نقش میانجی‌گر افسردگی و اضطراب در رابطۀ بین راهبردهای نشخوار ذهنی و سرکوبی فکر و افکار خودکشی

زمینه و هدف: فرایندهای شناختی درگیر که به افزایش آسیب‌پذیری در رفتارهای خودکشی‌گرا منجر می‌شود، به‌خوبی بررسی نشده است. هدف پژوهش حاضر، تعیین نقش میانجی‌گر افسردگی و اضطراب در رابطۀ بین راهبردهای تنظیم هیجانیِ نشخوار ذهنی و سرکوب فکر و افکار خودکشی بود.روش‌بررسی: پژوهش توصیفی از نوع هم‌بستگی و جامعۀ آماری شامل تمام ساکنان شهر کرج در بهار سال 1395 به‌ تعداد یک‌میلیون و 614هزار و 626 نفر بود که از میان آن‌ها 351 نفر به روش نمونه‌برداری خوشه‌ای چندمرحله‌ای تصادفی انتخاب شدند. ابزار پژوهش، شامل مقیاس افکار خودکشی بک (1979)، پرسش‌نامۀ افسردگی بک (1996)، پرسش‌نامۀ اضطراب بک (1988)، مقیاس سبک‌های پاسخ نشخواری نولنهوکسیما و مارو (1991) و پرسش‌نامۀ سرکوب خرس سفید وگنر و زاناکاس (1994) بود. داده‌ها با استفاده از نرم‌افزار آموس، روش الگویابی معادله‌های ساختاری و برآورد بیشینۀ احتمال و در سطوح معناداری 0٫01 و 0٫05 تحلیل شدند. یافته‌ها: ضریب مسیر مستقیم بین راهبرد تنظیم هیجانی نشخوار ذهنی با افکار خودکشی (0٫042=p و 0٫132= β) مثبت و در سطح 0٫05 و ضرایب مسیر مستقیم بین راهبرد تنظیم هیجانی نشخوار ذهنی با افسردگی (0٫001=p و 0٫702= β)، راهبرد تنظیم هیجانی نشخوار ذهنی با اضطراب (0٫001=p و 0٫596= β)، راهبرد تنظیم هیجانی سرکوبی فکر با اضطراب (0٫007=p و 0٫124= β) و افسردگی با افکار خودکشی (0٫001=p و 0٫305= β) مثبت و در سطح 0٫01 معنادار بود. نتایج پژوهش حاضر نشان داد افسردگی، رابطۀ بین راهبردِ تنظیم هیجانیِ نشخوار ذهنی و افکار خودکشی را میانجی‌گری کرد (0٫001=p و 0٫214= β). نتیجه‌گیری: با توجه به یافته‌های این پژوهش، نشخوار ذهنی با مانع‌شدن از به‌کارگیری گزینه‌های سازگارانه‌تر از جمله حل مسئله، خطر افسردگی و در نهایت، افکار و رفتارهای خودکشی‌گرا را افزایش می‌دهد.

The Mediating role of Depression and Anxiety in the Relationship between Rumination and Thought Suppression Strategies and Suicidal Ideation

Background Objective: Suicide is a global challenge and a considerable concern for public health. It is one of the main cause of death throughout the world. Suicide is a complex phenomenon that involves several domains of risk factors, and reliable perspective for both scientific explanation and prevention. Suffering from a mood disorder such as depression means a risk of death by suicide. Anxiety symptoms are common in patients with mood disorders, even in those without a diagnosis of an anxiety disorder. There is a correlation between anxiety symptoms and suicidal behavior in ordinary people and individuals with other psychiatric disorders. Patients with anxiety symptoms are more likely to report suicidal ideation, attempt to suicide and die by suicide in comparison with patients without anxiety symptoms, even after adjusting for comorbid depression. Suicide ideation is considered as one of the strongest predictors of subsequent suicidal behavior among various risk factors. It was observed that severe or pervasive ideation predicts suicide and even passive ideation, such as a wish to die, has been known to be a risk factor for death by suicide. Cognitive processes that increase one rsquo;s vulnerability to suicidal behaviors have not been adequately examined. Assessing suicidal thoughts and actions is an integral part of healthcare and research on the prevention of suicide. Thus, it is necessary to understand suicidal thinking to advance treatment and prevention. This study aimed to determine the role of depression and anxiety in the relationship between rumination and thought suppression emotion regulation strategies and suicidal ideation. Methods: The study was a descriptive -correlational. All residents of Karaj city (n=1,614,626) consisted of a statistical population in spring of 2016. Randomized multistage -clustered sampling method was used to select 351 participants for the study. Instruments of the study included Beck scale for suicide ideation (1979), Beck depression inventory (1996), Beck anxiety inventory (1988), ruminative response scale by Nolen -Hoeksema and Morrow (1991), and white bear suppression inventory by Wegner and Zanakos (1994). Data analyzed by Amos software (structural equation modelling and maximum likelihood estimation) 0.01 and 0.05 considered as significances. Results: The direct path coefficient between the rumination emotion regulation and suicidal thoughts (p=0.042, beta;=0.132) was significant. Direct path coefficients between the rumination emotion regulation with depression (p=0.001, beta;=0.702), rumination emotion regulation with anxiety (p=0.001, beta;=0.596), thought suppression emotion regulation with anxiety (p=0.007, beta;=0.124) and depression with suicidal thoughts (p=0.001, beta;=0.305) were positive at 0.01 level of significance. The results of the study indicated that depression mediates the relationship between rumination emotion regulation strategy and suicidal ideation (p=0.001, beta;=0.214).Conclusion: According to the study findings, suicidal thoughts and behaviors are associated with psychosocial disorders. It seems that stressful experiences are one of the factors that leading individual to suffer from depression and rumination that continually occur over time and could play an important role in creating suicidal thoughts. Ruminative processes include attentional biases for negatively valence content, particularly depression -related information so that if an individual becomes engaged in these thought processes; they will have difficulty extricating themselves and disengaging from such content. According to the cognitive model of suicidal behavior, such repetitive negative thinking may activate more suicide - relevant cognitive processes, including attentional biases toward suicide.