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Yıl:2014; Cilt: 51; Sayı: 2>> Özet
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Nöropsikiyatri Arşivi; 2014;51(2):133-140
Erişkin Unipolar Depresyon Örnekleminde Çocukluk Çağı İstismar ve İhmal Yaşantılarının İntihar Girişimi ile İlişkisi
F Yıldırım, S Küçükgöncü, EE Beştepe, MS Yıldırım
Erzurum Eğitim Araştırma Hastanesi, Erzurum
Bununla birlikte her depresyon hastası intihar girişiminde bulunmamaktadır. Bu durum, psikopatoloji varlığının dışında intiharla ilişkili olabilecek başka faktörlerin etkili olabileceğini düşündürmektedir. Çocukluk çağı istismar/ihmal yaşantılarının, intihar ile ilişkili olduğu bilinmektedir. Bu çalışmadaki amacımız, çocukluk çağı istismar ve ihmal yaşantılarının unipolar depresyon hastalarında intihar girişimi ile ilişkisini araştırmaktır. Yöntem: Çalışmaya 18-65 yaş aralığında 106 unipolar depresyon hastası dahil edilmiştir. Komorbid psikiyatrik hastalığı, nörolojik hastalığı, alkol-madde kötüye kullanımı olanlar ve Beck Depresyon Ölçeğine (BDÖ) göre 17 puan altında puan alanlar çalışmaya dahil edilmemiştir. Tüm olgulara BDÖ, Çocukluk Çağı Travma ve İhmal Yaşantıları Ölçeği (CTQ-28), Sürekli Öfke ve Öfke İfade Tarzı Ölçeği (SÖÖTÖ), İntihar Davranış Ölçeği (İDÖ) uygulanmıştır. İntihar girişimi olan ve olmayan olgular İDÖ yanıtına ve klinik görüşmelere göre belirlenmiştir. Bulgular: Çalışmaya alınan hastaların 64’ü hayatının bir döneminde intihar girişiminde bulunmuş, 42’si hiç intihar girişiminde bulunmamıştı. İntihar girişiminde bulunmuş unipolar depresyon olguları ile hiç intihar girişimi olmamış hastalar arasında yaş ortalamaları, eğitim ve medeni durum özellikleri açısından istatistiksel farklılık bulunmazken, intihar girişimi olan grupta kadın/erkek oranı, girişimi olmayan gruptan anlamlı olarak yüksek tespit edildi. İntihar girişimi olan grupta BDÖ, SÖÖTÖ sürekli öfke ve öfke dışa puan ortalamaları, CTQ- 28 duygusal istismar, fiziksel istismar ve toplam puan ortalamaları anlamlı olarak yüksek bulundu. Çalışmada geçmişte intihar girişiminde bulunmanın yordayıcıları olarak yüksek BDÖ ve CTQ-28 fiziksel istismar puanları ve kadın cinsiyette olma bulunmuştur. İDÖ puan ortalamalarının yordayıcılarının BDÖ, CTQ-28 cinsel istismar, SÖÖTÖ öfke dışa ve sürekli öfke puan ortalamaları yüksekliği olduğu bulunmuştur. Sonuç: Çocukluk çağı fiziksel ve cinsel istismar yaşantıları unipolar depresyon hastalarında intihar girişimi varlığı ve intihar davranışı riskinin değerlendirilebilmesinde önemli etkenlerdir. Çocukluk çağı travmatik yaşantılarının depresyon hastalarının psikiyatrik muayenesi ve izleminde dikkatle sorgulanması, tedavi protokolünün belirlenmesinde ve intihar girişimlerinin engellenmesinde oldukça önemlidir
The Relationship of Childhood Abuse and Neglect with Suicide Attempts in an Adult UnipolarDepression Sample
to an increased risk of suicide. However, not all depression patients attempt suicide. This reflects the presence of other factors that may be related to suicide other than the sole presence of psychopathology. Drawing upon the clinical evidence linking childhood abuse and neglect experiences with suicide; this study aimed at investigating the relationship of childhood abuse and neglect experiences with suicide attempts in patients with unipolar depression. Method: One hundred six unipolar depressed patients between the ages of 18 and 65 were included in the study. Patients with comorbid psychiatric disorders, neurological disorders, alcohol-substance abuse problems, and a Beck Depression Inventory (BDI) score of <17 were excluded from the study. The BDI, Childhood Trauma Questionnaire (CTQ-28), State-Trait Anger Expression Inventory (STAXI), and the Suicide Behavior Questionnaire (SBQ) were administered to all patients. Suicidal and non-suicidal cases were determined according to clinic interviews and the patients’ responses in the SBQ. Results: Sixty-four patients have previously attempted suicide. Although there was no significant difference between unipolar depression patients with a history of suicide attempts and patients with no history of suicide attempts in terms of average age, education and marital status, however, female/male ratio in the former group was determined to be significantly higher. BDI, STAXI continuous anger and outward anger average scores, and average CTQ-28 emotional abuse, physical abuse and total scores were significantly higher in the group with a history of suicide attempts. The predictors of suicide attempts were higher BDI and CTQ-28 physical abuse scores and female gender. The predictors for average SBQ scores were determined as higher BDI, CTQ-28 sexual abuse, and STAXI outward anger and continuous anger scores. Conclusion: Childhood physical and sexual abuse experiences are important factors in evaluating the presence of suicide attempts and risk of suicide in patients with unipolar depression. Careful questioning of traumatic childhood experiences during psychiatric examinations and monitoring of depression patients is crucial in determining treatment protocols and preventing suicide attempts.

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