Self-Transcendence Mediates the Relationship between Early Trauma and Fatal Methods of Suicide Attempts

다국어 초록 (Multilingual Abstract)

Background: Early trauma is known to be a risk factor of suicide-related behavior. On the other hand, people who attempt suicide using a fatal method are reported to be more likely to complete suicide. In this study, we assumed that early trauma affects an individual's temperament and character and thereby increases the risk of a fatal method of suicide attempts.
Methods: We analyzed 92 people with a history of previous suicide attempts. We compared the Temperament and Character Inventory-Revised scores between the groups with and without early trauma, and between the groups with and without a history of suicide attempt using fatal methods through an analysis of covariance with age, sex, and presence of a psychiatric history as covariates. A mediation analysis was conducted of the relationship between early trauma and fatal methods of suicide attempt with self-transcendence as a mediator.
Results: Higher self-transcendence was reported in the fatal group (27.71 ± 13.78 vs. 20.97 ± 12.27, P = 0.010) and the early trauma group (28.05 ± 14.30 vs. 19.43 ± 10.73, P = 0.001), respectively. The mediation model showed that self-transcendence mediates the relationship between early trauma and fatal methods of suicide attempt. The 95% confidence intervals for the direct and indirect effect were (−0.559, 1.390) and (0.026, 0.947), respectively.
Conclusion: Self-transcendence may mediate the relationship between early trauma and fatal methods of suicide attempt. Self-transcendence may be associated with unhealthy defenses and suicidal behavior for self-punishment and may constitute a marker of higher suicide risk.

참고문헌 (Reference)

1 김영은, "Years of Life Lost due to Premature Death in People with Disabilities in Korea: the Korean National Burden of Disease Study Framework" 대한의학회 34 (34): 1-12, 2019

2 Hardt J, "Validity of adult retrospective reports of adverse childhood experiences : review of the evidence" 45 (45): 260-273, 2004

3 Yoo SW, "Validity of Korean version of the miniinternational neuropsychiatric interview" 2 (2): 50-55, 2006

4 Birt MA, "Use of the temperament and character inventory personality questionnaire in dysthymic disorder. Medica" 1 (1): 29-34, 2006

5 Kim YE, "Trends and patterns of burden of disease and injuries in Korea using disability-adjusted life years" 34 (34): e75-, 2019

6 Zdankiewicz-Ścigała E, "Trauma, temperament, alexithymia, and dissociation among persons addicted to alcohol : mediation model of dependencies" 9 : 1570-, 2018

7 Allen AR, "Trauma and suicide : a pilot study assessing risk in adults diagnosed with schizophrenia spectrum disorders" 208 (208): 431-434, 2020

8 Yaden DB, "The varieties of self-transcendent experience" 21 (21): 143-160, 2017

9 Fergusson DM, "The stability of child abuse reports : a longitudinal study of the reporting behaviour of young adults" 30 (30): 529-544, 2000

10 Crestani Calegaro V, "The role of personality in posttraumatic stress disorder, trait resilience, and quality of life in people exposed to the Kiss nightclub fire" 14 (14): e0220472-, 2019

11 Margolin G, "The effects of family and community violence on children" 51 (51): 445-479, 2000

12 De Bellis MD, "The biological effects of childhood trauma" 23 (23): 185-222, 2014

13 Cloninger CR, "The Temperament and Character Inventory-Revised" Washington University 1999

14 Samsung Medical Center, "The Survey of Mental Disorders in Korea 2016" Ministry of Health and Welfare 2017

15 Giuseppe Craparo, "The Relationships between Early Trauma, Dissociation, and Alexithymia in Alcohol Addiction" 대한신경정신의학회 11 (11): 330-335, 2014

16 Sheehan DV, "The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10" 59 (59): 22-33, 1998

17 Park CH, "The Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior : study rationale, methodology, and baseline sample characteristics of a long-term, large-scale, multi-center, prospective, naturalistic, observational cohort study" 88 : 29-38, 2019

18 Ju-Ri Jeon, "The Early Trauma Inventory Self Report-Short Form: Psychometric Properties of the Korean Version" 대한신경정신의학회 9 (9): 229-235, 2012

19 우정민, "The Association of Childhood Experience of Peer Bullying with DSM-IV Psychiatric Disorders and Suicidality in Adults: Results from a Nationwide Survey in Korea" 대한의학회 34 (34): 1-12, 2019

20 Jylhä PJ, "Temperament, character, and suicide attempts in unipolar and bipolar mood disorders" 77 (77): 252-260, 2016

21 Perroud N, "Temperament personality profiles in suicidal behaviour : an investigation of associated demographic, clinical and genetic factors" 146 (146): 246-253, 2013

22 Nery FG, "Temperament and character traits in patients with bipolar disorder and associations with comorbid alcoholism or anxiety disorders" 42 (42): 569-577, 2008

23 Sarısoy G, "Temperament and character traits in patients with bipolar disorder and associations with attempted suicide" 53 (53): 1096-1102, 2012

24 Conrad R, "Temperament and character personality profile in relation to suicidal ideation and suicide attempts in major depressed patients" 170 (170): 212-217, 2009

25 Ardani AR, "Temperament and character personality profile and affective temperaments in self-poisoning nonlethal suicide attempters" 229 (229): 394-400, 2015

26 Okan Ekinci, "Temperament and Character in Euthymic Major Depressive Disorder Patients: The Effect of Previous Suicide Attempts and Psychotic Mood Episodes" 대한신경정신의학회 9 (9): 119-126, 2012

27 Min BB, "Temperament and Character Inventory-Family Manual" Maumsarang 2007

28 Hansenne M, "Temperament and Character Inventory(TCI)and depression" 33 (33): 31-36, 1999

29 Hong HS, "Survey on Mental Health Literacy of Korean Adults" Seoul National Hospital 2008

30 World Health Organization, "Suicide: fact sheets"

31 Pompili M, "Suicide risk and personality traits in physically and/or sexually abused acute psychiatric inpatients : a preliminary study" 105 (105): 554-568, 2009

32 Zhang J, "Suicide means used by Chinese rural youths : a comparison between those with and without mental disorders" 199 (199): 410-415, 2011

33 Bostwick JM, "Suicide attempt as a risk factor for completed suicide : even more lethal than we knew" 173 (173): 1094-1100, 2016

34 Spicer RS, "Suicide acts in 8 states : incidence and case fatality rates by demographics and method" 90 (90): 1885-1891, 2000

35 Paivio SC, "Stability of retrospective self-reports of child abuse and neglect before and after therapy for child abuse issues" 25 (25): 1053-1068, 2001

36 Melhem NM, "Severity and variability of depression symptoms predicting suicide attempt in High-risk individuals" 76 (76): 603-613, 2019

37 Rademaker AR, "Self-reported early trauma as a predictor of adult personality : a study in a military sample" 64 (64): 863-875, 2008

38 Joyce PR, "Self-mutilation and suicide attempts : relationships to bipolar disorder, borderline personality disorder, temperament and character" 44 (44): 250-257, 2010

39 Anderson CB, "Self-harm and suicide attempts in individuals with bulimia nervosa" 10 (10): 227-243, 2002

40 Maes M, "Seasonality in violent suicide but not in nonviolent suicide or homicide" 150 (150): 1380-1385, 1993

41 Parra-Uribe I, "Risk of re-attempts and suicide death after a suicide attempt : a survival analysis" 17 (17): 163-, 2017

42 Fergusson DM, "Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood" 30 (30): 23-39, 2000

43 Woo YS, "Relationship of temperament and character in remitted depressed patients with suicidal ideation and suicide attempts--results from the CRESCEND study" 9 (9): e105860-, 2014

44 Evren C, "Relationship of alexithymia and temperament and character dimensions with lifetime post-traumatic stress disorder in male alcohol-dependent inpatients" 64 (64): 111-119, 2010

45 Maltsberger JT, "Reducing suicide : a national imperative" 191 (191): 623-624, 2003

46 Haw C, "Psychiatric and personality disorders in deliberate self-harm patients" 178 (178): 48-54, 2001

47 Josefsson K, "Personality profiles identify depressive symptoms over ten years? A population-based study" 2011 : 431314-, 2011

48 North CS, "Personality and posttraumatic stress disorder among directly exposed survivors of the Oklahoma City bombing" 53 (53): 1-8, 2012

49 Yoon SJ, "Patterns of temperament and character in patients with posttraumatic stress disorder and their association with symptom severity" 50 (50): 226-231, 2009

50 "Organisation for Economic Co-operation and Development (OECD) Health Statistics"

51 Cero I, "Moderating factors in the path from physical abuse to attempted suicide in adolescents : application of the interpersonal-psychological theory of suicide" 43 (43): 296-304, 2013

52 Reed PG, "Middle Range Theory for Nursing" Springer Publishing 109-140, 2013

53 Denning DG, "Method choice, intent, and gender in completed suicide" 30 (30): 282-288, 2000

54 Dumais A, "Is violent method of suicide a behavioral marker of lifetime aggression" 162 (162): 1375-1378, 2005

55 Braquehais MD, "Is impulsivity a link between childhood abuse and suicide" 51 (51): 121-129, 2010

56 Hayes AF, "Introduction to Mediation, Moderation, and Conditional Process Analysis" Guilford Publications 2017

57 Quilty LC, "Harm avoidance as a mediator of treatment response to antidepressant treatment of patients with major depression" 79 (79): 116-122, 2010

58 Tsirigotis K, "Gender differentiation in methods of suicide attempts" 17 (17): PH65-PH70, 2011

59 Oh SH, "Factors associated with choice of high lethality methods in suicide attempters : a cross-sectional study" 8 (8): 43-, 2014

60 Yeum TS, "Factors affecting suicide method lethality among suicide attempters in the Korea national suicide survey" 206 (206): 202-210, 2018

61 MacDonald DA, "Examination of the psychometric properties of the temperament and character inventory self-transcendence dimension" 32 (32): 1013-1027, 2002

62 North CS, "Distinguishing distress and psychopathology among survivors of the Oakland/Berkeley firestorm" 71 (71): 35-45, 2008

63 Bortolon C, "Dissociation mediates the relationship between childhood trauma and experiences of seeing visions in a French sample" 206 (206): 850-858, 2018

64 Marusak HA, "Disrupted insula-based neural circuit organization and conflict interference in trauma-exposed youth" 8 : 516-525, 2015

65 Lim M, "Difference in suicide methods used between suicide attempters and suicide completers" 8 (8): 54-, 2014

66 American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR)"

67 Bernstein DP, "Development and validation of a brief screening version of the Childhood Trauma Questionnaire" 27 (27): 169-190, 2003

68 Bremner JD, "Development and preliminary psychometric properties of an instrument for the measurement of childhood trauma : the Early Trauma Inventory" 12 (12): 1-12, 2000

69 C. Hyung Keun Park, "Comparison of Baseline Characteristics between Community-based and Hospital-based Suicidal Ideators and Its Implications for Tailoring Strategies for Suicide Prevention: Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior" 대한의학회 32 (32): 1522-1533, 2017

70 De Fruyt F, "Cloninger's psychobiological model of temperament and character and the five-factor model of personality" 29 (29): 441-452, 2000

71 Yubeen Bae, "Clinical Characteristics of Non-Suicidal Self-Injury and Suicide Attempts among Psychiatric Patients in Korea: A Retrospective Chart Review" 대한신경정신의학회 17 (17): 320-330, 2020

72 de Carvalho HW, "Childhood trauma is associated with maladaptive personality traits" 44 : 18-25, 2015

73 Berkowski M, "Childhood trauma and the development of paranormal beliefs" 202 (202): 305-312, 2014

74 Perkins SL, "Childhood physical abuse and differential development of paranormal belief systems" 194 (194): 349-355, 2006

75 Brown J, "Childhood abuse and neglect : specificity of effects on adolescent and young adult depression and suicidality" 38 (38): 1490-1496, 1999

76 Bernstein DP, "Childhood Trauma Questionnaire : a Retrospective Self-Report" The Psychological Corporation 1998

77 우선진, "Characteristics of High-intent Suicide Attempters Admitted to Emergency Departments" 대한의학회 33 (33): 1-12, 2018

78 김하린, "Characteristics and Trends of Suicide Attempt or Non-suicidal Self-injury in Children and Adolescents Visiting Emergency Department" 대한의학회 35 (35): 1-11, 2020

79 Hom MA, "Atypical and severe nonsuicidal self-injury as an indicator of severe psychopathology : findings from a sample of high-risk community mental health clients" 206 (206): 582-588, 2018

80 Beck AT, "An inventory for measuring depression" 4 (4): 561-571, 1961

81 Beck AT, "An inventory for measuring clinical anxiety : psychometric properties" 56 (56): 893-897, 1988

82 Conwell Y, "Age differences in behaviors leading to completed suicide" 6 (6): 122-126, 1998

83 Fico G, "Affective temperaments and clinical course of bipolar disorder: an exploratory study of differences among patients with and without a history of violent suicide attempts" 55 (55): E390-, 2019

84 Cloninger CR, "A psychobiological model of temperament and character" 50 (50): 975-990, 1993

85 Carlson EA, "A prospective investigation of the development of borderline personality symptoms" 21 (21): 1311-1334, 2009

86 Paolucci EO, "A meta-analysis of the published research on the effects of child sexual abuse" 135 (135): 17-36, 2001

87 Seoul National University College of Medicine, "2018 National Survey on Suicide" Ministry of Health and Welfare 2019