adverse childhood experiences ad suicide (structured Equational Modeling)

Objectives: Major Depressive Disorder (MDD) is a severe and prevalent psychiatric disorder around the world. Suicidal ideation is one of the hallmark symptoms of this disorder. Multiple studies have investigated the role of adverse childhood experiences on the occurrence of suicidal ideation in adulthood. Nevertheless, research examining the underlying mechanisms that mediate this relationship is limited. Accordingly, the present study aimed to investigate whether the relationship between adverse childhood experiences and suicidal ideation is atemporally mediated by emotional reactivity, and probabilistic and reinforcement learning (PRL) in Iranian patients with MDD. Method: Participants included 201 inpatients with MDD who were hospitalized in psychiatric wards of various hospitals in Shiraz, Iran. Participants were selected through the convenient sampling method. The data were collected using the Probabilistic Reward Task, Emotional Reactivity Scale, Beck Scale of Suicidal Ideation, and the Modified Adverse Childhood Experiences – International Questionnaire. Collected data were analyzed using Pearson’s correlation test and structural equation modeling in SPSS and AMOS 26. Results: Adverse childhood experiences had a direct and significant relationship with suicidal ideation (p &lt; .001). Moreover, emotional reactivity and PRL significantly mediated the relationship between adverse childhood experiences and suicidal ideation. Conclusion: Our findings showed that multiple factors including adverse childhood experiences, emotional reactivity, and PRL may have a role in the occurrence of suicidal ideation in patients with MDD. Accordingly, addressing these factors in therapeutic plans should be taken into consideration.研究目的：重性抑郁障碍（Major Depressive Disorder, MDD）是全球范围内严重且高发的精神疾病。自杀意念是该疾病的标志性症状之一。既往多项研究探讨了童年不良经历对成年期自杀意念发生的作用，但针对介导该关联的潜在机制的研究仍较为有限。据此，本研究旨在探究伊朗重性抑郁障碍患者中，童年不良经历与自杀意念之间的关联是否可通过情绪反应性以及概率与强化学习（Probabilistic and Reinforcement Learning, PRL）实现非时间性中介。 研究方法：本研究纳入201名来自伊朗设拉子多家医院精神科病房的重性抑郁障碍住院患者，采用方便抽样法选取研究对象。数据采集工具包括概率奖赏任务、情绪反应性量表、贝克自杀意念量表以及改良版国际童年不良经历问卷。采用SPSS与AMOS 26软件进行Pearson相关分析与结构方程模型分析。 研究结果：童年不良经历与自杀意念存在直接且显著的关联（p < 0.001）。此外，情绪反应性与PRL显著介导了童年不良经历与自杀意念之间的关联。 研究结论：本研究结果显示，童年不良经历、情绪反应性以及PRL等多项因素可能参与重性抑郁障碍患者自杀意念的发生过程。据此，临床治疗方案的制定应考虑针对上述因素进行干预。