The Mediating Role of Sleep Disturbances in the Relationship Between Obsessive-Compulsive Symptoms and Suicidal Ideation: The Moderating Effect of Childhood Trauma

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The Mediating Role of Sleep Disturbances in the Relationship Between Obsessive-Compulsive Symptoms and Suicidal Ideation: The Moderating Effect of Childhood Trauma

https://doi.org/10.21203/rs.3.rs-4855298/v1

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Objective: This study aims to investigate the relationships and underlying mechanisms among obsessive-compulsive symptoms, sleep disturbances, childhood trauma, and suicidal ideation in patients with obsessive-compulsive disorder (OCD).

Methods: The study employed the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Pittsburgh Sleep Quality Index (PSQI), Childhood Trauma Questionnaire (CTQ), and a self-assessment scale for suicidal ideation (SIOSS) to survey 107 patients with OCD.

Results: Obsessive-compulsive symptoms significantly positively affected sleep quality (β = 0.31, t = 10.67, p < 0.001). Both sleep disturbances (β = 0.20, t = 7.86, p < 0.001) and obsessive-compulsive symptoms (β = 0.39, t = 14.65, p < 0.001) significantly predicted suicidal risk. Further analysis revealed that sleep disturbances served as a significant mediator between obsessive-compulsive symptoms and suicidal ideation (mediation effect value = 0.08, 95% CI = [0.22, 0.28]). Childhood trauma moderated the mediating effect, intensifying the positive impact of obsessive-compulsive symptoms on sleep disturbances and suicidal ideation as levels of childhood trauma increased.

Conclusion: Sleep disturbances mediate the relationship between obsessive-compulsive symptoms and suicidal ideation, with this mediation significantly influenced by the presence of childhood trauma. These findings underscore the importance of considering early life experiences and psychophysiological backgrounds when assessing and intervening in the suicidal risk of OCD patients.

Biological sciences/Psychology/Human behaviour

Health sciences/Neurology/Neurological disorders/Sleep disorders

Obsessive-Compulsive Disorder

Suicidal Ideation

Sleep Disturbances

Childhood Trauma

Suicide represents a significant public health issue and is currently the leading cause of death among individuals with mental disorders^[1].Suicidal ideation predicts suicidal planning, attempts, and behaviors^[2].Empirical research indicates that individuals with obsessive-compulsive disorder (OCD) face a higher risk of suicide compared to the healthy population^[3].In the obsessive-compulsive disorder (OCD) population, approximately one-third of individuals report current suicidal ideation, half report a history of past suicidal thoughts, and at least one-tenth have attempted suicide at some point in their lives^[4].The incidence of suicide death among patients with OCD is as high as 1.48%^[5],This is comparable to the risks reported for schizophrenia and bipolar disorder^[6].Therefore, enhancing focus on suicidal ideation among individuals with obsessive-compulsive disorder, along with timely assessment and early intervention, may be crucial pathways to effectively reduce suicidal behaviors in this population.

Increasing evidence indicates a significant positive correlation between suicidal behavior and symptoms of obsessive-compulsive disorder; that is, the more severe the OCD symptoms, the more intense the suicidal ideation^[7].Even after controlling for the impact of depressive symptoms, obsessive-compulsive symptoms independently predict the onset and progression of suicidal ideation^[3].Additionally, the persistence of obsessive-compulsive symptoms and prolonged periods without treatment can also increase the likelihood of suicide attempts^[3].Research has also found that obsessive-compulsive symptoms can adversely affect sleep quality.n a review, Paterson and colleagues highlighted that sleep disorders are present in as much as 48% of certain OCD populations, with individuals suffering from OCD exhibiting significantly shorter sleep durations and poorer sleep efficiency compared to healthy controls^[8].I Additionally, another study identified that bedtime rituals can prolong the time it takes for these patients to fall asleep^[9].It is evident that obsessive-compulsive symptoms may impact suicidal ideation directly, and possibly indirectly through the quality of sleep, suggesting that sleep disorders could mediate the relationship between OCD symptoms and suicidal ideation.

Sleep disorders primarily include symptoms such as insomnia and poor sleep quality. Previous research has shown that sleep problems are an independent risk factor for suicidal behavior^[10].A prospective study has shown that sleep disorders can predict an individual's suicidal ideation^[11].Therefore, timely identification and management of sleep disorders may reduce the risk level of suicidal ideation, thereby lowering the incidence of suicide events. Although it is known that sleep disorders can increase the risk of suicidal ideation, the detailed mechanisms of this process and the moderating effects of other potential variables still require further research for a clearer understanding.

Additionally, suicidal ideation is also influenced by childhood trauma. Research indicates that childhood trauma significantly predicts suicidal ideation. Childhood is a vulnerable period for psychological functioning and neurodevelopment, and traumatic experiences during this time increase the risk of developing mental disorders and suicidal behavior in adulthood^[12].Additionally, childhood trauma experiences can independently play a significant role in suicide risk, apart from the influences of depression and anxiety^[13].Childhood trauma can negatively impact the future seeking of treatment and the treatment process itself, potentially exacerbating symptoms^[14].On the other hand, childhood trauma experiences are significantly associated with sleep disorders^[15].We hypothesize that childhood trauma experiences may play a moderating role in the relationship between obsessive-compulsive symptoms, sleep disorders, and suicidal ideation. Specifically, high levels of childhood trauma may exacerbate the negative impact of obsessive-compulsive symptoms on sleep disorders and suicidal ideation, as well as potentially amplify the influence of sleep disorders on suicidal ideation.

Therefore, this study aims to construct a moderated mediation model to explore how obsessive-compulsive symptoms, childhood trauma, and sleep disorders influence suicidal ideation in individuals with OCD. Additionally, it seeks to analyze the mechanisms of mediation and moderation effects(Fig. 1).

Participants

The patient group consisted of individuals diagnosed with obsessive-compulsive disorder (OCD) who visited the psychiatric outpatient clinic at the Mental Health Center of Ningxia Medical University General Hospital from January 2023 to January 2024. The inclusion criteria were: (1) Diagnosis of OCD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5); (2) Age between 18 and 50 years; (3) Duration of illness of at least one year, with no psychiatric medications taken or psychological therapy received in the four weeks prior to enrollment; (4) Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score ≥ 16 (if only obsessive thoughts or behaviors, a minimum item score of ≥ 10); (5) Hamilton Depression Rating Scale (17-item) score < 24; (6) Hamilton Anxiety Rating Scale score < 24; (7) Willingness to participate in the study and provision of signed informed consent. Exclusion criteria included: (1) Diagnosis of schizophrenia, mood disorders, or other Axis I psychiatric disorders; (2) Presence of organic brain diseases or significant physical illnesses; (3) History of alcohol or substance abuse. This study was approved by the Ethics Committee of Ningxia Medical University General Hospital (KYLL-2022-1101), adhering to the principles of the Declaration of Helsinki.

Clinical Assessment

Diagnoses for participants were made by two associate chief psychiatrists according to the criteria for obsessive-compulsive disorder as outlined in the DSM-5. Clinical interviews and psychological assessments were conducted on enrolled participants by two psychiatrists trained in scale consistency, utilizing the Yale-Brown Obsessive Compulsive Scale (Y-BOCS)^[16], Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Suicidal Ideation and Suicidal Orientation Screening Scale (SIOSS)^[17],Pittsburgh Sleep Quality Index (PSQI)^[18], and the Scale of Childhood Trauma Questionnaire (CTQ)^[19].

Questionnaires

Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is a commonly employed tool to assess the severity of obsessive-compulsive symptoms, consisting of 10 items scored from 0 ("none") to 4 ("extremely severe"). The scale distinguishes between thoughts (items 1–5) and actions (items 6–10), with higher scores indicating more severe symptoms. The total is calculated by summing the first 10 item scores. For this sample, the self-report version of Y-BOCS showed a Cronbach's alpha of 0.92, confirming its reliability and internal consistency.

Hamilton Depression Rating Scale (HAMD)is used for measuring depression levels in patients with obsessive-compulsive disorder, featuring 17 items rated on a scale from 0 ("none") to 4 ("extremely severe"). Higher scores denote more severe depressive symptoms.

Hamilton Anxiety Rating Scale (HAMA) evaluates anxiety symptoms using 14 items, each rated from 0 ("none") to 4 ("extremely severe"). Higher scores suggest more severe anxiety symptoms.

Self-rating Idea of Suicide Scale (SIOSS) assesses suicidal ideation frequency over the past month through six items, each rated from 1 ("never") to 7 ("always"). The total score, indicating the severity of suicidal thoughts, is the sum of these items. The scale’s reliability in this study was indicated by a Cronbach's alpha of 0.76.

Pittsburgh Sleep Quality Index (PSQI)comprises 19 items grouped into seven components to assess sleep quality, scored from 0 to 21. Higher scores reflect poorer sleep quality. In this study, a score above 7 is used to indicate poor sleep, and the Cronbach's alpha for this index was 0.84.

Childhood Trauma Questionnaire (CTQ)designed by Bernstein et al., includes 28 items: 25 clinical and 3 validity items, spread across five categories: physical neglect, physical abuse, emotional neglect, emotional abuse, and sexual abuse. The internal consistency of this scale in the Chinese version is 0.62, indicating moderate reliability.

Statistical Analysis

The data was processed using SPSS version 26.0. The PROCESS macro was employed to carry out mediation and moderation effect tests. The mediation effect of sleep disorders between obsessive-compulsive symptoms and suicidal ideation was analyzed using Model 4. If mediation effects are found, the moderating effect of childhood trauma on this mediation model is further analyzed using Model 59. All models were tested using the bootstrap method with 5,000 resamples, and an effect was considered statistically significant if the 95% confidence interval did not include zero.

A Harman's single factor test was used to examine the presence of common method bias. The results revealed that there were 15 factors with eigenvalues greater than 1, and the first factor explained 29.18% of the variance, which is below the critical threshold of 40%. This indicates that the likelihood of common method bias in this study is relatively low.

Descriptive Statistics and Correlation Analysis

This study conducted clinical assessments on 129 patients with obsessive-compulsive disorder (OCD). Of these, 16 patients were excluded due to having Hamilton Depression Rating Scale (HAMD) scores greater than 24, and 12 were excluded due to Hamilton Anxiety Rating Scale (HAMA) scores exceeding 24. Additionally, four patients were excluded because their assessment results were incomplete. Ultimately, 107 OCD patients were included in the study: 59 males and 48 females, with an average age of 27.61 ± 9.59 years. The average HAMA score was 13.59 ± 3.28, and the average HAMD score was 12.65 ± 4.13. OCD patients' scores on the Scale of Suicidal Ideation and Suicidal Orientation Screening Scale (SIOSS) were consistently below 4, indicating good data reliability. Detailed scores for each variable are provided in Table 1. Correlation analysis showed that suicidal ideation in OCD patients was significantly positively correlated with obsessive-compulsive symptoms, sleep quality, and childhood trauma; there was also a significant positive correlation between obsessive-compulsive symptoms and experiences of childhood trauma, as well as between childhood trauma and sleep disorders.

Testing for Mediation Effects

After standardizing all continuous variables, the mediating role of sleep quality between obsessive-compulsive symptoms and suicidal ideation was tested. The results indicated that obsessive-compulsive symptoms significantly positively affected sleep quality (β=0.31, t=10.67, p<0.001), and both sleep disorders (β=0.20, t=7.86, p<0.001) and obsessive-compulsive symptoms (β=0.39, t=14.65, p<0.001) significantly predicted the risk of suicide. Further analysis using the bias-corrected bootstrap method to test the significance of the mediation effect revealed a significant mediation, with a mediation effect value of 0.08 and a 95% CI of [0.22, 0.28].

The relationship between obsessive-compulsive symptoms and suicide risk: Testing for moderated mediation effects.

First, the impact of obsessive-compulsive symptoms on suicide risk and the direct effect were examined to see if they were moderated by childhood trauma. The results indicated that obsessive-compulsive symptoms significantly positively predicted suicide risk (β=0.28, t=5.98, p<0.001). However, the interaction term between obsessive-compulsive symptoms and childhood trauma did not significantly predict suicide risk (β=0.16, t=8.18, p>0.05).

Next, a moderated mediation model was established to test whether the mediation model of sleep quality on suicide risk was moderated by childhood trauma. The results showed that obsessive-compulsive symptoms significantly positively affected sleep quality (β=0.21, t=10.52, p<0.001), and the interaction term between obsessive-compulsive symptoms and childhood trauma significantly positively predicted suicide risk (β=0.15, t=7.47, p<0.001). Sleep quality significantly positively predicted suicide risk (β=0.14, t=8.34, p<0.001), and the interaction term between sleep quality and childhood trauma also significantly positively predicted suicide risk (β=0.05, t=3.71, p<0.001). The model estimates confirmed the mediating role of sleep quality between obsessive-compulsive symptoms and suicide risk, and both the first half and the second half of this mediation effect were moderated by childhood trauma.(Table 2)

To further understand the nature of the moderating effect of childhood trauma, childhood trauma was divided into high and low groups based on one standard deviation above and below the mean, and simple effects analysis diagrams were drawn (Figure 2 and Figure 3). The results found that for OCD patients with low childhood trauma, as obsessive-compulsive symptoms increased, there was no significant increase in their sleep disorder scores (β=0.03, t=0.66, p>0.05); for OCD patients with high childhood trauma, as obsessive-compulsive symptoms increased, their sleep disorder scores significantly rose (β=0.26, t=5.87, p<0.001). This means that the impact of obsessive-compulsive symptoms on sleep quality intensifies with an increase in childhood trauma, suggesting that childhood trauma enhances the positive predictive effect of obsessive-compulsive symptoms on sleep quality. As sleep disorders increased, for OCD patients with low childhood trauma, their suicide risk showed a significant decreasing trend (β=0.09, t=2.46, p<0.05); for OCD patients with high childhood trauma, as their sleep disorder scores increased, their suicide risk showed a stronger upward trend (β=0.22, t=5.87, p<0.001). This means that the predictive effect of sleep disorders on suicide risk strengthens with an increase in the level of childhood trauma.

This study confirmed a significant positive correlation between obsessive-compulsive symptoms and suicidal ideation, consistent with previous research findings^[7].We further explored the role of sleep disorders in this relationship and found that sleep disorders not only directly affect emotional stability and increase the risk of suicidal ideation but also mediate the relationship between obsessive-compulsive symptoms and suicidal ideation.This finding reveals that sleep deprivation caused by obsessive-compulsive symptoms may impair cognitive functions, such as information processing and judgment, thereby increasing an individual's risk-taking and impulsive tendencies, which in turn contribute to the development of suicidal thoughts and behaviors.Specifically, our analysis shows that obsessive-compulsive rituals and thoughts can lead to delayed bedtimes, consistent with findings from other studies^[20].A significant proportion of OCD patients experience circadian rhythm sleep disorders and delayed sleep phase syndrome^[21].Compared to healthy controls, OCD patients have reduced total sleep duration and impaired sleep architecture^[22].Additionally, the positive correlation between sleep disorders and suicidal ideation^[23]further underscores the crucial role of sleep problems in the relationship between obsessive-compulsive symptoms and suicide risk^[24].

This study also further elucidated the impact of individual differences in the pathway from obsessive-compulsive symptoms to suicidal ideation, specifically highlighting the moderating role of childhood trauma. Childhood trauma not only had a direct effect on suicidal ideation but also intensified the indirect effect of obsessive-compulsive symptoms on suicidal ideation through sleep disorders. For individuals with high levels of childhood trauma, the influence of obsessive-compulsive symptoms on both sleep disorders and suicidal ideation was amplified, making this effect more significant compared to those with low levels of childhood trauma. Furthermore, we found that sleep disorders were a stronger predictor of suicidal ideation in the OCD population with high levels of childhood trauma.This finding is consistent with the vulnerability-stress model^[25], which posits that childhood trauma can irreversibly damage critical neurobiological systems during an individual's development, leading to long-term changes in stress regulation and psychophysiological responses^[26–30].Individuals with high levels of childhood trauma are more likely to exhibit negative emotions and heightened sensitivity to stress when experiencing obsessive-compulsive symptoms and sleep problems. This, in turn, leads them to adopt negative emotion regulation strategies, exacerbating the impact of obsessive-compulsive symptoms and sleep disorders on suicidal ideation.

Additionally, individuals with high levels of childhood trauma may find it more challenging to employ effective coping strategies when dealing with the distress caused by obsessive-compulsive symptoms due to long-term damage to their psychological and neurobiological systems. This makes sleep disorders a more prominent mediating factor, further increasing the risk of suicidal ideation. These findings emphasize the importance of considering an individual's history of childhood trauma when assessing and intervening in the suicide risk of OCD patients, particularly when developing interventions targeting sleep disorders.

In summary, our study not only strengthens the understanding of the relationships between obsessive-compulsive symptoms, sleep disorders, and suicidal ideation but also highlights the crucial moderating role of childhood trauma in exacerbating these relationships. This finding provides a new perspective for future research, underscoring the importance of considering individuals' early experiences and psychophysiological backgrounds when intervening in the suicide risk of OCD patients.

Limitations

This study, being cross-sectional in nature, can only reveal correlations between clinical variables and cannot establish causal relationships. Additionally, the findings are limited by the small sample size, necessitating larger studies in the future to further validate the relationships among these variables.

OCD Obsessive-compulsive disorder

HC Healthy control

CTQ Childhood Trauma Questionnaire

Y- BCOS Yale-Brown Obsessive Compulsive Scale

HAMD Hamilton Depression Rating Scale

HAMA Hamilton Anxiety Rating Scale

PSQI Pittsburgh Sleep Quality Index

SIOSS Self-rating Idea of Suicide Scale

Data availability

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request，you can email [email protected] to obtain the data.

Author contributions

Concept and design: Shaoxia Wang,Jianqun Fang. Acquisition, analysis, or interpretation of data: Shaoxia Wang, Xiang Zhang, Chujun Wu. Drafing of the manuscript: Shaoxia Wang.Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: Shaoxia Wang. Obtained funding: Jianqun Fang. Administrative, technical, or material support: Shaoxia Wang, Yanrong Wang, Jianqun Fang. Supervision: Yanrong Wang, Jianqun Fang.

Funding

This work was supported by Natural Science Foundation of Ningxia Program (No.2022AAC02067). It provided the fund for the investigation, editing and the subject’s allowance. We gratefully acknowledge the participants of this study for generously donating their time.

Competing interests

The authors declare no competing interests.

Additional information

Correspondence and requests for materials should be addressed to J.F.

Isung J, Isomura K, Almqvist C, et al. Association of chronic and acute inflammation of the mucosa-associated lymphoid tissue with psychiatric disorders and suicidal behavior. Transl Psychiatry, 2019, 9(1): 227
Chen R, An J, Ou J. Suicidal behaviour among children and adolescents in China. Lancet Child Adolesc Health, 2018, 2(8): 551-553
Bramante S, Maina G, Borgogno R, et al. Assessing suicide risk in patients with obsessive-compulsive disorder: a dimensional approach. Braz J Psychiatry, 2023, 45(1): 28-37
Pellegrini L, Maietti E, Rucci P, et al. Suicide attempts and suicidal ideation in patients with obsessive-compulsive disorder: A systematic review and meta-analysis. J Affect Disord, 2020, 276: 1001-1021
Fernandez DLCL, Rydell M, Runeson B, et al. Suicide in obsessive-compulsive disorder: a population-based study of 36 788 Swedish patients. Mol Psychiatry, 2017, 22(11): 1626-1632
Osborn D, Levy G, Nazareth I, et al. Suicide and severe mental illnesses. Cohort study within the UK general practice research database. Schizophr Res, 2008, 99(1-3): 134-138
Zweben JE, Sorensen JL. Misunderstandings about methadone. J Psychoactive Drugs, 1988, 20(3): 275-281
Paterson JL, Reynolds AC, Ferguson SA, et al. Sleep and obsessive-compulsive disorder (OCD). Sleep Med Rev, 2013, 17(6): 465-474
Timpano KR, Carbonella JY, Bernert RA, et al. Obsessive compulsive symptoms and sleep difficulties: exploring the unique relationship between insomnia and obsessions. J Psychiatr Res, 2014, 57: 101-107
Bernert RA, Kim JS, Iwata NG, et al. Sleep disturbances as an evidence-based suicide risk factor. Curr Psychiatry Rep, 2015, 17(3): 554
Shi X, Zhu Y, Wang S, et al. The prospective associations between different types of sleep disturbance and suicidal behavior in a large sample of chinese college students. J Affect Disord, 2021, 279: 380-387
Zhong QY, Wells A, Rondon MB, et al. Childhood abuse and suicidal ideation in a cohort of pregnant Peruvian women. Am J Obstet Gynecol, 2016, 215(4): 501
Ay R, Erbay LG. Relationship between childhood trauma and suicide probability in obsessive-compulsive disorder. Psychiatry Res, 2018, 261: 132-136
Gershuny BS, Baer L, Parker H, et al. Trauma and posttraumatic stress disorder in treatment-resistant obsessive-compulsive disorder. Depress Anxiety, 2008, 25(1): 69-71
Agorastos A, Pervanidou P, Chrousos GP, et al. Developmental Trajectories of Early Life Stress and Trauma: A Narrative Review on Neurobiological Aspects Beyond Stress System Dysregulation. Front Psychiatry, 2019, 10: 118
Goodman WK, Price LH, Rasmussen SA, et al. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry, 1989, 46(11): 1006-1011
Xia C, Wang D, He Y. Study of self-rating idea of undergraduates in the mountain area of southern Zhejiang. Chin J Sch Health. (2012) 33:144–6.
Buysse DJ, Reynolds CR, Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res, 1989, 28(2): 193-213
Bernstein DP, Stein JA, Newcomb MD, et al. Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl, 2003, 27(2): 169-190
Coles ME, Sharkey KM. Compulsion or chronobiology? A case of severe obsessive-compulsive disorder treated with cognitive-behavioral therapy augmented with chronotherapy. J Clin Sleep Med, 2011, 7(3): 307-309
Turner J, Drummond LM, Mukhopadhyay S, et al. A prospective study of delayed sleep phase syndrome in patients with severe resistant obsessive-compulsive disorder. World Psychiatry, 2007, 6(2): 108-111
Insel TR, Gillin JC, Moore A, et al. The sleep of patients with obsessive-compulsive disorder. Arch Gen Psychiatry, 1982, 39(12): 1372-1377
Mccarthy E, Deviva JC, Southwick SM, et al. Self-rated sleep quality predicts incident suicide ideation in US military veterans: Results from a 7-year, nationally representative, prospective cohort study. J Sleep Res, 2022, 31(1): e13447
Krakow B, Ribeiro JD, Ulibarri VA, et al. Sleep disturbances and suicidal ideation in sleep medical center patients. J Affect Disord, 2011, 131(1-3): 422-427
Mortier P, Cuijpers P, Kiekens G, et al. The prevalence of suicidal thoughts and behaviours among college students: a meta-analysis. Psychol Med, 2018, 48(4): 554-565
Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med, 1998, 14(4): 245-258
Kaufman J, Plotsky PM, Nemeroff CB, et al. Effects of early adverse experiences on brain structure and function: clinical implications. Biol Psychiatry, 2000, 48(8): 778-790
Mock SE, Arai SM. Childhood trauma and chronic illness in adulthood: mental health and socioeconomic status as explanatory factors and buffers. Front Psychol, 2010, 1: 246
Teicher MH, Andersen SL, Polcari A, et al. Developmental neurobiology of childhood stress and trauma. Psychiatr Clin North Am, 2002, 25(2): 397-426
Nemeroff CB. Neurobiological consequences of childhood trauma. J Clin Psychiatry, 2004, 65 Suppl 1: 18-28

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You are reading this latest preprint version

The Mediating Role of Sleep Disturbances in the Relationship Between Obsessive-Compulsive Symptoms and Suicidal Ideation: The Moderating Effect of Childhood Trauma

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Abstract

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Introduction

Methods

Participants

Clinical Assessment

Questionnaires

Statistical Analysis

Results

Discussion

Limitations

Abbreviations

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References

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