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Measurement of mentalizing: A systematic review and development of a construct validity framework 心理化的测量:建构效度框架的系统回顾与发展
IF 12.2 1区 心理学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2025-12-01 Epub Date: 2025-10-10 DOI: 10.1016/j.cpr.2025.102657
Hannah Hawksdale , Beichen Meng , Janet Feigenbaum , Peter Fonagy , Tobias Nolte
Mentalizing—holding in mind, appraising and reappraising mental states—is evidenced across research disciplines as a key psychological capacity of developmental and clinical importance. Due to this interdisciplinary context, there are a broad range of mentalizing measures available. The primary aim of this review was to systematically review existing mentalizing measures. MEDLINE, PSYCHINFO, HAPI and PSYCHTESTS were searched to identify English-language, text-based, general adult population mentalizing measures.
Mentalizing is established as a multidimensional concept that varies across relational contexts. However, explicit dimensional definition and systematic contextualisation of mentalizing measures is rare. The secondary aim of the review was to develop and pilot a novel framework for classifying the mentalizing dimensions and relational context operationalised by each measure. Following reference to the literature and expert discussion, a dimensional construct framework of mentalizing with 18 components was proposed and applied to existing instruments.
57 text-based measures were identified by the review. Inter-rater agreement using the novel framework was 75%. No measures completely overlapped on dimensions and relational context. Relational contexts of measures were largely mentalizing the self (52) and/or hypothetical unspecified others (33). The review demonstrates that measures of mentalizing can be compared on the basis of dimensions operationalised and relational context, increasing utility in measure selection. Divergent construct validity highlights a need for careful selection of appropriate measures on the basis of mentalizing components of interest. Increased clarity of construct validity could be used to illuminate conflicting findings in the mentalizing literature and to advance the development of new assessment instruments.
心理化——牢记、评估和重新评估心理状态——在各个研究学科中都被证明是一种具有发展和临床重要性的关键心理能力。由于这种跨学科的背景,有广泛的心理测量可用。本次审查的主要目的是系统地审查现有的心理措施。检索MEDLINE, PSYCHINFO, HAPI和PSYCHTESTS以确定英语,基于文本的一般成人人群心理化措施。
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引用次数: 0
The motivational anatomy of fear: A closer look at core threats 恐惧的动机剖析:对核心威胁的更近距离观察。
IF 12.2 1区 心理学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2025-12-01 Epub Date: 2025-10-03 DOI: 10.1016/j.cpr.2025.102655
Elad Zlotnick, Jonathan D. Huppert
“Core threats” are the ultimate feared consequences motivating avoidance behaviors and underpinning surface-level fears. For example, the surface fear of contamination may stem from core threats such as death, suffering, or harming loved ones. Whereas traditional models of anxiety recognize the role of motivation, they have not emphasized how global motivations shape threat appraisal and avoidance. We distinguish core threats from core beliefs: while core beliefs describe how individuals view themselves, others, and the world (which typically influence the likelihood of core threats), core threats specify why outcomes matter emotionally—what makes them motivating (i.e., why are they individually costly). Core threats provide the motivational structure that organizes diverse fears across anxiety disorders and beyond. They help explain generalization, persistence, and relapse. Phenomenologically, core threats are highly individualized, reflecting personal values over diagnostic categories. Contemporary models of treatment of anxiety often emphasize metacognitive regulation processes while treating fear content as interchangeable or secondary. We propose a complementary perspective: motivationally guided appraisals determine what becomes threatening and why. We formalize this perspective in a computational framework that distinguishes motivational drivers of avoidance, including core threats, distress intolerance, and exaggerated duration. Just as categories are organized around central exemplars, fear structures are organized around motivationally central threats. Conditioning research mirrors this principle: fear generalizes more strongly from central exemplars and remains sensitive to the value of the underlying outcome. Targeting core threats—the motivational focus of fear—offers a pathway to engage broader fear networks, improve generalization, reduce relapse, and guide personalized interventions.
“核心威胁”是最终恐惧的结果,激发了逃避行为,并支撑了表面的恐惧。例如,表面上对污染的恐惧可能源于死亡、痛苦或伤害亲人等核心威胁。尽管传统的焦虑模型承认动机的作用,但它们并没有强调全局动机如何影响威胁评估和回避。我们将核心威胁与核心信念区分开来:核心信念描述了个人如何看待自己、他人和世界(这通常会影响核心威胁的可能性),而核心威胁则说明了为什么结果在情感上很重要——是什么让它们具有激励作用(即,为什么它们对个人来说代价高昂)。核心威胁提供了一种动机结构,将焦虑障碍和其他障碍之间的各种恐惧组织起来。它们有助于解释普遍化、持续性和复发。在现象学上,核心威胁是高度个性化的,反映了个人价值观而不是诊断类别。当代焦虑治疗模式往往强调元认知调节过程,而将恐惧内容视为可互换或次要的。我们提出了一个补充的观点:动机导向的评估决定了什么会成为威胁,以及为什么会成为威胁。我们在一个计算框架中将这一观点形式化,该框架区分了回避的动机驱动因素,包括核心威胁、痛苦不容忍和夸大的持续时间。正如类别是围绕中心范例组织的,恐惧结构是围绕动机中心威胁组织的。条件反射研究反映了这一原则:恐惧更强烈地从中心范例中概括出来,并对潜在结果的价值保持敏感。针对核心威胁——恐惧的动机焦点——提供了一条参与更广泛的恐惧网络、提高普遍性、减少复发和指导个性化干预的途径。
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引用次数: 0
Together and beyond: A systematic review on characteristics and efficacy of transdiagnostic psychotherapeutic group-based interventions for children and adolescents 共同和超越:对儿童和青少年跨诊断心理治疗群体干预的特征和疗效的系统回顾
IF 12.2 1区 心理学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2025-11-01 Epub Date: 2025-08-14 DOI: 10.1016/j.cpr.2025.102642
Celia Bähr , David Phan , Natalia Murawska , Julia Gerber , Annie Jordan , Kyra Hoffmann , Claudia Calvano
Transdiagnostic group interventions address the limitations of youth mental health care services, including the disorder-specific nature of existing treatments and the limited capacity of individual psychotherapies. This review synthesizes the 1) characteristics, applications, parental involvement, patient and public involvement (PPI), and 2) data on efficacy, adherence, safety and treatment satisfaction evidence of transdiagnostic group interventions for children and adolescents. Following PRISMA guidelines, a preregistered systematic literature search identified 6845 publications on transdiagnostic in-person group-based interventions for children and adolescents (mean age ≤ 18 years). Two reviewers independently screened for inclusion, extracted data, and assessed risk of bias using the RoB-2 and ROBINS-I tool. The review examined 80 studies encompassing 4152 participants (Mage = 12.81 years), mostly conducted in high-income countries. Cognitive behavioural therapy was the most commonly used approach (κ = 59), with the core components mindfulness, emotion regulation, and cognitive restructuring. Interventions averaged 11 sessions and 52 % involved parents. 22 studies targeted anxiety and depression jointly with positive pre-post effects. Significant reductions in symptom severity were also reported for other disorders, though outcome measures highly varied and group comparisons with active control conditions or treatment-as-usual were often non-significant. Few studies examined disorder-unspecific outcomes like psychosocial functioning, quality of life, or reported remission rates, treatment satisfaction or applied a PPI framework. While a large number of different transdiagnostic group interventions for youth have been developed and evaluated, the lack of rigorous reporting and high risk of bias highlight the need for better-quality research to strengthen evidence and improve clinical implementation.
跨诊断团体干预措施解决了青年心理保健服务的局限性,包括现有治疗方法的特定障碍性质和个人心理治疗的有限能力。本文综述了儿童和青少年跨诊断群体干预的特点、应用、家长参与、患者和公众参与(PPI),以及儿童和青少年跨诊断群体干预的有效性、依从性、安全性和治疗满意度证据。遵循PRISMA指南,预先注册的系统文献检索确定了6845份关于儿童和青少年(平均年龄≤18岁)跨诊断面对面群体干预措施的出版物。两位审稿人使用rob2和ROBINS-I工具独立筛选纳入、提取数据并评估偏倚风险。该综述检查了80项研究,包括4152名参与者(年龄为12.81岁),主要在高收入国家进行。认知行为疗法是最常用的方法(κ = 59),其核心成分是正念、情绪调节和认知重组。干预平均为11次,52%涉及父母。22项研究针对焦虑和抑郁的联合,并有积极的前后效应。其他疾病的症状严重程度也有显著降低的报道,尽管结果测量差异很大,与积极对照条件或常规治疗的组比较通常不显著。很少有研究检查非特异性疾病的结果,如心理社会功能、生活质量,或报告的缓解率、治疗满意度或应用PPI框架。虽然已经开发和评估了大量不同的青年跨诊断群体干预措施,但缺乏严格的报告和高偏倚风险突出表明需要进行更高质量的研究,以加强证据和改善临床实施。
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引用次数: 0
Towards a transdiagnostic approach to psychopathology in the postpartum period 产后精神病理的跨诊断方法
IF 12.2 1区 心理学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2025-11-01 Epub Date: 2025-09-06 DOI: 10.1016/j.cpr.2025.102646
Jessilyn M. Froelich, Emily D. Gerstein
Psychopathology research and clinical practice have historically relied on traditional diagnostic approaches, though there is a growing body of evidence suggesting these methods are likely outdated and are not suited for capturing the nuance and complexity of mental health symptomatology. Transdiagnostic approaches to psychopathology have been proposed as an alternative to traditional nosology, such as the Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Diseases and their corresponding versions. The postpartum period may be a time when transdiagnostic approaches could be useful, as it has both normative and maladaptive psychological challenges with clear overlapping risk, protective, and maintenance factors related to its psychopathology. The benefits of taking a transdiagnostic approach in the postpartum period are vast – examining postpartum psychopathology transdiagnostically can help identify common thematic elements experienced by new mothers, thus leading to improved screening, further assessment, and targeted treatment. This paper reviews the current diagnostic approaches to postpartum psychopathology, the benefits of a transdiagnostic approach in the postpartum period, relevant biopsychosocial factors, and proposes ways to incorporate this transdiagnostic approach in a way that works to benefit new mothers. Additionally, potential challenges and barriers to implementation are explored.
精神病理学研究和临床实践历来依赖于传统的诊断方法,尽管越来越多的证据表明,这些方法可能已经过时,不适合捕捉精神健康症状学的细微差别和复杂性。精神病理学的跨诊断方法已被提议作为传统分类学的替代方法,如《精神疾病诊断与统计手册》或《国际疾病分类》及其相应版本。产后可能是一个跨诊断方法有用的时期,因为它既有规范性的心理挑战,也有适应不良的心理挑战,与精神病理相关的风险、保护和维持因素明显重叠。在产后期间采用跨诊断方法的好处是巨大的-跨诊断检查产后精神病理可以帮助确定新妈妈经历的共同主题因素,从而改善筛查,进一步评估和有针对性的治疗。本文回顾了目前产后精神病理学的诊断方法,产后跨诊断方法的益处,相关的生物心理社会因素,并提出了将这种跨诊断方法纳入新母亲的方法。此外,还探讨了实施的潜在挑战和障碍。
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引用次数: 0
Angry without Borders: Global prevalence and factors of intermittent explosive disorder: A systematic review and meta-analysis 愤怒无国界:间歇性爆发性精神障碍的全球患病率和影响因素:一项系统回顾和荟萃分析
IF 12.2 1区 心理学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2025-11-01 Epub Date: 2025-08-15 DOI: 10.1016/j.cpr.2025.102643
Fangqing Liu , Xiaoshan Yin
This systematic review and meta-analysis aimed to synthesise global data on the prevalence, determinants, and moderators of Intermittent Explosive Disorder (IED). Analysing 29 studies (N = 182,112 participants across 17 countries), pooled lifetime and 12-month prevalence estimates were 5.1 % (95 % CI: 3.4–7.5 %) and 4.4 % (95 % CI: 2.9–6.7 %), respectively. Prevalence varied significantly across subgroups, with higher rates in clinical (10.5 %), refugee (8.5 %), and adolescent populations. Male gender (OR = 3.39), younger age, trauma exposure, and psychiatric comorbidities (mood, anxiety, and substance use disorders) emerged as robust risk factors. Studies using DSM-5 criteria reported lower prevalence than DSM-IV. Regional disparities were notable, with elevated rates in conflict-affected and Global South regions. Heterogeneity was partially explained by population type, diagnostic criteria, and sociocultural context. Findings underscore the multifactorial etiology of IED, shaped by biological vulnerabilities, trauma, and structural adversities. A tiered intervention framework integrating universal prevention, targeted therapies, and policy advocacy is therefore proposed to address its global burden.
本系统综述和荟萃分析旨在综合有关间歇性爆炸障碍(IED)患病率、决定因素和调节因素的全球数据。分析了29项研究(17个国家的182,112名参与者),汇总终生和12个月患病率估计值分别为5.1% (95% CI: 3.4 - 7.5%)和4.4% (95% CI: 2.9 - 6.7%)。不同亚组的患病率差异显著,临床人群(10.5%)、难民人群(8.5%)和青少年人群的患病率较高。男性性别(OR = 3.39)、年轻、创伤暴露和精神合并症(情绪、焦虑和物质使用障碍)成为强有力的危险因素。使用DSM-5标准的研究报告的患病率低于DSM-IV。地区差异显著,受冲突影响地区和全球南方地区的比率较高。异质性部分可以由人群类型、诊断标准和社会文化背景来解释。研究结果强调了IED的多因素病因,由生物脆弱性、创伤和结构性逆境形成。因此,提出了一个整合普遍预防、靶向治疗和政策宣传的分层干预框架,以解决其全球负担。
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引用次数: 0
Understanding the mechanisms underlying the association between insecure attachment and intimate partner violence (IPV): Meta-analyses using two meta-analytical methods and a systematic review of mediators 了解不安全依恋与亲密伴侣暴力(IPV)之间关联的潜在机制:使用两种元分析方法的元分析和对中介的系统回顾
IF 12.2 1区 心理学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2025-11-01 Epub Date: 2025-09-11 DOI: 10.1016/j.cpr.2025.102645
Iana Wong , Thomas F. Denson
Little is known about why insecure attachment is related to greater perpetration and victimization of intimate partner violence (IPV). Many studies have examined the underlying mechanisms, but no studies have integrated them. The present article aimed to systematically identify and quantify the magnitude of the mediators between anxious and avoidant attachment and IPV perpetration and victimization. We used two meta-analytic methods (two-stage structural equation modelling and multi-level meta-analyses) to accomplish this goal. After screening 5087 records, 63 eligible studies were identified. The mediators were reviewed using the framework of the I3 model. We meta-analyzed seven categories of mediators, including: 1) jealousy, anger, distrust, and perceived partner's infidelity, 2) dysfunctional beliefs, 3) maladaptive personality traits, 4) relationship dissatisfaction, 5) dominance and need for control, 6) destructive communication, and 7) emotion dysregulation. Results showed that interpersonal instigating (jealousy, anger, distrust, and perceived partner's infidelity), interpersonal impelling (relationship dissatisfaction, dominance and need for control, destructive communication), and personal disinhibiting (emotion dysregulation) factors significantly mediated the attachment-IPV relationships. The indirect effects of most instigating, impelling, and disinhibiting factors had small effect sizes, but interpersonal impelling factors such as dominance/need for control and relationship dissatisfaction had medium effect sizes in the anxiety-IPV and avoidance-IPV links respectively. Moreover, some mediators between avoidance and IPV were significant without having significant direct effects. An additional 26 mediators were presented in the Systematic Review section. The findings suggest IPV interventions should consider addressing attachment insecurity along with the relevant mediators, especially interpersonal impellance for avoidant attachment.
为什么不安全的依恋与亲密伴侣暴力(IPV)的更大的犯罪和受害有关,人们知之甚少。许多研究已经检查了潜在的机制,但没有研究将它们整合起来。本文旨在系统地识别和量化焦虑型和回避型依恋与IPV犯罪和受害之间的中介因子的大小。我们使用了两种元分析方法(两阶段结构方程模型和多层次元分析)来实现这一目标。在筛选5087份记录后,确定了63份符合条件的研究。使用I3模型的框架对中介进行了审查。我们元分析了七种类型的中介因素,包括:1)嫉妒、愤怒、不信任和感知伴侣的不忠;2)功能失调的信念;3)适应不良的人格特征;4)关系不满;5)支配和控制需求;6)破坏性沟通;7)情绪失调。结果表明,人际唆使(嫉妒、愤怒、不信任和感知伴侣不忠)、人际强迫(关系不满、支配和控制需求、破坏性沟通)和个人解除抑制(情绪失调)因素显著调节依恋- ipv关系。在焦虑- ipv和回避- ipv环节中,多数诱导因素、驱使因素和去抑制因素的间接效应均具有较小的效应量,而人际驱动因素如支配/控制需求和关系不满的间接效应量分别具有中等效应量。此外,回避和IPV之间的一些中介因素是显著的,但没有显著的直接影响。系统审查部分还介绍了另外26种介质。研究结果表明,IPV干预应考虑解决依恋不安全感以及相关的中介因素,特别是回避型依恋的人际冲动。
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引用次数: 0
Underrepresentation and moderation of parent education levels in ADHD psychosocial treatment trials: A meta-analysis ADHD心理社会治疗试验中父母教育水平的不足和适度:一项荟萃分析
IF 12.2 1区 心理学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2025-11-01 Epub Date: 2025-08-13 DOI: 10.1016/j.cpr.2025.102639
Samantha M. Margherio , Hannah Brockstein , Azadeh Bakhtiari , Steven W. Evans

Objective

We sought to ascertain the representativeness of psychosocial treatment trials for youth with ADHD in terms of parent education (PE) and race and to determine whether these study characteristics moderated treatment outcomes.

Method

High-quality randomized controlled trials (RCTs) of psychosocial treatments for children and adolescents with ADHD conducted in the U.S. and published between 2007 and 2025 were included in this study if they reported PE (% of parents with a college degree or higher) and race/ethnicity.

Results

A total of 46 studies were included, representing 5837 participants. Between 48 % and 52 % of parents had a college degree or higher, compared to 38 % in the U.S. population. Two-thirds of studies overrepresented highly educated parents. Samples were generally representative of diverse races and ethnicity, although this appeared driven by the 35 % of studies that oversampled racially minoritized youth whereas 26 % underrepresented racially minoritized youth. Subgroup meta-analyses indicated treatment was only superior to control conditions in reducing ADHD symptoms in samples with highly educated parents. For race, treatment was only associated with significant effects on hyperactivity/impulsivity symptoms among racially-representative samples who also had high PE.

Conclusion

These findings question the effectiveness of psychosocial interventions for youth with ADHD for families of diverse educational backgrounds. There is a dire need to recruit more diverse samples in terms of PE, and to develop interventions that are effective for families across all educational backgrounds.
目的:我们试图从父母教育(PE)和种族方面确定青少年多动症心理社会治疗试验的代表性,并确定这些研究特征是否会调节治疗结果。方法2007年至2025年间在美国进行并发表的关于儿童和青少年多动症心理社会治疗的高质量随机对照试验(rct),如果他们报告了PE(具有大学或更高学历的父母的百分比)和种族/民族,则纳入本研究。结果共纳入46项研究,5837名受试者。48%到52%的父母拥有大学或更高学历,而在美国,这一比例为38%。三分之二的研究过度代表了受过高等教育的父母。样本通常具有不同种族和民族的代表性,尽管这似乎是由于35%的研究过度抽样了少数民族青年,而26%的研究未充分代表少数民族青年。亚组荟萃分析显示,在父母受过高等教育的样本中,治疗仅在减少ADHD症状方面优于对照组。就种族而言,治疗仅在具有高PE的具有种族代表性的样本中对多动/冲动症状有显著影响。结论这些发现质疑了不同教育背景家庭对青少年ADHD患者进行心理社会干预的有效性。迫切需要在体育方面招募更多不同的样本,并制定对所有教育背景的家庭有效的干预措施。
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引用次数: 0
Does meta-analytic evidence support inter-identity amnesia in dissociative identity disorder? A commentary and corrected analysis for Beker et al. (2024) 元分析证据是否支持分离性身份障碍患者的身份间遗忘?的评论和修正分析。
IF 12.2 1区 心理学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2025-11-01 Epub Date: 2025-08-08 DOI: 10.1016/j.cpr.2025.102638
Wencke Donath , Robin Van der Linde , Bruno Verschuere , John J.B. Allen , Richard J. McNally , Rafaele J.C. Huntjens
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引用次数: 0
The association between subjective and objective cognitive functioning from a transdiagnostic perspective: An umbrella review and meta-analysis 从跨诊断角度看主客观认知功能之间的关系:概括性回顾和荟萃分析
IF 12.2 1区 心理学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2025-11-01 Epub Date: 2025-09-05 DOI: 10.1016/j.cpr.2025.102648
Ryan Van Patten , Kyler Mulhauser , Tara A. Austin , John A. Bellone , Erica Cotton , Lawrence Chan , Elizabeth W. Twamley , Kelsey Sawyer , W. Curt LaFrance Jr.
The relationship between subjective (self-reported) and objective (performance-based) cognitive functioning has significant clinical implications across neuropsychiatric syndromes. We performed an umbrella review examining literature on the association between subjective and objective cognition from a transdiagnostic perspective. Eligible studies were full reports of review papers examining the relationship between subjective and objective cognition in humans across the lifespan. Risk of bias was evaluated using a modified version of the AMSTAR rating scale. Of 7329 initial reports screened, 50 reviews of mostly cross-sectional data were included. Review size ranged from 4 to 488 studies and demographic factors aside from age were rarely reported. Risk of bias was mixed. A narrative synthesis across more than 20 neuropsychiatric and neuromedical conditions found an inconsistent relationship between subjective and objective cognition, with effect sizes ranging from null to weak. Mental health factors such as depression and anxiety were more reliably and strongly related to subjective cognition than were objective cognitive test scores. In a second-order meta-analysis (10 reviews; N = 92,606), the pooled correlation between overall objective and subjective cognition was 0.14 (95 % CI [0.08, 0.21]; p = 0.001, Q(9) = 179.50, τ = 0.09, I2 = 95.00, <2 % variance shared). Subjective and objective cognition are largely non-overlapping constructs, reflecting unique and complementary aspects of overall cognitive functioning regardless of the specific population investigated or assessment method used. Researchers and clinicians should not expect to find concordance between concurrent self-reported cognition and neuropsychological testing, and simple discrepancies between subjective and objective cognition are so common as to be diagnostically unhelpful.
主观(自我报告)和客观(基于表现)认知功能之间的关系在神经精神综合征中具有重要的临床意义。我们从跨诊断的角度对主观认知和客观认知之间的关系进行了综述。合格的研究是研究人类一生中主观认知和客观认知之间关系的综述论文的完整报告。使用改良版AMSTAR评定量表评估偏倚风险。在筛选的7329份初始报告中,包括了50份主要是横断面数据的综述。综述规模从4到488项研究不等,除年龄外的人口统计学因素很少报道。偏倚风险是混合的。一项针对20多种神经精神病学和神经医学疾病的叙事综合研究发现,主观认知和客观认知之间存在不一致的关系,效应大小从零到弱不等。与客观认知测试分数相比,抑郁和焦虑等心理健康因素与主观认知的关系更为可靠和强烈。在二阶荟萃分析(10篇综述,N = 92,606)中,总体客观认知和主观认知之间的总相关性为0.14 (95% CI [0.08, 0.21]; p = 0.001, Q(9) = 179.50, τ = 0.09, I2 = 95.00, <; 2%的方差共享)。主观认知和客观认知在很大程度上是不重叠的结构,反映了整体认知功能的独特和互补方面,而不管所调查的特定人群或使用的评估方法如何。研究人员和临床医生不应该期望在同时自我报告的认知和神经心理学测试之间找到一致性,主观和客观认知之间的简单差异是如此普遍,以至于对诊断没有帮助。
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引用次数: 0
Multidimensional perspective of dissociation and suicide-related outcomes: A Meta-analysis and systematic review 分离和自杀相关结果的多维视角:荟萃分析和系统回顾
IF 12.2 1区 心理学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2025-11-01 Epub Date: 2025-09-10 DOI: 10.1016/j.cpr.2025.102647
Serena Bruno, Gaia Cichetti, Patrizia Velotti PhD

Background

The relationship between suicide-related outcomes and dissociation is a critical issue. In recent years, research has focused on understanding dissociation as an acquired capacity factor for suicide attempts. Moreover, meta-analysis findings demonstrate the relationship between dissociation and suicidal ideation. To unravel the role of dissociation in the development of suicidal ideation and attempt, this study adopts a multidimensional perspective, that conceptualizes a complex construct comprising distinct but related domains which reflects disruptions in perception, cognition, emotion, and somatic experience.

Methods

We conducted systematic research on the main databases (PubMed, Medline, APA PsycInfo, Scopus, Web of Science, APA PsycArticles), collecting the literature of the last 30 years. A total of 84 studies (Ntotalsample = 129.582) studies were included in the systematic review. Of these, 68 studies were included in the meta-analysis. The analyses are based on the Pearson correlation coefficient as the effect size for the relationship between suicide-related outcomes and dissociation domains. The outcome variables included suicidal ideation, suicide attempts, and suicide risk - a composite or dimensional construct reflecting the likelihood of suicidal thoughts or behaviors, as well as specific psychological factors associated with the emergence of suicidal outcomes, as reported in the selected studies.
We used a random effects model, conducted moderation analyses to explain the heterogeneity of study variance, controlled for publication bias, and assessed the methodological quality of the included studies.

Results

General dissociation was significantly correlated with suicidal risk (r = 0.29; p < .001), suicidal ideation (r = 0.25; p < .001), and suicide attempts (r = 0.27; p < .001). A positive and significant relationship was found between suicidal ideation and detachment (r = 0.31; p < .001), as well as with maladaptive daydreaming (r = 0.27; p < .001). A statistically significant but small association was also observed between suicide attempts and somatoform dissociation (r = 0.02; p < .001), whereas a stronger connection was found with suicidal ideation (r = 0.31; p < .001). Moderator effects related to sample characteristics, sociocultural factors, and methodological quality of studies were identified with no evidence of publication bias.

Conclusions

These findings support the importance of a multidimensional approach to examining dissociation and suicide-related outcomes, revealing differential relationships based on the specific domains assessed. The resulting clinical implications and future directions are discussed.
自杀相关结果和分离之间的关系是一个关键问题。近年来,研究集中在理解解离是自杀企图的获得性能力因素。此外,荟萃分析结果证实了分离与自杀意念之间的关系。为了揭示分离在自杀意念和企图发展中的作用,本研究采用了多维视角,将一个复杂的结构概念化,该结构由不同但相关的领域组成,反映了感知、认知、情感和躯体体验的中断。
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引用次数: 0
期刊
Clinical Psychology Review
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