초록
Although aggression has been associated with suicidal behavior among individual with alcohol use disorders (AUD), little is known about the mechanism this association. hypothesized that aggression an indirect effect on suicidal behavior and this relationship mediated by acquired capability for suicide the ability to overcome the fear and pain associated with suicide (Van Orden et al., 2008). Participants were patients undergoing residential alcohol use disorder treatment at local hospitals in Korea. As hypothesized, the relationship between aggression and suicidal behavior was partially mediated by acquired capability for suicide. Our findings the role of acquired capability in the association between aggression and suicidal behavior in AUD individuals. Implications for suicide risk assessment individuals with AUD discussed.
키워드
Aggression, Suicidal Behavior, Alcohol Use Disorders (AUD), Acquired Capability for Suicide
Intro
Suicidal behavior is a common problem in individuals with alcohol dependence
Several studies have identified some risk factors for suicidal behavior in people with alcohol dependence. The association between aggression and suicidal behavior in AUD has been repeatedly and firmly supported
Acquired capability for suicide, which is a construct within the Interpersonal-psychological theory of suicidal behavior (IPTS;
The IPTS proposes that aggressive individuals are more likely to experience these painful and provocative events that habituate them to fear and pain related to lethal self-injury, and thus, are more likely to have acquired capability for suicide. People with a high aggression level are more likely to disregard the warning signs against self-harm and engage in risky behavior, which in turn increases their acquired capability for suicide
The purpose of the current study was to examine the associations between aggression, acquired capability for suicide and suicidal behavior in individuals with AUD. On the basis of existing literature, we hypothesized that (1) aggression would be positively associated with suicidal behavior; (2) aggression would be positively associated with acquired capability for suicide; (3) acquired capability for suicide would be positively associated with suicidal behavior, and (4) acquired capability for suicide would mediate the relationship between aggression and suicidal behavior in individuals with AUD.
Methods
Participants
The sample consisted of individuals who were either inpatients from or outpatients of three treatment centers for alcohol use disorders, located in Gyeonggi-do and Incheon, Korea. Subjects who were not able to complete a battery of questionnaires due to undergoing detoxification, those with psychotic features or neurological problems, as well as those who scored < 8 on the 10-item Alcohol Use Disorders Identification Test – Korean
One hundred and ninety participants (91.3%) were male, 17 participants (8.2%) were female, and one participant declined to provide gender information. The proportion of female was too low to be able to understand gender differences, thus we decided to analyze only the male data (
Procedures
All participants were given an informed consent prior to participation. For compensation, participants received writing utensils or a cafeteria coupon worth $ 3. After completing the study questionnaires, one of the authors of the current study also gave a lecture entitled ‘Suicide prevention for individuals with alcohol use problems’
The current study is a part of a larger research project into suicidal behavior in AUD individuals that is being carried out by the present authors.
Measures
Statistical analyses
To examine the reliability of study measures, coefficient alpha were assessed. Correlation analysis was conducted to examine the correlations between all study variables. Mediation analysis was performed using a bootstrapping method recommended by
Results
Descriptive statistics and correlations for all m easures
Descriptive statistics and correlations for all study variables are presented in
Table 1.. Descriptive statistics and correlations for all measures.
**
Note. AQ-K = The Aggression Questionnaire-Korean version, ACSS = The Acquired Capability for Suicide Scale
Mediation analysis of aggression and suicidal behavior
The results of the indirect effect analysis are presented in
Table 2.. The results of the indirect effect analysis.
*
Note. AQ-K = The Aggression Questionnaire-Korean version
Note. All values represent the unstandardized beta for regression or path coefficients. IV=independent variable(i.e., AQ-K, AQ-K Physical); M=mediator(i.e., acquired capability for suicide); DV=dependent variable(i.e., suicidal behavior). The total effect is the effect of the IV on the DV without considering the mediator. The direct effect is the effect of the IV on DV when controlling for the effects of the mediators. The indirect effect is the effect of the IV on the DV via the mediator.
For better understanding, we carried out further analyses examining each subscale of the AQ-K (physical aggression, verbal aggression, anger, and hostility) as independent variables. Among these four sub-factors, only physical aggression had an indirect effect on suicidal behavior through its impact on the elevated level of acquired capability for suicide (
Discussion
The purpose of the present study was to examine the associations between aggression, suicidal behavior and acquired capability for suicide in individuals with AUD.
Additionally, among the four dimensions of aggression, only physical aggression has an indirect relationship with suicidal behavior and that relationship is mediated by acquired capability for suicide. Within the context of the theory, this may indicate that people who express their aggression physically are more likely to engage in painful and provocative events and are thus more likely to have a lowered fear of death and an increased tolerance to the pain related to suicidal behavior
The association between aggression, acquired capability for suicide and suicidal behavior is also consistent with the neurological evidence. A large amount of studies have indicated that altered serotonergic function is associated with suicidal behavior (For a review, see
The indirect effect sizes were low and the confidence interval in the study probably did not include zero but was nevertheless at a low level. Thus the results should be interpreted with caution. The smaller indirect effect sizes found in this is understandable considering that acquired capability is unlikely to be a single indicator of suicidal behavior. Indeed, in several IPTS studies, acquired capability for suicide did not seem to be related to clinician-rated risk for suicide
There are several limitations to the current study. First, our samples comprised only male AUD individuals and most of these participants were also inpatients of treatment centers for alcohol use disorders. Therefore, it was impossible to examine potential gender differences in aggression, acquired capability for suicide, and suicidal behavior. Likewise, it is not possible to generalize the findings to non-treatment populations. The cross-sectional study design and the evaluation of suicidal behavior based on retrospective information are also limitations. Further study is needed to determine the causalities involved in the relations between aggression, acquired capability for suicide, and suicidal behavior. Although history of suicide attempt is a major risk factor for future suicide
Although there are several limitations to the present work, our findings nevertheless underline the importance of aggression and acquired capability for suicide in understanding suicidal behavior in male AUD individuals. The results of the present study add to a previous understanding that aggressiveness contributes to suicidal behavior in alcohol dependent patients. Given the high rate of suicidal behavior among individuals with AUD, it is critical for suicide risk assessment to detect risk factors associated with suicidal behavior among individuals with AUD. Our findings indicate that assessing acquired capability for suicide could be helpful for suicide risk assessment, especially for identifying at-risk individuals. This would be particularly important when AUD patients express suicide ideation. The presence of suicide ideation accompanied by high level of acquired capability for suicide may lead to a greater possibility for making a lethal suicide attempt.
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