Background

While posttraumatic stress disorder (PTSD) symptoms in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are categorized into four clusters, emerging studies suggest the disorder is best characterized by seven symptom clusters: re-experiencing, avoidance, negative affect, anhedonia, externalizing behaviors, and anxious and dysphoric arousal symptoms. However, data are sparse regarding the relation between this novel model of DSM-5 PTSD symptoms and suicide risk.

Methods

Using data from the National Survey for Stress and Health, a sample of 6180 Japanese individuals, we evaluated the relationship between suicide ideation and PTSD symptoms using 4- and 7-factor models.

Results

Different association patterns were observed between each model and suicidal ideation. In the 4-factor model, we found re-experiencing feelings (odds ratio [OR] = 1.03, 95% confidence interval [CI] = 1.01–1.06, p = 0.002), negative alterations in cognition and mood symptoms (OR = 1.08, 95%CI = 1.06–1.09, p < 0.001), and hyperarousal (OR = 1.03, 95% CI = 1.01–1.05, p = 0.014) were associated with increased suicide ideation. In the 7-factor model, we found re-experiencing feelings (OR = 1.04, 95%CI = 1.02–1.06, p = 0.001), negative affect (OR = 1.04, 95%CI = 1.01–1.07, p = 0.012), anhedonia (OR = 1.08–1.16, 95%CI, p < 0.001), and externalizing behavior (OR = 1.12, 95%CI = 1.07–1.17, p < 0.001) were associated with increased suicide risk.

Conclusions

A more refined 7-factor model of DSM-5 PTSD symptoms may help us understand their associations with comorbid psychopathology and suicide. Prevention and treatment efforts that target distinct aspects of the PTSD phenotype may be more effective in mitigating key clinical and functional outcomes in this population.

中文翻译：

---

PTSD症状与自杀风险之间的关联：4因子和7因子模型的比较。

背景

虽然《精神障碍诊断和统计手册》第五版（DSM-5）中的创伤后应激障碍（PTSD）症状分为四个类别，但新兴研究表明，该疾病的特征是七个症状类别：重新体验，回避，负面影响，快感不足，外在行为以及焦虑和烦躁的唤醒症状。但是，关于这种新颖的DSM-5 PTSD症状模型与自杀风险之间关系的数据很少。

方法

我们使用来自6180名日本人的全国压力与健康调查（National Survey for Stress and Health）的数据，使用4因子和7因子模型评估了自杀观念与PTSD症状之间的关系。

结果

在每个模型和自杀意念之间观察到不同的关联模式。在四因素模型中，我们发现了重新体验（奇数比[OR] = 1.03，95％置信区间[CI] = 1.01–1.06，p = 0.002），认知和情绪症状的消极变化（OR = 1.08） ，95％CI = 1.06-1.09，p <0.001）和过度兴奋（OR = 1.03，95％CI = 1.01-1.05，p = 0.014）与自杀意念增加有关。在7因素模型中，我们发现了重新体验（OR = 1.04，95％CI = 1.02-1.06，p = 0.001），负面影响（OR = 1.04，95％CI = 1.01-1.07，p = 0.012） ，快感不足（OR = 1.08–1.16，95％CI，p <0.001）和外在化行为（OR = 1.12，95％CI = 1.07-1.17，p <0.001）与自杀风险增加相关。

结论

DSM-5 PTSD症状的更精确的7因素模型可能有助于我们了解其与合并症，心理病理学和自杀的关系。针对PTSD表型不同方面的预防和治疗工作可能会更有效地缓解该人群的关键临床和功能结局。