Which PTSD clusters and symptoms are central to reducing suicidal ideation? A network and cross-lagged analysis among individuals receiving cognitive processing therapy

Posttraumatic stress disorder (PTSD) is associated with suicidal ideation (SI) and SI tends to improve over the course of evidence-based psychotherapy for PTSD. However, it remains unclear which PTSD clusters and symptoms are central to changes in SI throughout treatment. To use (1) network analysis to identify the PTSD clusters and symptoms most uniquely related to SI (at baseline and post-treatment); and (2) cross-lagged analyses to examine whether these PTSD clusters and symptoms prospectively predicted decreases in SI over the course of cognitive processing therapy (CPT). Participants were 188 individuals with PTSD receiving CPT as part of an implementation-effectiveness trial. At each session, DSM-IV PTSD clusters and symptoms were assessed using the PTSD Checklist and SI was assessed using the Outcome Questionnaire-45. Multi-staged cross-sectional network analyses indicated that at baseline and post-treatment the avoidance and reexperiencing clusters were uniquely associated with SI. Within these clusters, the symptoms uniquely associated with SI were recurrent thoughts and dreams of trauma, restricted range of affect, and sense of foreshortened future at baseline; and sense of foreshortened future, restricted range of affect, recurrent dreams of trauma, feelings of detachment from others, memory impairment, avoidance of reminders of trauma, and psychological cue reactivity at post-treatment. Multilevel cross-lagged analyses indicated that the avoidance cluster and the restricted range of affect and sense of foreshortened future symptoms, uniquely predicted next-session decreases in SI. These findings suggest that reductions in SI within treatment may be due to direct targeting of avoidance, affect, and future-related cognitions. Further research remains necessary to determine whether the present findings extend to DSM-5 PTSD clusters and symptoms. At baseline and post-treatment the avoidance and reexperiencing PTSD clusters were uniquely associated with suicidal ideation.At baseline and post-treatment sense of foreshortened future and restricted range of affect were uniquely associated with suicidal ideation.The avoidance cluster and the restricted range of affect and sense of foreshortened future symptoms uniquely predicted next-session decreases in suicidal ideation.Targeting avoidance, affect, and future-related cognitions may be important for the treatment of suicidal ideation in the context of PTSD. At baseline and post-treatment the avoidance and reexperiencing PTSD clusters were uniquely associated with suicidal ideation. At baseline and post-treatment sense of foreshortened future and restricted range of affect were uniquely associated with suicidal ideation. The avoidance cluster and the restricted range of affect and sense of foreshortened future symptoms uniquely predicted next-session decreases in suicidal ideation. Targeting avoidance, affect, and future-related cognitions may be important for the treatment of suicidal ideation in the context of PTSD.

创伤后应激障碍（Posttraumatic stress disorder, PTSD）与自杀意念（suicidal ideation, SI）存在关联，且在针对PTSD的循证心理治疗过程中，自杀意念通常会有所改善。然而，目前仍不清楚在整个治疗过程中，哪些PTSD群集与症状是自杀意念变化的核心影响因素。本研究旨在通过两种分析方法展开研究：（1）采用网络分析，识别基线及治疗后阶段与自杀意念最具独特相关性的PTSD群集与症状；（2）运用交叉滞后分析，检验上述PTSD群集与症状是否能前瞻性预测认知加工治疗（cognitive processing therapy, CPT）过程中自杀意念的下降情况。本研究的被试为188名符合PTSD诊断的个体，他们作为实施有效性试验的受试者接受了CPT治疗。在每次会谈中，研究人员采用创伤后应激障碍检查表（PTSD Checklist）评估受试者的DSM-IV（《精神障碍诊断与统计手册第四版》）PTSD群集与症状，采用症状问卷-45（Outcome Questionnaire-45）评估自杀意念水平。多阶段横断面网络分析结果显示，在基线及治疗后阶段，回避群集与再体验群集均与自杀意念存在独特相关性。在这两类群集中，基线阶段与自杀意念独特相关的症状包括创伤相关反复想法与梦境、情感范围受限、预期寿命缩短感；治疗后阶段相关的症状则包括预期寿命缩短感、情感范围受限、创伤相关反复梦境、与他人脱离感、记忆损害、创伤线索回避及心理线索反应性。多层交叉滞后分析结果表明，回避群集以及情感范围受限、预期寿命缩短感这两项症状，能够独特预测下一次会谈时自杀意念的下降程度。本研究结果提示，治疗过程中自杀意念的缓解可能源于对回避行为、情感调节及未来相关认知的直接靶向干预。未来仍需开展进一步研究，以确认本研究发现是否适用于DSM-5（《精神障碍诊断与统计手册第五版》）的PTSD群集与症状。在基线及治疗后阶段，回避与再体验PTSD群集均与自杀意念存在独特相关性。在基线及治疗后阶段，预期寿命缩短感与情感范围受限均与自杀意念存在独特相关性。回避群集以及情感范围受限、预期寿命缩短感症状能够独特预测下一次会谈时自杀意念的下降。针对回避行为、情感调节及未来相关认知的干预，对于PTSD背景下的自杀意念治疗或具有重要意义。在基线及治疗后阶段，回避与再体验PTSD群集均与自杀意念存在独特相关性。在基线及治疗后阶段，预期寿命缩短感与情感范围受限均与自杀意念存在独特相关性。回避群集以及情感范围受限、预期寿命缩短感症状能够独特预测下一次会谈时自杀意念的下降。针对回避行为、情感调节及未来相关认知的干预，对于PTSD背景下的自杀意念治疗或具有重要意义。