title: Pathways from life-historical events and borderline personality disorder to symptomatic disorders among suicidal psychiatric patients: A study of structural equation modeling.
abstract: OBJECTIVE
  Suicidal behavior (SB) is a major mental health problem. The research has identified many factors related to SB, such as problems in the developmental period and psychiatric and personality disorders. However, the interrelation of these factors has not been clearly delineated.
  
  
  METHODS
  The subjects were 155 patients consecutively admitted with SB to a psychiatric center in Tokyo. Structured interviews, including the Structured Clinical Interview for DSM-IV (SCID)-I and SCID-II, were conducted to determine characteristics of the SB-related factors. To illustrate their interrelation, this study applied the technique of structural equation modeling. The latent constructs of life-historical events, borderline personality disorder (BPD) features and three symptomatic disorders (depression, anxiety disorders and substance dependence) were aligned in the chronological order of their manifestation, and connected one another within the model. Indicator variables of life-historical events were maltreatment in the developmental period and early onset of problematic behaviors. Indicators of BPD features and symptomatic disorders included the scales composed of the items in the SCID-I and II.
  
  
  RESULTS
  The constructed model with favorable goodness-of-fit indices confirmed that BPD features had a mediating role in which they were influenced by life-historical events, and exerted an influence on the symptomatic disorders. Outside the BPD-mediating paths, the model suggested three clinically interpretable links between life-historical events and symptomatic disorders.
  
  
  CONCLUSIONS
  The model of this study demonstrated the pathways from life-historical events and BPD to symptomatic disorders, and indicated a generating process of psychiatric comorbidity among suicidal patients. The wide-range view this study portrayed has important clinical implications, and deserves further substantiation by future studies.
authors: Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan.
authors: Naoki
authors: N
authors: Hayashi
authors: Tokyo Metropolitan Chubu Comprehensive Center for Mental Health and Welfare, Tokyo, Japan.
authors: Miyabi
authors: M
authors: Igarashi
authors: Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan.
authors: Atsushi
authors: A
authors: Imai
authors: Osaka Prefectural Tondabayashi Health Center, Osaka, Japan.
authors: Yuka
authors: Y
authors: Yoshizawa
authors: Kaori
authors: K
authors: Asamura
authors: Kitanomaru Clinic, Tokyo, Japan.
authors: Yoichi
authors: Y
authors: Ishikawa
authors: Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan.
authors: Taro
authors: T
authors: Tokunaga
authors: Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan.
authors: Kayo
authors: K
authors: Ishimoto
authors: Affective Disorders Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
authors: Yoshitaka
authors: Y
authors: Tatebayashi
authors: Tokyo Government Bureau of Social Welfare and Public Health, Tokyo, Japan.
authors: Naoki
authors: N
authors: Kumagai
authors: Graduate School of Education and Human Development, Nagoya University, Nagoya, Japan.
authors: Hidetoki
authors: H
authors: Ishii
authors: Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan.|Michinoo Hospital, Nagasaki, Japan.
authors: Yuji
authors: Y
authors: Okazaki
mesh_terms: D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology*; D001008:Anxiety Disorders / Q000523:psychology; D001883:Borderline Personality Disorder / Q000523:psychology*; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D019966:Substance-Related Disorders / Q000523:psychology; D059020:Suicidal Ideation; D014041:Tokyo; D055815:Young Adult
keywords: borderline personality disorder; childhood and adolescent maltreatment; psychiatric admission; psychiatric diagnosis; suicidal behavior