.377, 95%CI (0.179, 0.485) , P<0.001〕.
Self-esteem and resilience play a chain mediating role between childhood trauma and aggressive behavior in patients with schizophrenia. In the future, a risk prediction model of aggressive behavior in schizophrenia patients can be constructed to assess the risk of aggressive behavior, which is contributive to early identification and management of those at risk of aggression, thereby reducing or preventing the occurrence of aggressive behavior.
The accuracy of data collection can be affected by bias in the understanding of the items between the developer and the target population during scale development.
To adjust the items of the Schizophrenia Help-seeking Motivation Scale using the cognitive interview.
A purposive sampling method was used to select 30 schizophrenia patients from a psychiatric hospital in Daqing City from December 2021 to January 2022 to attend three rounds of cognitive interviews. The interview data were collected, and coded using the Question Appraisal System (QAS-99) , and after the coding results were collated, the scale entries were adjusted by integrating respondent feedback and expert panel comments.
During the 1st round of interview, interviewees raised doubts on 11 entries, among which three were due to wording, seven were due to vague expressions, two were due to lack of inadequate knowledge, and one was due to the difficulty in recalling. And some of the entries were revised after discussion. The results of the 2nd round of interview showed that one entry was assumed to be inappropriate and was revised after discussion. The 3rd round of interview continued until the interviewees were able to understand the entries correctly, and they thought that there was no need to further revise the entries.
The cognitive interview effectively solved the problem of understanding differences between the developer and schizophrenia patients in the development of the Schizophrenia Help-seeking Motivation Scale, thus improving the accuracy and applicability of the scale.
