Data Sheet 1_The mediating role of depression in the association between health-related quality of life and suicidal ideation in adolescents: findings from a longitudinal study.pdf

IntroductionAdolescent suicidality is a significant public health issue. To develop effective interventions aimed at preventing suicide in this vulnerable population, it is essential to understand the complex interplay of health-related quality of life, depression and suicidal ideation.
MethodsFor this purpose, we analyzed longitudinal data of 250 children and adolescents diagnosed with major depressive disorder (M = 15.7, SD = 1.6, range 8–18 years, 74% females). The main goal of the study was to examine whether the effect of health-related quality of life on individual trajectories of suicidal ideation is mediated by depression severity. A series of t-tests, Chi-squared-tests, Fisher’s exact tests and a mediation analysis including three robust linear mixed-effects models were conducted.
ResultsDepressed adolescents with suicidal ideation reported lower health-related quality of life across physical, psychological, peer, and school domains compared to those without suicidal ideation, while no significant difference was observed in the family-related domain. Psychological well-being emerged as the sole domain of health-related quality of life with a direct influence on suicidal ideation. Notably, depression severity mediated the effect of physical, psychological, peer- and school-related quality of life on suicidal ideation.
DiscussionOur findings suggest that improving health-related quality of life reduces depressive symptoms, which in turn leads to lower suicidal ideation. This highlights the importance of including health-related quality of life in the clinical assessment of suicide risk as well as targeting health-related quality of life in therapeutic interventions. In the light of the results of this study, interventions should not only focus on classical clinical criteria of psychiatric diagnoses such as major depressive disorder, but also on broader, more resource-oriented constructs such as health-related quality of life to better mitigate the risk of suicide in this vulnerable population.

Clinical Trial Registrationwww.ClinicalTrials.gov, identifier [NCT03167307].

引言 青少年自杀相关行为是一项重大公共卫生议题。为开发针对这一脆弱群体的自杀预防有效干预方案，明确健康相关生活质量（health-related quality of life）、抑郁与自杀意念（suicidal ideation）之间的复杂交互作用至关重要。

方法 为此，我们对250名确诊为重性抑郁障碍（major depressive disorder, MDD）的儿童及青少年的纵向数据开展分析，研究对象的年龄均值为15.7岁（标准差SD=1.6，年龄范围8~18岁，女性占比74%）。本研究的核心目标为检验抑郁严重程度是否在健康相关生活质量对自杀意念个体轨迹的影响中发挥中介作用。我们采用了一系列t检验、卡方检验、Fisher精确检验，并实施了包含3个稳健线性混合效应模型的中介分析。

结果 与无自杀意念的抑郁青少年相比，存在自杀意念的抑郁青少年在躯体、心理、同伴及学校领域的健康相关生活质量评分更低，而在家庭相关领域未观察到显著差异。心理幸福感是健康相关生活质量中唯一对自杀意念具有直接影响的维度。值得注意的是，抑郁严重程度在躯体、心理、同伴及学校相关生活质量对自杀意念的影响中起到了中介作用。

讨论 本研究结果表明，提升健康相关生活质量可减轻抑郁症状，进而降低自杀意念水平。这凸显了将健康相关生活质量纳入自杀风险临床评估，以及在治疗干预中针对健康相关生活质量进行干预的重要性。结合本研究结果，自杀预防干预不应仅聚焦于重性抑郁障碍等精神疾病的经典临床诊断标准，还应涵盖更广泛的、以资源为导向的构念，如健康相关生活质量，从而更好地降低这一脆弱群体的自杀风险。

临床试验注册：www.ClinicalTrials.gov，标识符[NCT03167307]。