Ergenlerde intihar olasılığını yordayan etmenler: Katı-duyarsız özellikler, çocukluk çağı travmaları ve algılanan sosyal destek

Öz

Amaç: Bu çalışmada ergenlerde intihar riski ile psikiyatrik özellikler, aile yapısı, algılanan sosyal destek, katı duyarsız kişilik özellikleri ve çocukluk çağı travmaları arasındaki ilişki incelenmiştir. Ergenlik döneminde intiharın çok boyutlu bir olgu olduğu ve biyopsikososyal etkenlerin birlikte ele alınmasının önem taşıdığı kabul edilmektedir. Bu bağlamda çalışmanın amacı, intihar riski yüksek ve düşük ergen gruplarını çeşitli psikososyal ve klinik değişkenler açısından karşılaştırarak riskle ilişkili belirleyici faktörleri ortaya koymaktır. Gereç ve Yöntemler: Çalışmaya çocuk ve ergen ruh sağlığı polikliniğine başvuran, 14–18 yaş aralığında toplam 77 ergen dahil edilmiştir. Katılımcılar, İntihar Olasılığı Ölçeği puanlarına göre yüksek risk (n=40) ve düşük risk (n=37) olmak üzere iki gruba ayrılmıştır. Tüm katılımcılara Çocukluk Çağı Travmaları Ölçeği, Katı-Duyarsız Özellikler Ölçeği ve Çok Boyutlu Algılanan Sosyal Destek Ölçeği uygulanmış, ardından deneyimli bir çocuk ve ergen psikiyatristi tarafından klinik değerlendirme yapılmıştır. Veriler uygun parametrik ve parametrik olmayan testlerle analiz edilmiş, anlamlılık düzeyi p < 0,05 olarak belirlenmiştir. Bulgular: Yaş, cinsiyet, aile yapısı, gelir düzeyi, sosyal destek ve uyku süresi açısından gruplar arasında anlamlı fark bulunmamıştır. Yüksek risk grubunda geçmiş intihar girişimi ve depresyon tanısı daha sık görülmüştür. Bu gruptaki ergenlerin katı duyarsız özellik puanları ile fiziksel ve duygusal istismar düzeyleri anlamlı derecede daha yüksek bulunmuştur. Cinsel istismar, fiziksel ihmal ve duygusal ihmal açısından anlamlı fark saptanmamıştır. Sonuç: Bulgular, ergenlerde intihar olasılığının özellikle depresif belirtiler, katı duyarsız kişilik özellikleri ve fiziksel ile duygusal istismar deneyimleriyle ilişkili olduğunu göstermektedir. Klinik değerlendirmede intihar riskinin çok boyutlu biçimde ele alınması ve travma ile duygu düzenleme odaklı müdahalelerin önceliklendirilmesi gerektiği sonucuna varılmaktadır.

Anahtar Kelimeler

• Ergen
• katı-duyarsız özellikler
• çocukluk çağı travması
• depresyon
• intihar

Proje Numarası

Yoktur

Predictors of suicide risk in adolescents: Callous–unemotional traits, childhood traumas, and perceived social support

Öz

Aim: This study examined the relationship between suicide risk and psychiatric characteristics, family structure, perceived social support, callous–unemotional personality traits, and childhood trauma in adolescents. Suicide in adolescence is considered a multidimensional phenomenon, and the simultaneous evaluation of biopsychosocial factors is regarded as essential. Accordingly, the aim of this study is to identify the determinants associated with suicide risk by comparing adolescents with high and low suicide risk across various psychosocial and clinical variables. Material and Methods: The study included a total of 77 adolescents aged 14–18 who presented to a child and adolescent mental health outpatient clinic. Participants were divided into two groups based on their Suicide Probability Scale scores: high risk (n=40) and low risk (n=37). All participants completed the Childhood Trauma Questionnaire, the Inventory of Callous–Unemotional Traits (CU traits), and the Multidimensional Scale of Perceived Social Support, followed by a clinical psychiatric evaluation conducted by an experienced child and adolescent psychiatrist. Data were analyzed using appropriate parametric and non-parametric statistical tests, and the significance level was set at p < 0.05. Results: There were no significant differences between the groups regarding age, gender, family structure, income level, perceived social support, or sleep duration. A history of suicide attempt and a diagnosis of depression were more common in the high-risk group. Adolescents in this group also had significantly higher callous–unemotional trait scores and higher levels of physical and emotional abuse. No significant differences were found for sexual abuse, physical neglect, or emotional neglect. Conclusion: The findings indicate that suicide risk in adolescents is particularly associated with depressive symptoms, CU traits, and experiences of physical and emotional abuse. It is concluded that a multidimensional approach is essential in the clinical assessment of suicide risk and that interventions focusing on trauma and emotion regulation should be prioritized particularly in adolescents with depressive symptoms and elevated callous–unemotional traits.

Anahtar Kelimeler

• Adolescent
• callous–unemotional traits
• childhood trauma
• depression
• suicide

Proje Numarası

Yoktur

Kaynakça

1. Shain B, Braverman PK, Adelman WP, Alderman EM, Breuner CC, Levine DA, et al. Suicide and suicide attempts in adolescents. Pediatrics. 2016;138(1):e20161420. https://doi.org/10.1542/peds.2016-1420
2. Hua L, Lee J, Rahmandar M, Sigel E. Suicide and suicide risk in adolescents. Pediatrics. 2024;153(1):e2023064800. https://doi.org/10.1542/peds.2023-064800
3. Ati NA, Paraswati MD, Windarwati HD. What are the risk factors and protective factors of suicidal behavior in adolescents? A systematic review. J Child Adolesc Psychiatr Nurs. 2021;34(1):7-18. https://doi.org/10.1111/jcap.12295
4. Bilsen J. Suicide and youth: risk factors. Front Psychiatry. 2018;9:540. https://doi.org/10.3389/fpsyt.2018.00540
5. Jiménez T, Estévez-García F, Estévez E. Suicidal behavior in adolescents: An ecological-relational study. Psicothema. 2024;36(4):389-402. https://doi.org/10.7334/psicothema2023.258
6. Bae S, Lee DH, Lee DH, Seo AY, Choi YH. Comparative analysis of characteristics of patients who visited the emergency department due to suicide attempts during coronavirus disease-2019 pandemic. Omega (Westport). 2022;90(1):372-387. https://doi.org/10.1177/00302228221106286
7. Asante KO, Kugbey N, Osafo J, Quarshie ENB, Sarfo JO. The prevalence and correlates of suicidal behaviours (ideation, plan and attempt) among adolescents in senior high schools in Ghana. SSM Popul Health. 2017;3:427-434. https://doi.org/10.1016/j.ssmph.2017.05.005
8. Hogg B, Gardoki-Souto I, Valiente-Gómez A, Rosa A, Fortea L, Raduà J, et al. Psychological trauma as a transdiagnostic risk factor for mental disorder: an umbrella meta-analysis. Eur Arch Psychiatry Clin Neurosci. 2022;273:397-410. https://doi.org/10.1007/s00406-022-01495-5

9. Jiménez-Treviño L, González-Blanco L, García-Portilla M, Fontecilla B, Castroman L, Courtet P, et al. Childhood trauma in suicide attempters: Case-control study. Eur Psychiatry. 2016;33:S111-S111. https://doi.org/10.1016/j.eurpsy.2016.01.105
10. Zatti C, Rosa V, Barros A, Valdivia L, Calegaro V, Freitas L, et al. Childhood trauma and suicide attempt: A meta-analysis of longitudinal studies from the last decade. Psychiatry Res. 2017;256:353-358. https://doi.org/10.1016/j.psychres.2017.06.082
11. Shi X, Meng Y, Cheng B, Long L, Yin L, Ye A, et al. Association between traumatic events with suicidality among adolescents: A large-scale cross-sectional study of 260,423 participants. Psychiatry Res. 2024;333:115762. https://doi.org/10.1016/j.psychres.2024.115762
12. Ashaba S, Cooper-Vince C, Maling S, Satinsky E, Baguma C, Akena D, et al. Childhood trauma, major depressive disorder, suicidality, and the modifying role of social support among adolescents living with HIV in rural Uganda. J Affect Disord Rep. 2021;4:100094. https://doi.org/10.1016/j.jadr.2021.100094
13. Viding E, Fontaine NMG, McCrory E. Antisocial behaviour in children with and without callous-unemotional traits. J R Soc Med. 2012;105(5):195-200. https://doi.org/10.1258/jrsm.2011.110223
14. Liu J, Ran G, Zhang Q, Li Y, Zhang Q. The association between callous-unemotional traits and suicide ideation among youth: A conditional process analysis. J Affect Disord. 2023;328:245-254. https://doi.org/10.1016/j.jad.2023.02.063
15. Atlı Z, Eskin M, Dereboy Ç. İntihar olasılığı ölçeğinin (İOÖ) klinik örneklemde geçerlik ve güvenirliği. Klinik Psikiyatri Dergisi. 2009;12(3):111-124.
16. Bernstein DP, Fink L, Handelsman L, Foote J. Childhood trauma questionnaire. In: Assessment of family violence: a handbook for researchers and practitioners. 1998.
17. Şar V, Öztürk E, İkikardeş E. Çocukluk çağı ruhsal travma ölçeğinin Türkçe uyarlamasının geçerlilik ve güvenilirliği. Türk Psikiyatri Dergisi. 2012;23(1):46-57.
18. Cull JG, Gill WS. Suicide probability scale. Los Angeles: Western Psychological Services, 1988.
19. Frick PJ. The inventory of callous-unemotional traits. University of New Orleans, 2003 https://doi.org/10.1037/t62639-000
20. Essau CA, Sasagawa S, Frick PJ. Callous-unemotional traits in a community sample of adolescents. Assessment. 2006;13(4):454-469. https://doi.org/10.1177/1073191106287354
21. Köse S, Kalyoncu T, Özyurt B, Özbaran N. Katı-duygusuz özellikleri tarama ölçeği-gençlik formu Türkçe uyarlamasının psikometrik özellikleri. J Pediatr Res. 2017;4(3):123-129.
22. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess. 1988;52(1):30-41. https://doi.org/10.1207/s15327752jpa5201_2
23. Efthymiou V, Chrousos GP, Kounenou K, Kalamatianos A, Pezirkianidis C, Korelopoulos M, et al. Validity and reliability of the multidimensional scale of perceived social support (MSPSS) in Greek secondary school students. Children (Basel). 2025;12(6):706. https://doi.org/10.3390/children12060706
24. Eker D, Arkar H, Yaldız H. Çok boyutlu algılanan sosyal destek ölçeği'nin gözden geçirilmiş formunun faktör yapısı, geçerlik ve güvenirliği. Türk Psikiyatri Dergisi. 2001;9.
25. Amerikan Psikiyatri Birliği. Ruhsal bozuklukların tanısal ve istatistiksel el kitabı. 5. baskı. Çev. Köroğlu E. Hekimler Yayın Birliği, 2013.
26. IBM Corp. IBM SPSS Statistics for Windows, version 26.0. Armonk (NY): IBM Corp, 2019.
27. King C, Grupp-Phelan J, Brent D, Dean J, Webb M, Bridge J, et al. Predicting 3-month risk for adolescent suicide attempts among pediatric emergency department patients. J Child Psychol Psychiatry. 2019;60(10):1055-1064. https://doi.org/10.1111/jcpp.13087
28. Lee J, Bang YS, Min S, Ahn J, Kim H, Sung Y, et al. Characteristics of adolescents who visit the emergency department following suicide attempts: comparison study between adolescents and adults. BMC Psychiatry. 2019;19(1). https://doi.org/10.1186/s12888-019-2213-5
29. Orri M, Scardera S, Perret L, Bolanis D, Temcheff C, Séguin J, et al. Mental health problems and risk of suicidal ideation and attempts in adolescents. Pediatrics. 2020;146. https://doi.org/10.1542/peds.2019-3823
30. Fergusson DM, Horwood LJ, Ridder EM, Beautrais AL. Suicidal behaviour in adolescence and subsequent mental health outcomes in young adulthood. Psychol Med. 2005;35(7):983-993. https://doi.org/10.1017/S0033291704004167
31. Souza LC, Galvão LP, Paiva HS, Périco CdA, Ventriglio A, Torales J, et al. Major depressive disorder as a risk factor for suicidal ideation for attendees of educational institutions: a meta-analysis and meta-regression. Rev Paul Pediatr. 2023;41: e2021344. https://doi.org/10.1590/1984-0462/2023/41/2021344
32. Kim HS, Kim HS. Risk factors for suicide attempts among Korean adolescents. Child Psychiatry Hum Dev. 2007;39(3):221-235. https://doi.org/10.1007/s10578-007-0083-4
33. Zhang S, Chen J, Kuang L, Cao J, Zhang H, Ai M, et al. Association between abnormal default mode network activity and suicidality in depressed adolescents. BMC Psychiatry. 2016;16(1): 337. https://doi.org/10.1186/s12888-016-1047-7
34. Zhong H, Zhang J, Mo D, Zheng H, Li M, Liu W, et al. Functional connectivity density of different suicidal behaviors in adolescents with major depressive disorders. Front Psychiatry. 2024;15:1491042. https://doi.org/10.3389/fpsyt.2024.1491042
35. Geduk G, Sağlam G, Biltekin H. Koronavirüs hastalığı 2019 (COVID-19) pandemisi sırasında diş hekimine başvuran hastalarda bilgi ve endişe düzeyinin değerlendirilmesi: anket çalışması. Med J West Black Sea. 2021;5(2):232-239.https://doi.org/10.29058/mjwbs.868872
36. Ibrahim N, Din NC, Ahmad M, Amit N, Ghazali SE, Wahab S, et al. The role of social support and spiritual wellbeing in predicting suicidal ideation among marginalized adolescents in Malaysia. BMC Public Health. 2019;19(S4): 553. https://doi.org/10.1186/s12889-019-6861-7
37. Bao X, Guo T, Xu L, Chen W, Luan L, Yang H, et al. Suicidal ideation in Chinese adolescents: prevalence, risk factors, and partial mediation by family support, a cross-sectional study. Front Psychiatry. 2024;15: 1427560. https://doi.org/10.3389/fpsyt.2024.1427560
38. Kalgren T, Brausch AM. Social support and suicide ideation in clinical and community adolescents. J Clin Psychol. 2025;81(9):847-854. https://doi.org/10.1002/jclp.70001
39. Xin M, Petrovic J, Zhang L, Yang X. Relationships between negative life events and suicidal ideation among youth in China: the direct and moderating effects of offline and online social support from gender perspective. Front Psychol. 2022;13: 998535. https://doi.org/10.3389/fpsyg.2022.998535
40. Javdani S, Sadeh N, Verona E. Suicidality as a function of impulsivity, callous-unemotional traits, and depressive symptoms in youth. J Abnorm Psychol. 2011;120(2):400-413. https://doi.org/10.1037/a0021805
41. Frick PJ, Ray JV, Thornton LC, Kahn RE. Annual research review: a developmental psychopathology approach to understanding callous-unemotional traits in children and adolescents with serious conduct problems. J Child Psychol Psychiatry. 2013;55(6):532-548. https://doi.org/10.1111/jcpp.12152
42. Fan Q, Liu Q, Liu C, Wang Z. Childhood trauma and suicidal ideation among Chinese adolescents: the mediating effects of character strengths and perceived stress. J Psychiatr Ment Health Nurs. 2023;30(3):526-536. https://doi.org/10.1111/jpm.12892
43. Dykxhoorn J, Hatcher S, Roy-Gagnon M, Colman I. Early life predictors of adolescent suicidal thoughts and adverse outcomes in two population-based cohort studies. PLoS One. 2017;12(8):e0183182. https://doi.org/10.1371/journal.pone.0183182
44. Dube SR, Anda RF, Felitti VJ, Chapman DP, Williamson DF, Giles WH. Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study. JAMA. 2001;286(24):3089-3096. https://doi.org/10.1001/jama.286.24.3089