{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:28:07Z","timestamp":1787027287262,"version":"build-2736575974"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,3,28]],"date-time":"2023-03-28T00:00:00Z","timestamp":1679961600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>As a mental health issue, suicide is a growing global concern, with patients who have post-traumatic stress disorder (PTSD) being at particularly high risk. This study aimed to investigate whether the link between PTSD and suicidal ideation is mediated by trauma-related guilt.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were obtained from Wave 1, Time 1 (November 2016), and Time 2 (March 2017) of the National Survey for Stress and Health (NSSH) in Japan. The NSSH is an online longitudinal survey conducted on Japan\u2019s national population aged 18\u2009years and older. The cumulative response rate of the survey was 66.7% at Time 2. A total of 1,005 patients with PTSD were included for analyses. The severity of PTSD symptoms was assessed with PTSD DSM-5 Checklist, and the trauma-related guilt were assessed using the two subscales (hindsight-bias\/responsibility and global guilt scale) of the trauma-related guilt inventory (TRGI). Suicidal ideation was evaluated using the suicidal ideation attributes scale (SIDAS). Pearson\u2019s correlation was used to investigate the associations among PTSD symptoms, TRGI scores, and SIDAS scores. Causal mediation analysis was applied to evaluate the causal relationship between PTSD, trauma-related guilt, and suicidal ideation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Pearson\u2019s correlation did not show patients\u2019 age, gender, and household income significantly associated with SIDAS scores. On the other hand, severities of PTSD symptoms (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.361,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) and trauma-related guilt (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.235,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) were positively associated with SIDAS scores. After adjusting for age, gender, and household income, the mediation analysis revealed that trauma-related guilt significantly mediates the effects of PTSD symptoms on suicidal ideation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our results implied that trauma-related guilt may represent a critical link between PTSD and suicidal ideation, which may be a noteworthy target for therapeutic intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2023.1131733","type":"journal-article","created":{"date-parts":[[2023,3,28]],"date-time":"2023-03-28T01:39:52Z","timestamp":1679967592000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Trauma-related guilt as a mediator between post-traumatic stress disorder and suicidal ideation"],"prefix":"10.3389","volume":"14","author":[{"given":"Po-Han","family":"Chou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao-Cheng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi-Shin","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaya","family":"Ito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,3,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.jpsychires.2020.06.004","article-title":"Associations between PTSD symptoms and suicide risk: a comparison of 4-factor and 7-factor models","volume":"129","author":"Chou","year":"2020","journal-title":"J Psychiatr Res"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1048","DOI":"10.1001\/archpsyc.1995.03950240066012","article-title":"Posttraumatic stress disorder in the National Comorbidity Survey","volume":"52","author":"Kessler","year":"1995","journal-title":"Arch Gen Psychiatry"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2260","DOI":"10.1017\/S0033291717000708","article-title":"Posttraumatic stress disorder in the world mental health surveys","volume":"47","author":"Koenen","year":"2017","journal-title":"Psychol Med"},{"key":"ref4","first-page":"22","article-title":"Comorbidity of psychiatric disorders and posttraumatic stress disorder","volume":"61","author":"Brady","year":"2000","journal-title":"J Clin Psychiatry"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.jpsychores.2007.07.006","article-title":"Trauma, PTSD, and physical health: an epidemiological study of Australian Vietnam veterans","volume":"64","author":"O'Toole","year":"2008","journal-title":"J Psychosom Res"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.genhosppsych.2019.03.004","article-title":"Risk of incident hypertension, diabetes, and dyslipidemia after first posttraumatic stress disorder diagnosis: a nationwide cohort study in Taiwan","volume":"58","author":"Lin","year":"2019","journal-title":"Gen Hosp Psychiatry"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.jocn.2018.01.030","article-title":"Reduced frontal activity during a verbal fluency test in fibromyalgia: a near-infrared spectroscopy study","volume":"50","author":"Chou","year":"2018","journal-title":"J Clin Neurosci"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.5664\/jcsm.7910","article-title":"The impact of antidepressants on the risk of developing obstructive sleep apnea in posttraumatic stress disorder: a Nationwide cohort study in Taiwan","volume":"15","author":"Lin","year":"2019","journal-title":"J Clin Sleep Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1016\/j.jpsychires.2018.12.001","article-title":"Associations between childhood maltreatment and risk of myocardial infarction in adulthood: results from the National Epidemiologic Survey on alcohol and related conditions","volume":"116","author":"Chou","year":"2019","journal-title":"J Psychiatr Res"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e140","DOI":"10.1017\/S2045796020000529","article-title":"Does physical ill-health increase the risk of suicide? 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