Ergenlikten beliren yetişkinliğe geçişte intihar davranışının gidişi ve gelişimsel bağlamı: Boylamsal bir çalışma
Küçük Resim Yok
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Giriş: Ergenlik döneminde depresyon geçiren ve intihar davranışları olan bireylerde, intihar ile ilişkili olan klinik ve gelişimsel risk faktörlerin boylamsal olarak değerlendirilmesi son derece önemlidir. Kimlik duygusu, duygusal özerklik ve ebeveynlerle olan ilişkiler gibi gelişimsel kavramların boylamsal olarak ele alındığı çalışmaların alanda sınırlı sayıda olduğu görülmektedir. Amaç: Bu çalışmada ergenlik döneminde gelişimsel nedenler ile depresyon geçiren ve bir kısmında intihar davranışları olan gençlerin, beliren yetişkinlik döneminde intihar davranışlarının seyri ve intiharın klinik ve gelişimsel risk faktörlerinin değerlendirilmesi amaçlanmıştır. İntihar davranışlarında etkisi olduğu bilinen depresyon şiddeti, yaşam kalitesi, kimlik duygusu, duygusal özerklik, ebeveyn-genç ilişkilerinin intihar riski üzerindeki etkileri değerlendirilecektir. Ayrıca, ergenlik dönemindeki depresyonunun beliren yetişkinlikte tanısal gidişatı ve süreçteki klinik ve gelişimsel ölçek verilerinin değişimi incelenecektir. Yöntem: EÜTF ÇERSAH Anabilim Dalı Gençlik Ruh Sağlığı Danışma ve Tedavi Birimi'nde 2013 yılında Prof. Dr. Tezan Bildik'in danışmanlığında yürütülmüş olan, Doç. Dr. Çiğdem Yektaş'ın ''Depresyon Tanılı Kız Ergenlerde I?ntı?har Davranıs?ının Dog?ası ve Gelı?s?ı?msel Bag?lamı: Kı?mlı?k Duygusu, Ergen-Ebeveyn I?lı?s?kı?lerı? ve Duygusal O?zerklı?k'' adlı tez çalışmasının devamı niteliğinde bir izlem çalışması yapılmıştır. 2012 yılındaki tez çalışmasına 94 kız ergen kız hastanın dahil edildiği görülmüştür. Bu hastalara arşiv dosya kayıtları ve hastane bilgi sistemi üzerinden ulaşılmaya çalışılmış ve çalışmaya katılmayı kabul eden 54 hasta ile izlem çalışması tamamlanmıştır. Çalışmaya katılan hastaların gönüllü onamları alınmıştır. Hastaların, izlemin başında ve sonunda olmak üzere 2 noktada değerlendirmeleri yapılmıştır. 2012 yılına ait veri setinde çalışmaya katılan hastaların, Beck Depresyon Ölçeği (BDÖ), Duygusal Özerklik Ölçeği (DÖÖ), Anne-Baba Ergen İlişki Envanteri (PARQ), Kimlik Duygusu Değerlendirme Aracı (KDDA), Özkıyım Değerlendirme Formu (ÖDF), Çocuk Yaşam Kalitesi Ölçeği (KIDDO-KINDL) skorları yer almaktadır. İzlem sonunda (2022) hastalara BDÖ, DÖÖ, PARQ, KDDA, ÖDF tekrar uygulanmıştır. Ayrıca Beliren Yetişkinlik Ölçeği (BYÖ), Yaşam Kalitesi Ölçeği (SF-36) ve Tehdit Edici Yaşam Olayları Listesi (TEOL) uygulanmıştır. DSM-5 tanı ölçütlerine göre yarı yapılandırılmış bir görüşme olan SCID-5 ile tanısal değerlendirme yapılmıştır. Global Değerlendirme Ölçeği (GAS) esas alınarak işlevsellik düzeyleri kaydedilmiştir. Sosyodemografik bilgiler olgu rapor formuna kaydedilmiştir. Etik kurul onayı Ege Üniversitesi Tıbbi Araştırmalar Etik Kurulu'ndan alınmış olup karar no 22-1.1T/41'dir. Bulgular: 2013 yılında tez çalışmasına alınan 94 hastadan 54'ü izlem çalışmasını tamamlamıştır. Çalışmaya katılamayan hastalar ve çalışmaya alınan hastaların bazal klinik karakteristik özelliklerinin benzer olduğu, izlemdeki kayıplar nedeniyle grubun homojenizasyonun etkilenmediği saptanmıştır. İntiharda etkili olabilecek proksimal ve distal risk faktörleri değerlendirildiğinde, proksimal ve distal risk faktörü olan hastaların, sadece distal risk faktörü olan hastalara göre intihar için anlamlı bir risk altında oldukları saptanmıştır (p<0,001). Ruhsal hastalığa sahip olmanın intihar riski üzerinde katkısı bulunmamıştır (OR: ,494, p=0,460). BDÖ 2012-2022, KIDDO-KINDL toplam puanı, SF-36 genel sağlık puanının, PARQ-GA2012-2022, PARQ-B2012-2022, DDÖ toplam puanı2012-2022, KDDA 2012-2022 skorlarının intihar riski üzerinde anlamlı etkisi tespit edilememiştir. Depresyon varlığında DÖÖ (2022)'nün intihar riski için anlamlı etkisi saptanmamıştır (p>0,05). İzlem sonunda, çalışmayı tamamlayan 54 hastaya son 12 ay içerisinde intihar girişimi yapıp yapmadıkları ve intihar düşünceleri sorulmuştur. Son bir yılda hiçbir hastanın intihar girişiminde bulunmadığı tespit edilmiştir. Çalışmamızda izlem sonunda 54 hastanın 9 (%16,6)'unda mevcut intihar düşüncesi olduğu görülmüştür. Çocuk psikiyatrisine daha erken yaşta başvuru yapmanın (p=0,027, OR: 0,396) ve ergenlik döneminde evden-okuldan kaçma davranışlarının (p=0,024, OR: 5,910) intihar riski için öngördürücü olduğu tespit edilmiştir. Örneklemimizin tamamı izlemin başındaki ilk değerlendirmede MDB tanılı hastalardan oluşmakta olup, izlemin sonunda SCID-5 yarı yapılandırılmış tanısal görüşmesine göre çalışmayı tamamlayan 54 hastanın 43'ünün (%79,62) en az bir psikiyatrik bozukluğu olduğu saptanmıştır. 51 (%94,44) hasta izlem sonuna değin ikinci bir depresif epizot geçirmiştir. İzlemin sonundaki değerlendirmede, hastalarımızın 19(%35,18)'unun şimdiki tanısı MDB olarak saptanmıştır. Beş (%9,25) hastamız distimik bozukluk tanısı almıştır. BPB'a dönüşen 6 (%11,11) hasta bulunmaktadır. On sekiz (%33,33) hastamız, anksiyete ve ilişkili bozukluklara sahiptir. Hastalarımızın 19 (%35,18)'unda erişkin DEHB tanısı olduğu görülmüştür. Ergenlikten beliren yetişkinliğe olan süreçte hastaların BDÖ(p<0,001), KDDA(p<0,001) ve PARQ genel anlaşmazlık-çatışma (p=0,001) puanlarının azaldığı, DÖÖ bireyleşme(p<0.001) ve ebeveyne bağımlı olmama (p=0.003) puanlarının arttığı saptanmıştır. Sonuç: İntihar davranışlarında distal ve proksimal risklerin birlikte bulunuşunun intihar girişimleri için öngördürücü olması nedeniyle klinik görüşmelerde intihar risk değerlendirmesinde hastaların bu açıdan ayrıntılı bir şekilde değerlendirilmesi gerekmektedir. Kimlik duygusu, ergenlik ve beliren yetişkinlik dönemi boyunca gelişimini sürdürmektedir. Ergenlikte depresyon geçiren kişilerin beliren yetişkinliğe geçiş süreçlerinde aileleriyle olan çatışmaları azalırken duygusal kopmalarının artışı, bu bireylerin zaman içerisinde bağ kurmayla ilgili zorluklar yaşıyor olabileceklerine işaret etmektedir. İntihar riski konusunda yapılacak çalışmalarda, intihar riskinin ve ilişkili etmenlerin zamansal değişimini istatistiksel açıdan ortaya koyabilecek yeni yöntemsel metotlara ihtiyaç bulunmaktadır. Anahtar kelimeler: İntihar Riski, Beliren Yetişkinlik, Kimlik Duygusu, Duygusal Özerklik, Boylamsal Çalışma, Depresyon
Introduction: It is seen that there are a limited number of studies examining the diagnostic progress of individuals who had depression and attempted suicide in adolescence until adulthood with developmental concepts associated with suicide attempts such as a sense of identity, emotional autonomy and relationships with parents. Objective: In this study, it was aimed to evaluate the course of suicidal behavior and the clinical and developmental risk factors of suicide in the emerging adulthood of young people who had depression due to developmental reasons in adolescence and some of them had suicidal behaviors.The effects of depression severity, quality of life, sense of identity, emotional autonomy, parent-youth relationships on suicide risk, which are known to have an effect on suicidal behaviors, will be evaluated. In addition, the diagnostic course of depression in adolescence in emerging adulthood and the change in clinical and developmental scale data in the process will be examined. Method: In 2013, at Ege University Youth Mental Health Unit, under the supervision of Tezan Bildik, Dr. Çiğdem Yektaş's thesis titled "The Nature and Developmental Context of Suicidal Behavior in Adolescents Diagnosed with Depression: Sense of Identity, Adolescent-Parent Relationship and Emotional Autonomy" was conducted. In 2022, a thesis study is planned as a continuation of this study. In the thesis study in 2012, 94 female adolescent female patients were included. These patients were tried to be reached through archive file records and the hospital information systems. The follow-up study was completed with 54 patients who agreed to participate. Voluntary consent was obtained from the patients participating in the study. Patients were evaluated at two-time points, at the beginning and the end of follow-up. Scale data included in the data set of 2012: Beck Depression Inventory (BDI), Emotional Autonomy Inventory (EAS), Parent Adolescent Relationship Inventory (PARQ), Sense of Identity Assessment Tool (SOIE), Suicide Evaluation Form (SEF), Child Quality of Life Scale (KIDDO-KINDL). At the end of the follow-up (2022), the BECK Depression Scale (BDI), the Emotional Autonomy Scale (EAS), the Parent-Adolescent Relationship Inventory (PARQ), the Sense of Identity Evaluation Tool (SOIE), and the Suicide Evaluation Form (SEF) were re-administered to the patients. In addition, the Emerging Adulthood Scale (the IDEA) and the Quality of Life Scale (SF-36) were applied. The diagnostic evaluation was performed by applying SCID-5 to the patients. The functionality levels of the patients were recorded based on the Global Assessment Scale (GAS). Sociodemographic information was recorded in the case report form. Ethics committee approval was obtained from Ege University Medical Research Ethics Committee, and the decision number is 22-1.1T/41. Results: Of the 94 patients included in the thesis study in 2013, 54 completed the follow-up study. When proximal and distal risk factors that may be effective in suicide were evaluated, it was determined that patients with proximal and distal risk factors were at a significant risk for suicide compared to patients with only distal risk factors (p<0.001). Having a mental illness did not contribute to suicide risk (OR: .494, p=0.460). No significant effect of BECK 2012-2022, KIDDO-KINDL total score, SF-36 general health score, PARQ-GA 2012-2022, PARQ-B2012-2022, EAS total score2012-2022, SOIE 2012-2022 scores on suicide risk was determined. At the end of the follow-up, 54 patients who completed the study were asked whether they had attempted suicide in the last 12 months and had suicidal thoughts. It was determined that no patient had attempted suicide in the last year. In our study, it was observed that 9 (16.6%) of 54 patients had suicidal ideation at the end of the follow-up. It was determined that earlier admission to child psychiatry (p=0.027, OR: 0.396) and avoiding home-school behaviors during adolescence (p=0.024, OR: 5.910) were predictive for suicide risk. All of our sample consisted of patients diagnosed with MDD at the first evaluation at the beginning of the follow-up, and at the end of the follow-up, 43 (79.62%) of the 54 patients who completed the study according to the SCID-5 semi-structured diagnostic interview were found to have at least one psychiatric disorder. In the evaluation at the end of the follow-up, the current diagnosis of 19 (35.18%) of our patients was found to be MDD. Five (9.25%) patients were diagnosed with dysthymic disorder. There are 6 (11.11%) patients who converted to BPD. Eighteen (33.33%) of our patients had anxiety and related disorders.In the period from adolescence to emerging adulthood, it was determined that the patients' BECK (p<0.001), SOIE (p<0.001) and PARQ general disagreement-conflict (p=0.001) scores decreased, while the EAS individuation (p<0.001) and parental non-dependence (p=0.003) scores increased. Conclusion: Since the coexistence of distal and proximal risks in suicidal behaviors is predictive for suicide attempts, patients should be evaluated in detail in this respect in the suicidal risk assessment in clinical interviews. Sense of identity continues to develop throughout adolescence and emerging adulthood. While the conflicts with their families decrease during the transition to adulthood, the increase in emotional disconnection of people with depression in adolescence indicates that these individuals may have difficulties in establishing bonds over time. There is a need for new methodological methods that can statistically reveal the temporal variation of suicide risk and related factors in studies on suicide risk.
Introduction: It is seen that there are a limited number of studies examining the diagnostic progress of individuals who had depression and attempted suicide in adolescence until adulthood with developmental concepts associated with suicide attempts such as a sense of identity, emotional autonomy and relationships with parents. Objective: In this study, it was aimed to evaluate the course of suicidal behavior and the clinical and developmental risk factors of suicide in the emerging adulthood of young people who had depression due to developmental reasons in adolescence and some of them had suicidal behaviors.The effects of depression severity, quality of life, sense of identity, emotional autonomy, parent-youth relationships on suicide risk, which are known to have an effect on suicidal behaviors, will be evaluated. In addition, the diagnostic course of depression in adolescence in emerging adulthood and the change in clinical and developmental scale data in the process will be examined. Method: In 2013, at Ege University Youth Mental Health Unit, under the supervision of Tezan Bildik, Dr. Çiğdem Yektaş's thesis titled "The Nature and Developmental Context of Suicidal Behavior in Adolescents Diagnosed with Depression: Sense of Identity, Adolescent-Parent Relationship and Emotional Autonomy" was conducted. In 2022, a thesis study is planned as a continuation of this study. In the thesis study in 2012, 94 female adolescent female patients were included. These patients were tried to be reached through archive file records and the hospital information systems. The follow-up study was completed with 54 patients who agreed to participate. Voluntary consent was obtained from the patients participating in the study. Patients were evaluated at two-time points, at the beginning and the end of follow-up. Scale data included in the data set of 2012: Beck Depression Inventory (BDI), Emotional Autonomy Inventory (EAS), Parent Adolescent Relationship Inventory (PARQ), Sense of Identity Assessment Tool (SOIE), Suicide Evaluation Form (SEF), Child Quality of Life Scale (KIDDO-KINDL). At the end of the follow-up (2022), the BECK Depression Scale (BDI), the Emotional Autonomy Scale (EAS), the Parent-Adolescent Relationship Inventory (PARQ), the Sense of Identity Evaluation Tool (SOIE), and the Suicide Evaluation Form (SEF) were re-administered to the patients. In addition, the Emerging Adulthood Scale (the IDEA) and the Quality of Life Scale (SF-36) were applied. The diagnostic evaluation was performed by applying SCID-5 to the patients. The functionality levels of the patients were recorded based on the Global Assessment Scale (GAS). Sociodemographic information was recorded in the case report form. Ethics committee approval was obtained from Ege University Medical Research Ethics Committee, and the decision number is 22-1.1T/41. Results: Of the 94 patients included in the thesis study in 2013, 54 completed the follow-up study. When proximal and distal risk factors that may be effective in suicide were evaluated, it was determined that patients with proximal and distal risk factors were at a significant risk for suicide compared to patients with only distal risk factors (p<0.001). Having a mental illness did not contribute to suicide risk (OR: .494, p=0.460). No significant effect of BECK 2012-2022, KIDDO-KINDL total score, SF-36 general health score, PARQ-GA 2012-2022, PARQ-B2012-2022, EAS total score2012-2022, SOIE 2012-2022 scores on suicide risk was determined. At the end of the follow-up, 54 patients who completed the study were asked whether they had attempted suicide in the last 12 months and had suicidal thoughts. It was determined that no patient had attempted suicide in the last year. In our study, it was observed that 9 (16.6%) of 54 patients had suicidal ideation at the end of the follow-up. It was determined that earlier admission to child psychiatry (p=0.027, OR: 0.396) and avoiding home-school behaviors during adolescence (p=0.024, OR: 5.910) were predictive for suicide risk. All of our sample consisted of patients diagnosed with MDD at the first evaluation at the beginning of the follow-up, and at the end of the follow-up, 43 (79.62%) of the 54 patients who completed the study according to the SCID-5 semi-structured diagnostic interview were found to have at least one psychiatric disorder. In the evaluation at the end of the follow-up, the current diagnosis of 19 (35.18%) of our patients was found to be MDD. Five (9.25%) patients were diagnosed with dysthymic disorder. There are 6 (11.11%) patients who converted to BPD. Eighteen (33.33%) of our patients had anxiety and related disorders.In the period from adolescence to emerging adulthood, it was determined that the patients' BECK (p<0.001), SOIE (p<0.001) and PARQ general disagreement-conflict (p=0.001) scores decreased, while the EAS individuation (p<0.001) and parental non-dependence (p=0.003) scores increased. Conclusion: Since the coexistence of distal and proximal risks in suicidal behaviors is predictive for suicide attempts, patients should be evaluated in detail in this respect in the suicidal risk assessment in clinical interviews. Sense of identity continues to develop throughout adolescence and emerging adulthood. While the conflicts with their families decrease during the transition to adulthood, the increase in emotional disconnection of people with depression in adolescence indicates that these individuals may have difficulties in establishing bonds over time. There is a need for new methodological methods that can statistically reveal the temporal variation of suicide risk and related factors in studies on suicide risk.
Açıklama
08.12.2024 tarihine kadar kullanımı yazar tarafından kısıtlanmıştır
Anahtar Kelimeler
Psikiyatri, Psychiatry
