Abstract
This study is purposed to examine the predictive role of adverse childhood experiences (ACEs) on suicidal ideation and social dysfunction with regards to the mediating influence of defense mechanisms based on Structural Equation Modeling (SEM). The sample consisted of 384 outpatients which were selected by the purposive sampling method within a survey design. A demographic questionnaire, the Beck Scale for Suicidal Ideation (BSSI), the Social Dysfunction Rating Scale (SDRS), the Adversity Childhood Experience International Questionnaire (ACE-IQ), and the Defense Style Questionnaire (DSQ-40) were used in this study. The results showed that ACEs with mediating effect of defense mechanisms explained 0.76% of social dysfunction and 0.97% of suicidal ideation variations with the mediating role of defense mechanisms in this sample. Also, ACEs explained 0.93% of defense mechanisms variations. Overall, this conceptual model is suitable for the direct and indirect role of ACEs on social dysfunction and suicidal ideation in terms of the mediating effect of defense mechanisms.
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The datasets generated and analyzed during the current study are available from the relevant author upon reasonable request.
References
Andrews, G., Singh, M., & Bond, M. (1993). The defense style questionnaire. Journal of Nervous and Mental Disease, 181(4), 246–256. https://doi.org/10.1097/00005053-199304000-00006
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, Va. American Psychiatric Association.
Bahk, Y. C., Jang, S. K., Choi, K. H., & Lee, S. H. (2017). The relationship between childhood trauma and suicidal ideation: Role of maltreatment and potential mediators. Psychiatry Investigation, 14(1), 37–43. https://doi.org/10.4306/pi.2017.14.1.37
Beck, A. T., Kovacs, M., & Weissman, A. (1979). Assessment of suicidal intention: The scale for suicide ideation. Journal of Consulting and Clinical Psychology, 47(2), 343. https://doi.org/10.1037/0022-006X.47.2.343
Bledsoe, M., Captanian, A., & Somji, A. (2021). Special Report from the CDC: Strengthening social connections to prevent suicide and adverse childhood experiences (ACEs): Actions and opportunities during the COVID-19 pandemic. Journal of Safety Research, 77, 328–333. https://doi.org/10.1016/j.jsr.2021.03.014
Boullier, M., & Blair, M. (2018). Adverse childhood experiences. Paediatrics and Child Health, 28(3), 132–137. https://doi.org/10.1016/j.paed.2017.12.008
CDC. (2022). Centers for Disease Control and Prevention (CDC) WISQARS leading causes of death reports: Suicide is a leading cause of death in the United States. Atlanta, GA: US National Institute of Mental Health; Office of Science Policy, Planning, and Communications.
Chegeni, M., Haghdoost, A., Shahrbabaki, M. E., Shahrbabaki, P. M., & Nakhaee, N. (2020). Validity and reliability of the Persian version of the adverse childhood experiences abuse short form. Journal of Education and Health Promotion, 9(140), 1–7. https://doi.org/10.4103/jehp.jehp_15_20
Chen, M., Zhou, L., Ye, L., Lin, G., Pang, Y., Lu, L., & Wang, X. (2022). Initial adherence by psychiatric outpatients in a general hospital and relevant personal factors. BMC Pychiatry, 22(1), 137. https://doi.org/10.1186/s12888-022-03797-3
Christoforou, R., & Ferreira, N. (2020). Psychometric assessment of adverse childhood Experiences International Questionnaire (Ace-Iq) with adults engaging in non-suicidal self-injury. Mediterranean Journal of Clinical Psychology, 8(3), 1–23. https://doi.org/10.6092/2282-1619/mjcp-2601
Corruble, E., Bronnec, M., Falissard, B., & Hardy, P. (2004). Defense styles in depressed suicide attempters. Psychiatry and Clinical Neurosciences, 58(3), 285–288. https://doi.org/10.1111/j.1440-1819.2004.01233.x
Cui, R., Gujral, S., Galfalvy, H., & Szanto, K. (2022). The role of perceived and objective social connectedness on risk for suicidal thoughts and behavior in late-life and their moderating effect on cognitive deficits. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 30(4), 527–532. https://doi.org/10.1016/j.jagp.2021.08.014
Ehrenthal, J. C., Levy, K. N., Scott, L. N., & Granger, D. A. (2018). Attachment-related regulatory processes moderate the impact of adverse childhood experiences on stress reaction in borderline personality disorder. Journal of Personality Disorders, 32(Supplement), 93–114. https://doi.org/10.1521/pedi.2018.32.supp.93
Esfahani, M., Hashemi, Y., & Alavi, K. (2015). Psychometric assessment of beck scale for suicidal ideation (BSSI) in general population in Tehran. Medical journal of the Islamic Republic of Iran, 29(1), 268. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4715388/
Evren, C., Ozcetinkaya, S., Ulku, M., Cagil, D., Gokalp, P., Cetin, T., & Yigiter, S. (2012). Relationship of defense styles with history of childhood trauma and personality in heroin dependent inpatients. Psychiatry Research, 200(2–3), 728–733. https://doi.org/10.1016/j.psychres.2012.07.026
Fang, S., Chung, M. C., & Wang, Y. (2020). The impact of past trauma on psychological distress: The roles of defense mechanisms and alexithymia. Frontiers in Psychology, 11, 992. https://doi.org/10.3389/fpsyg.2020.00992
Farmani, A., Rahimianbougar, M., Mohammadi, Y., Faramarzi, H., Khodarahimi, S., & Nahaboo, S. (2021). Psychological, structural, social and economic determinants of suicide attempt: Risk assessment and decision making strategies. OMEGA-Journal of death and dying, 00302228211003462. https://doi.org/10.1177/00302228211003462
Ferrajão, P., Dias, J., & Elklit, A. (2022). Defense mechanisms mediate associations between exposure to adverse childhood experiences and anxiety and depression in kenyan adolescents. Traumatology Advance online publication. https://doi.org/10.1037/trm0000426
Finzi-Dottan, R., & Karu, T. (2006). From emotional abuse in childhood to psychopathology in adulthood: A path mediated by immature defense mechanisms and self-esteem. The Journal of Nervous and Mental Disease, 194(8), 616–621. https://doi.org/10.1097/01.nmd.0000230654.49933.23
Foroughan, M., Rostami, M., & Jalal Younesi, S. (2021). Determinants of suicidal ideation among older adults: A cross-sectional survey in Iran. GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry, 34(2), 91–99. https://doi.org/10.1024/1662-9647/a000250
Freud, A. (1992). The ego and the mechanisms of defence. Routledge.
Freud, S. (1962). Further remarks on the neuro-psychoses of defence The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume III (1893–1899): Early Psycho-Analytic Publications (pp. 157–185).
Freud, S. (1894). The neuro-psychoses of defence. The standard edition of the complete psychological works of Sigmund Freud, 3, 41–61.
Fuller-Thomson, E., Baird, S., Dhrodia, R., & Brennenstuhl, S. (2016). The association between adverse childhood experiences (ACEs) and suicide attempts in a population‐based study. Child: Care Health and Development, 42(5), 725–734. https://doi.org/10.1111/cch.12351
Ganson, K. T., Murray, S. B., Mitchison, D., Hawkins, M. A., Layman, H., Tabler, J., & Nagata, J. M. (2021). Associations between adverse childhood experiences and performance-enhancing substance use among young adults. Substance Use & Misuse, 56(6), 854–860. https://doi.org/10.1080/10826084.2021.1899230
Glenn, C. R., Kleiman, E. M., Kellerman, J., Pollak, O., Cha, C. B., Esposito, E. C., & Boatman, A. E. (2020). Annual Research Review: A meta-analytic review of worldwide suicide rates in adolescents. Journal of Child Psychology and Psychiatry, 61(3), 294–308. https://doi.org/10.1111/jcpp.13106
Guillou-Landreat, M., Guilleux, A., Sauvaget, A., Brisson, L., Leboucher, J., Remaud, M., & Grall-Bronnec, M. (2016). Factors associated with suicidal risk among a french cohort of problem gamblers seeking treatment. Psychiatry Research, 240, 11–18. https://doi.org/10.1016/j.psychres.2016.04.008
Hamilton, J. L., Biernesser, C., Moreno, M. A., Porta, G., Hamilton, E., Johnson, K., & Goldstein, T. G. (2021). Social media use and prospective suicidal thoughts and behaviors among adolescents at high risk for suicide. Suicide and Life-Threatening Behavior, 51(6), 1203–1212. https://doi.org/10.1111/sltb.12801
Harmer, B., Lee, S., Duong, T. V. H., & Saadabadi, A. (2023). Suicidal ideation. StatPearls Publishing.
Heshmati, R., Bayrami, M., & Norouzi, H. (2021). The role of lived childhood trauma experience and self-destruction on suicidal ideation: The mediating effect of emotional suppression. Journal of Modern Psychological Researches, 17(65), –. https://psychologyj.tabrizu.ac.ir/article_13468.html?lang=en
Hovanesian, S., Isakov, I., & Cervellione, K. L. (2009). Defense mechanisms and suicide risk in major depression. Archives of Suicide Research, 13(1), 74–86. https://doi.org/10.1080/13811110802572171
Hymowitz, G., Salwen, J., & Salis, K. L. (2017). A mediational model of obesity related disordered eating: The roles of childhood emotional abuse and self-perception. Eating Behaviors, 26, 27–32. https://doi.org/10.1016/j.eatbeh.2016.12.010
Kaplow, J. B., Gipson, P. Y., Horwitz, A. G., Burch, B. N., & King, C. A. (2014). Emotional suppression mediates the relation between adverse life events and adolescent suicide: Implications for prevention. Prevention Science: The Official Journal of the Society for Prevention Research, 15(2), 177–185. https://doi.org/10.1007/s11121-013-0367-9
Kidman, R., Smith, D., Piccolo, L. R., & Kohler, H. P. (2019). Psychometric evaluation of the adverse childhood experience international questionnaire (ACE-IQ) in malawian adolescents. Child Abuse & Neglect, 92, 139–145. https://doi.org/10.1016/j.chiabu.2019.03.015
Kim, Y., Lee, H., & Park, A. (2022). Patterns of adverse childhood experiences and depressive symptoms: Self-esteem as a mediating mechanism. Social Psychiatry and Psychiatric Epidemiology, 57(2), 331–341. https://doi.org/10.1007/s00127-021-02129-2
Laghaei, M., Mehrabizadeh honarmand, M., & Arshadi, N. (2020). A structural equation modeling of students’ suicidal ideation based on resilience and coping strategies with the Mediating Role of Depression. Quarterly of Clinical Psychology Studies, 10(40), 27–46. https://doi.org/10.22054/JCPS.2021.56410.2458
Li, X-Y., Phillips, M. R., Zhang, Y-L., Xu, D., Tong, Y-S., Yang, F-D., & Kuang, L. (2011). Reliability and validity of the chinese version of Beck Scale for suicide ideation (BSI-CV) among university students. Chinese Mental Health Journal, 25(11), 862–866. https://doi.org/10.3969/j.issn.1000-6729.2010.04.003
Linn, M. W., Sculthorpe, W. B., Evje, M., Slater, P. H., & Goodman, S. P. (1969). A social dysfunction rating scale (SDRS). Journal of Psychiatric Research, 6(4), 299–306. https://doi.org/10.1016/0022-3956(69)90023-5
Lozupone, M., Panza, F., Piccininni, M., Copetti, M., Sardone, R., Imbimbo, B. P., & Battista, P. (2018). Social dysfunction in older age and relationships with cognition, depression, and apathy: The GreatAGE study. Journal of Alzheimer’s Disease, 65(3), 989–1000. https://doi.org/10.3233/JAD-180466
Maniam, T., Chinna, K., Lim, C. H., Kadir, A. B., Nurashikin, I., Salina, A. A., & Mariapun, J. (2013). Suicide prevention program for at-risk groups: Pointers from an epidemiological study. Preventive Medicine, 57, S45–S46. https://doi.org/10.1016/j.ypmed.2013.02.022
Mercy, J., & Houry, D. (2019). Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence.Centre for Disease Control and Prevention. https://www.cdc.gov/vitalsigns/aces
Merz, E. M., & Jak, S. (2013). The long reach of childhood. Childhood experiences influence close relationships and loneliness across life. Advances in Life Course Research, 18(3), 212–222. https://doi.org/10.1016/j.alcr.2013.05.002
Mokhtari, A. M., Gholamzadeh, S., Salari, A., Hassanipour, S., & Mirahmadizadeh, A. (2019). Epidemiology of suicide in 10–19 years old in southern Iran, 2011–2016: A population-based study on 6720 cases. Journal of Forensic and Legal Medicine, 66, 129–133. https://doi.org/10.1016/j.jflm.2019.06.018
Naghavi, M., & Nakhaee, N. (2021). Associations between childhood abuse, resilience, mindfulness, and waterpipe smoking: Implications for cessation interventions. Journal of Smoking Cessation, 2021, 1–6. https://doi.org/10.1155/2021/6648779
Nickel, R., & Egle, U. T. (2006). Psychological defense styles, childhood adversities and psychopathology in adulthood. Child Abuse & Neglect, 30(2), 157–170. https://doi.org/10.1016/j.chiabu.2005.08.016
Nock, M. K., Borges, G., Bromet, E. J., Alonso, J., Angermeyer, M., Beautrais, A., Bruffaerts, R., Chiu, W. T., de Girolamo, G., Gluzman, S., de Graaf, R., Gureje, O., Haro, J. M., Huang, Y., Karam, E., Kessler, R. C., Lepine, J. P., Levinson, D., Medina-Mora, M. E., Ono, Y., & Williams, D. (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. The British Journal of Psychiatry:The Journal of Mental Science, 192(2), 98–105. https://doi.org/10.1192/bjp.bp.107.040113
Otten, D., Ernst, M., Tibubos, A. N., Brähler, E., Fleischer, T., Schomerus, G., Wild, P. S., Zöller, D., Binder, H., Kruse, J., Johar, H., Atasoy, S., Grabe, H. J., Ladwig, K., Münzel, T., Völzke, H., König, J., & Beutel, M. E. (2022). Does social support prevent suicidal ideation in women and men? Gender-sensitive analyses of an important protective factor within prospective community cohorts. Journal of Affective Disorders, 306, 157–166. https://doi.org/10.1016/j.jad.2022.03.031
Ozcelik, H. S., Ozdel, K., Bulut, S. D., & Orsel, S. (2015). The reliability and validity of the turkish version of the Beck scale for suicide ideation (turkish BSSI). Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology, 25(2), 141–150. https://doi.org/10.5455/bcp.20141214105009
Poole, J. C., Dobson, K. S., & Pusch, D. (2018). Do adverse childhood experiences predict adult interpersonal difficulties? The role of emotion dysregulation. Child Abuse & Neglect, 80, 123–133. https://doi.org/10.1016/j.chiabu.2018.03.006
Porcelli, S., Van Der Wee, N., van der Werff, S., Aghajani, M., Glennon, J. C., van Heukelum, S., Mogavero, F., Lobo, A., Olivera, F. J., Lobo, E., Posadas, M., Dukart, J., Kozak, R., Arce, E., Ikram, A., Vorstman, J., Bilderbeck, A., Saris, I., Kas, M. J., & Serretti, A. (2019). Social brain, social dysfunction and social withdrawal. Neuroscience and Biobehavioral Reviews, 97, 10–33. https://doi.org/10.1016/j.neubiorev.2018.09.012
Prout, T. A., Gerber, L. E., & Gottdiener, W. H. (2015). Trauma and substance use: The role of defences and religious engagement. Mental Health Religion & Culture, 18(2), 123–133. https://doi.org/10.1080/13674676.2015.1008442
Rahmani, A., & Rezaeian, M. (2021). Possible Effects of COVID-19 pandemic on suicide behavior in the World: A structured review study. Journal of Rafsanjan University of Medical Sciences, 20(1), 85–118. https://doi.org/10.52547/jrums.20.1.85
Redlich, R., Opel, N., Förster, K., Engelen, J., & Dannlowski, U. (2018). Structural neuroimaging of maltreatment and inflammation in depression. Inflammation and immunity in Depression (pp. 287–300). Elsevier.
Reinecke, M. A., & Franklin-Scott, R. L. (2005). Assessment of suicide: Beck’s scales for assessing mood and suicidality. Assessment, Treatment, and Prevention of Suicidal Behavior, 29–61.
Ruuttu, T., Pelkonen, M., Holi, M., Karlsson, L., Kiviruusu, O., Heilä, H., & Marttunen, M. (2006). Psychometric properties of the Defense Style Questionnaire (DSQ-40) in adolescents. The Journal of Nervous and Mental Disease, 194(2), 98–105. https://doi.org/10.1097/01.nmd.0000198141.88926.2e
Rytilä-Manninen, M., Haravuori, H., Fröjd, S., Marttunen, M., & Lindberg, N. (2018). Mediators between adverse childhood experiences and suicidality. Child Abuse & Neglect, 77, 99–109. https://doi.org/10.1016/j.chiabu.2017.12.007
Satinsky, E. N., Kakuhikire, B., Baguma, C., Rasmussen, J. D., Ashaba, S., Cooper-Vince, C. E., & Bangsberg, D. R. (2021). Adverse childhood experiences, adult depression, and suicidal ideation in rural Uganda: A cross-sectional, population-based study. PLoS Medicine, 18(5), e1003642. https://doi.org/10.1371/journal.pmed.1003642
Shabanpour, R., Zahiroddin, A. R., Janbozorgi, M., & Ghaeli, P. (2012). Assessment of defense styles and mechanisms in iranian patients suffering from obsessive compulsive or panic disorders versus normal controls using persian version of Defense Style Questionnaire-40. Iranian Journal of Psychiatry, 7(1), 31–35. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395963/
Shahab, M. K., de Ridder, J. A., Spinhoven, P., Penninx, B. W., Mook-Kanamori, D. O., & Elzinga, B. M. (2021). A tangled start: The link between childhood maltreatment, psychopathology, and relationships in adulthood. Child Abuse & Neglect, 121, 105228. https://doi.org/10.1016/j.chiabu.2021.105228
Shiraly, R., & Kokabi, E. (2019). Prevalence and factors Associated with suicidal ideation in General population of Shiraz, 2017. Journal of Ilam University of Medical Sciences, 27(3), 27–36. https://www.sid.ir/en/Journal/ViewPaper.aspx?ID=791864
Solomon, M. F. (2009). Attachment repair in couples therapy: A prototype for treatment of intimate relationships. Clinical Social Work Journal, 37(3), 214–223. https://doi.org/10.1007/s10615-009-0217-1
Tapp, J., Cottle, L., Christmas, M., Stratton, R., Gannon, T. A., & Moore, E. (2018). A psychometric evaluation of the Defence Style Questionnaire-40 in a UK forensic patient population. The Journal of Forensic Psychiatry & Psychology, 29(2), 288–307. https://doi.org/10.1080/14789949.2017.1375542
Thompson, M. P., Kingree, J., & Lamis, D. (2019). Associations of adverse childhood experiences and suicidal behaviors in adulthood in a US nationally representative sample. Child: Care Health and Development, 45(1), 121–128. https://doi.org/10.1111/cch.12617
Turecki, G., Brent, D. A., Gunnell, D., O’Connor, R. C., Oquendo, M. A., Pirkis, J., & Stanley, B. H. (2019). Suicide and suicide risk. Nature Reviews Disease Primers, 5(1), 1–22. https://doi.org/10.1038/s41572-019-0121-0
Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E. Jr. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575–600. https://doi.org/10.1037/a0018697
World Health Organization (2018). Adverse childhood experiences international questionnaire. 28 January 2018. https://www.who.int/publications/m/item/adverse-childhood-experiences-international-questionnaire-(ace-iq)
Wolf, E. J., Harrington, K. M., Clark, S. L., & Miller, M. W. (2013). Sample size requirements for structural equation models: An evaluation of power, bias, and solution propriety. Educational and Psychological Measurement, 73(6), 913–934. https://doi.org/10.1177/0013164413495237
Yang, G., Xiao, C., Li, S., & Yang, N. (2020). The effect and mechanism of adverse childhood experience on suicide ideation in young cancer patients during Coronavirus Disease 2019 (COVID-19) pandemic. Risk Management and Healthcare Policy, 13, 1293–1300. https://doi.org/10.2147/RMHP.S266269
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Mozafari, S., Bahadivand, A.H., Khodarahimi, S. et al. The role of adverse childhood experiences and defense mechanisms on suicidal ideation and social dysfunction. Curr Psychol 43, 5462–5471 (2024). https://doi.org/10.1007/s12144-023-04742-7
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DOI: https://doi.org/10.1007/s12144-023-04742-7