An explanatory model of suicidal ideation based on family functionality and mental health problems: A cross-sectional study of medical students
Abstract
Background: One of the mental health problems with the greatest impact on people's lives is suicidal behavior, a largely preventable public health problem that accounts for almost half of all violent deaths. The aim of the study is to propose a model that can explain and predict suicidal ideation based on mental health problems (stress-anxiety-depression) and family functionality (cohesion, flexibility, and cohesion).
Methods: Our study is cross-sectional. The population consisted of medical interns from all over Peru. Non-probability sampling was used. We used Family Cohesion and Adaptability Evaluation Scale (FACES-III), Family Communication Scale, Family Satisfaction Scale, Depression Anxiety and Stress Scales (DASS-21), and the Scale for Suicide Ideation – Worst (SSI-W).
Results: A total of 480 participants were included. The prevalence of suicidal ideation was 39Poisson regression analysis adjusted identified that people with anxiety symptoms were more than four times more likely to have suicidal ideation (PR=4.89; 95% CI:1.90-12.64). Also, people with moderate to high levels of family communication were much less likely to have suicidal ideation (PR= 0.07; 95% CI: 0.01-0.41), making it a protective factor. The proposed model presented optimal goodness-of-fit indices (CFI=0.974; TLI=0.974; SRMR=0.055; RMSEA=0.062). In addition, the proposed model can explain the presence of suicidal ideation in 88.3% (R2=0.883).
Conclusions: Our model can explain 88.3% of suicidal behavior based on family relationships and mental health problems in medical interns. In addition, the variables that alone were most associated with suicidal behavior were anxious symptoms and family communication as risk factors and protective factors, respectively.
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References
American Psychiatric Association (2013). Guía de consulta de los criterios diagnósticos del DSM 5. Asociación Americana de Psiquiatría; Arlington, VA.
Bazo-Alvarez, J. C., Bazo-Alvarez, O. A., Aguila, J., Peralta, F., Mormontoy, W., & Bennett, I. M. (2016). Propiedades psicométricas de la escala de funcionalidad familiar FACES-III: un estudio en adolescentes peruanos. Revista peruana de medicina experimental y salud publica, 33(3), 462–470. https://doi.org/10.17843/rpmesp.2016.333.2299
Beck, A. T., Brown, G. K., Steer, R. A., Dahlsgaard, K. K., & Grisham, J. R. (1999). Suicide ideation at its worst point: a predictor of eventual suicide in psychiatric outpatients. Suicide & Life-Threatening Behavior, 29(1), 1–9. https://www.ncbi.nlm.nih.gov/pubmed/10322616
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), 343–352. https://doi.org/10.1037//0022-006x.47.2.343
Beran, T. N., & Violato, C. (2010). Structural equation modeling in medical research: a primer. BMC Research Notes, 3, 267. https://doi.org/10.1186/1756-0500-3-267
Chavez-Cáceres, R., Luna-Muñoz, C., Mendoza-Cernaqué, S., Ubillus, J. J., & Lopez, L. C. (2020). Factors associated with suicide ideation in patients of a Peruvian Hospital. Revista de la Facultad de Medicina Humana, 20(3), 1–1. https://doi.org/10.25176/RFMH.v20i3.3054
Contreras-Cordova, C. R., Atencio-Paulino, J. I., Sedano, C., Ccoicca-Hinojosa, F. J., & Huaman, W. P. (2022). Suicidios en el Perú: Descripción epidemiológica a través del Sistema Informático Nacional de Defunciones (SINADEF) en el periodo 2017-2021. Revista de neuro-psiquiatria, 85(1), 19–28. https://doi.org/10.20453/rnp.v85i1.4152
Copez-Lonzoy, A. J. E., Villarreal-Zegarra, D., & Paz-Jesús, Á. (2016). Propiedades psicométricas de la Escala de Comunicación Familiar en estudiantes universitarios. Revista Costarricense de Psicología, 35(1), 31–46. https://doi.org/10.22544/rcps.v35i01.03
Della Monica, A., Ferrara, P., Dal Mas, F., Cobianchi, L., Scannapieco, F., & F Ruta, F. R. (2022). The impact of Covid-19 healthcare emergency on the psychological well-being of health professionals: a review of literature. Annali Di Igiene: Medicina Preventiva E Di Comunita, 34(1), 34. https://doi.org/10.7416/ai.2021.2445
Denis-Rodríguez, E., Alarcón, M. E. B., Delgadillo-Castillo, R., Denis-Rodríguez, P. B., & Melo-Santiesteban, G. (2017). Prevalence of Suicidal Ideation in Medical Students of Latin America: a Meta-analysis. RIDE Revista Iberoamericana Para La Investigación Y El Desarrollo Educativo, 8(15), 387–418. https://doi.org/10.23913/ride.v8i15.304
Dominguez-Lara, S. (2014). ¿Matrices Policóricas/Tetracóricas o Matrices Pearson? Un estudio metodológico. Revista Argentina de Ciencias Del Comportamiento, 6(1), 39–48. https://doi.org/10.32348/1852.4206.v6.n1.6357
Eugenio Torres, S. R., & Zelada Alcántara, M. B. (2011). Relación entre estilos de afrontamiento e ideación suicida en pacientes viviendo con VIH del GAM “Somos Vida” del hospital nacional Sergio E. Bernales de la ciudad de Lima (M. E. Dorival Sihuas (ed.)) [Licenciatura en Psicología , Universidad Señor de Sipán]. https://hdl.handle.net/20.500.12802/1600
Ferguson, C. J. (2009). An effect size primer: A guide for clinicians and researchers. Professional Psychology: Research and Practice, 40(5), 532–538. https://doi.org/10.1037/a0015808
Fulgoni, C. M. F., Melvin, G. A., Jorm, A. F., Lawrence, K. A., & Yap, M. B. H. (2019). The Therapist-assisted Online Parenting Strategies (TOPS) program for parents of adolescents with clinical anxiety or depression: Development and feasibility pilot. Internet Interventions, 18, 100285. https://doi.org/10.1016/j.invent.2019.100285
Gómez Tabares, A. S., Núñez, C., Caballo, V. E., Agudelo Osorio, M. P., Aguirre, G., & Mauricio, A. (2019). Predictores psicológicos del riesgo suicida en estudiantes universitarios. Behavioral Psychology / Psicología Conductual, 27(3), 391–413.
González Pando, D., Cernuda Martínez, J. A., Alonso Pérez, F., Beltrán García, P., & Aparicio Basauri, V. (2018). Transdiagnóstico: origen e implicaciones en los cuidados de salud mental. Revista de La Asociación Española de Neuropsiquiatría, 38(133), 145–166. https://doi.org/10.4321/s0211-57352018000100008
Hernández-Vásquez, A., Azañedo, D., Rubilar-González, J., Huarez, B., & Grendas, L. (2016). Evolución y diferencias regionales de la mortalidad por suicidios en el Perú, 2004-2013. Revista Peruana de Medicina Experimental Y Salud Pública, 33(4), 751–757. https://doi.org/10.17843/rpmesp.2016.334.2562
Huarcaya-Victoria, J. (2020). Consideraciones sobre la salud mental en la pandemia de COVID-19. Revista Peruana de Medicina Experimental Y Salud Pública, 37(2), 327–334. https://doi.org/10.17843/rpmesp.2020.372.5419
Iacobucci, D. (2010). Structural equations modeling: Fit Indices, sample size, and advanced topics. Journal of Consumer Psychology, 20(1), 90–98. https://doi.org/10.1016/j.jcps.2009.09.003
Jacob, R., Li, T.-Y., Martin, Z., Burren, A., Watson, P., Kant, R., Davies, R., & Wood, D. F. (2020). Taking care of our future doctors: a service evaluation of a medical student mental health service. BMC Medical Education, 20(1), 1–11. https://doi.org/10.1186/s12909-020-02075-8
Joshi, S. V., Hartley, S. N., Kessler, M., & Barstead, M. (2015). School-based suicide prevention: content, process, and the role of trusted adults and peers. Child and Adolescent Psychiatric Clinics of North America, 24(2), 353–370. https://doi.org/10.1016/j.chc.2014.12.003
Kaggwa, M. M., Najjuka, S. M., Favina, A., Griffiths, M. D., & Mamun, M. A. (2023). Suicidal behaviors and associated factors among medical students in Africa: A systematic review and meta-analysis. Journal of Affective Disorders Reports, 11, 100456. https://doi.org/10.1016/j.jadr.2022.100456
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales. Psychology Foundation of Australia; Sydney, Australia. https://doi.org/10.1037/t01004-000
Lu, L., Jian, S., Dong, M., Gao, J., Zhang, T., Chen, X., Zhang, Y., Shen, H., Chen, H., Gai, X., & Liu, S. (2020). Childhood trauma and suicidal ideation among Chinese university students: the mediating effect of Internet addiction and school bullying victimisation. Epidemiology and Psychiatric Sciences, 29, e152. https://doi.org/10.1017/S2045796020000682
Meda, N., Pardini, S., Slongo, I., Bodini, L., Zordan, M. A., Rigobello, P., Visioli, F., & Novara, C. (2021). Students’ mental health problems before, during, and after COVID-19 lockdown in Italy. Journal of Psychiatric Research, 134, 69–77. https://doi.org/10.1016/j.jpsychires.2020.12.045
Mortier, P., Auerbach, R. P., Alonso, J., Bantjes, J., Benjet, C., Cuijpers, P., Ebert, D. D., Green, J. G., Hasking, P., Nock, M. K., O’Neill, S., Pinder-Amaker, S., Sampson, N. A., Vilagut, G., Zaslavsky, A. M., Bruffaerts, R., Kessler, R. C., & WHO WMH-ICS Collaborators. (2018). Suicidal Thoughts and Behaviors Among First-Year College Students: Results From the WMH-ICS Project. Journal of the American Academy of Child and Adolescent Psychiatry, 57(4), 263–273.e1. https://doi.org/10.1016/j.jaac.2018.01.018
Olson, D. H. (1986). Circumplex Model VII: validation studies and FACES III. Family Process, 25(3), 337–351. https://doi.org/10.1111/j.1545-5300.1986.00337.x
Olson, D. H., Waldvogel, L., & Schlieff, M. (2019). Circumplex Model of Marital and Family Systems: An Update. Journal of Family Theory & Review, 11(2), 199–211. https://doi.org/10.1111/jftr.12331
Peng, P., Hao, Y., Liu, Y., Chen, S., Wang, Y., Yang, Q., Wang, X., Li, M., Wang, Y., He, L., Wang, Q., Ma, Y., He, H., Zhou, Y., Wu, Q., & Liu, T. (2023). The prevalence and risk factors of mental problems in medical students during COVID-19 pandemic: A systematic review and meta-analysis. Journal of Affective Disorders, 321, 167–181. https://doi.org/10.1016/j.jad.2022.10.040
Perales, A., Sánchez, E., Barahona, L., Oliveros, M., Bravo, E., Aguilar, W., Ocampo, J. C., Pinto, M., Orellana, I., & Padilla, A. (2019). Prevalencia y factores asociados a conducta suicida en estudiantes de la Universidad Nacional Mayor de San Marcos, Lima-Perú. Anales de La Facultad de Medicina, 80(1), 28–33. https://doi.org/10.15381/anales.v80i1.15865
Ramírez, J. A. R., & Oduber, J. A. (2015). Ideación suicida y grupo de iguales: análisis en una muestra de adolescentes venezolanos. Universitas Psychologica, 14(3). https://doi.org/10.11144/Javeriana.upsy14-3.isgi
Román Mella, F., Vinet, E. V., & Alarcón Muñoz, A. M. (2014). Escalas de Depresión, Ansiedad y Estrés (DASS-21): Adaptación y propiedades psicométricas en estudiantes secundarios de temuco. Revista Argentina de Clínica Psicológica, 23(2), 179–190.
Rotenstein, L. S., Ramos, M. A., Torre, M., Segal, J. B., Peluso, M. J., Guille, C., Sen, S., & Mata, D. A. (2016). Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA: The Journal of the American Medical Association, 316(21), 2214–2236. https://doi.org/10.1001/jama.2016.17324
Santos, H. G. B. dos, dos Santos, H. G. B., Marcon, S. R., Espinosa, M. M., Baptista, M. N., & de Paulo, P. M. C. (2017). Factors associated with suicidal ideation among university students. Revista Latino-Americana de Enfermagem, 25, e2878. https://doi.org/10.1590/1518-8345.1592.2878
Skaczkowski, G., van der Kruk, S., Loxton, S., Hughes-Barton, D., Howell, C., Turnbull, D., Jensen, N., Smout, M., & Gunn, K. (2022). Web-Based Interventions to Help Australian Adults Address Depression, Anxiety, Suicidal Ideation, and General Mental Well-being: Scoping Review. JMIR Mental Health, 9(2), e31018. https://doi.org/10.2196/31018
Suh, Y. (2015). The Performance of Maximum Likelihood and Weighted Least Square Mean and Variance Adjusted Estimators in Testing Differential Item Functioning With Nonnormal Trait Distributions. Structural Equation Modeling: A Multidisciplinary Journal, 22(4), 568–580. https://doi.org/10.1080/10705511.2014.937669
Valle, W., & Cabrera, M. (2020). Valores normativos de las escalas de satisfacción y comunicación familiar: Un estudio preliminar. Teoría y Práctica: Revista Peruana de Psicología, 1(1), e23.
Villarreal-Zegarra, D., Copez-Lonzoy, A., Paz-Jesús, A., & Costa-Ball, C. D. (2017). Validez y confiabilidad de la Escala Satisfacción Familiar en estudiantes universitarios de Lima Metropolitana, Perú. Actualidades en Psicología, 31(123), 90–99. https://doi.org/10.15517/ap.v31i123.23573
Witt, K., Boland, A., Lamblin, M., McGorry, P. D., Veness, B., Cipriani, A., Hawton, K., Harvey, S., Christensen, H., & Robinson, J. (2019). Effectiveness of universal programmes for the prevention of suicidal ideation, behaviour and mental ill health in medical students: a systematic review and meta-analysis. Evidence-Based Mental Health, 22(2), 84–90. https://doi.org/10.1136/ebmental-2019-300082
World Health Organization. (2014). Preventing Suicide: a Global Imperative. WHO; Geneva, Geneva.
World Health Organization. (2021). Suicidio. World Health Organization. https://www.who.int/es/news-room/fact-sheets/detail/suicide
World Health Organization. (2023). WHO Coronavirus Disease (COVID-19) Dashboard. World Health Organization. https://doi.org/10.46945/bpj.10.1.03.01
Xia, Y., & Yang, Y. (2018). RMSEA, CFI, and TLI in structural equation modeling with ordered categorical data: The story they tell depends on the estimation methods. Behavior Research Methods, 51(1), 409–428. https://doi.org/10.3758/s13428-018-1055-2
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