Predicción de comportamientos suicidas y autolesiones no suicidas en adolescentes argentinos

Abstract

Actualmente uno de los debates centrales el campo de la suicidología se refiere a si los comportamientos suicidas y las autolesiones no suicidas (NSSI) representan clusters diferentes o un continuum en el espectro autodestructivo. Si se las considerara entidades nosológicas separadas debiera ser factible identificar características diferenciales entre ellos de manera que, por ejemplo, fuera posible predecir en qué casos de NSSI sería más probable que un adolescente cometiera un intento suicida. Este estudio se propuso establecer la capacidad predictiva de habilidades emocionales e interpersonales para ambos tipos de comportamientos. Para ello se administraron el Inventario de Orientaciones Suicidas ISO-30, la Escala Rasgo de Metaconocimientos sobre Estados Emocionales TMMS-24 y las escalas Recursos Sociales de las Escalas de Recursos Psicológicos a 510 adolescentes escolarizados de la ciudad de Mar del Plata, Argentina. Se seleccionaron 81 casos con autolesiones no suicidas (Grupo NSSI) y 61 con ideaciones suicidas (Grupo IS). Los resultados muestran que los modelos de regresión obtenidos para cada grupo son diferentes. El ajuste general del modelo del Grupo IS resultó adecuado (χ2 10.54 p = .22), los coeficientes de determinación revelan una capacidad explicativa que da cuenta de entre un 25 y 46% de la varianza total y la variable de mayor peso en el modelo fue la Incapacidad para Pedir Ayuda. En cambio el modelo del grupo NSSI mostró un pobre ajuste y solamente quedaron incluidas las variables emocionales. Se discuten los resultados según consecuencias aplicadas y futuras líneas de investigación.

Currently, one of the central debates in the field of suicidology refers to whether suicidal behavior and non suicidal self-injury (NSSI) represent different clusters or a continuum in the self-harm spectrum. The first approach, which runs in the same line than DSM-5, defines the NSSI as self-inflected injuries on any surface the own body with the goal of releasing negative thought or feelings, as a reaction to an interpersonal conflict, aiming at the achievement of a positive affective state, clearly understanding that in any case these injuries could cause death. The second approach states that the non-suicidal qualification represents a restriction and is potentially dangerous, given the close link between NSSI and suicidal behavior. If they were separate nosological entities it should be possible to identify differential features in each one. Literature focused on the study of pathological variables, suggest that it seems to be a difference of degree rather than qualitative since adolescents showing suicidal behaviors report more severe psychopathological symptoms, more depression, more hopelessness and loneliness, many family conflicts, and finding less reasons to stay alive compared to those who only exhibit NSSI. These data, somehow, offer support to both approaches. Following this debate, this study aimed at establishing the predictive value of emotional and interpersonal skills as independent variables for both types of behaviors. The selection of these variables was based on previous research findings, which provide robust evidence regarding the huge difficulties showed by adolescents with suicidal behaviors and NSSI in emotional expression and regulation. As for of interpersonal variables, diverse studies offer consistent results about the low perception of social support, the presence of intense feeling of loneliness and alienation, as well as the communication difficulties manifested by adolescents with suicidal behaviors. Based on this background, the hypothesis states that such difficulties with emotional skills will be useful predictors for both groups, only showing differences of degree. This way, adolescents with NSSI will show fewer difficulties in this aspect than the suicidal ideation group; meanwhile difficulties in interpersonal skills will arise as predictors only for the suicidal ideation group. The Inventory for Suicidal Orientations, the Trait MetaMood Scale and the Social Resources Scales from the Psychological Resources Scales were used to examine to 510 adolescent students from the city of Mar del Plata, Argentina. From the total sample, 142 participants were selected and separated into two groups. Suicidal Ideation Group -IS- (82% females, M= 16.16; sd= 1.11) accomplished at least one of the following criteria for high suicidal risk with active suicidal ideation: a) total score of ISO-30 ≥ 45; b) score ≥ 2 in the item #30 of the ISO-30 scale, “If my problems get worst, I will kill myself”; c) score ≥ 1 in item 30 and total score ≥ 37 (P 84) in ISO30, or d) explicit information on ideation and/or suicidal attempt in responses to personal data survey. The other group –NSSI- was composed of 81 cases (71.6% females, M= 16.35; sd= 1.13) according to the following criteria: (a) having reported self-injury thoughts and/or committing self-injuries; (b) not achieving any of the 4 criteria established for the suicidal ideation group. Results identified different regression models for each group. The overall fit showed for IS-Group model was adequate (χ2 = 10.54; p= .22). As for coefficients of determination reported, 25 to 46% of the total variance was explained, and the inability to ask for help played a major role within predictive variables. Instead, the model for the NSSI Group achieved a poor fit, including only emotional variables, as hypothesized. Results and further research lines are discussed.