Adequacy of antidepressant treatment after discharge and the occurrence of suicidal acts in major depression: A prospective study
Adequacy of antidepressant treatment after discharge and the occurrence of suicidal acts in major depression: A prospective study
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DOI：
10.1176/appi.ajp.159.10.1746
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发表时间：
2002-10-01
影响因子：
17.7
通讯作者：
Mann, JJ
中科院分区：
文献类型：
--
作者：
Oquendo, MA;Kamali, M;Mann, JJ
目的：自杀未遂预测重复企图和自杀完成。需要住院治疗的重度抑郁症是自杀行为的危险因素，特别是在出院后的2年内。作者前瞻性地研究了抑郁症患者（N=136）入院后3个月，1年，2年后的抗抑郁治疗的充分性及其对自杀行为的影响。在每次访谈中，对重度抑郁症和自杀行为的存在以及抗抑郁治疗的充分性进行评估。考克斯的比例风险分析与随时间变化的协变量被用来模拟自杀企图的风险在随访period.Results：在随访期间的抑郁症增加自杀企图的风险七倍。对于受试者历史中的每一次自杀企图，随访期间尝试自杀的风险增加30%。随访期间的抗抑郁治疗大多不足。因此，足够的抗抑郁药治疗在随访期间和自杀企图的风险之间的关系不能被发现。此外，在基线自杀企图的历史的受试者没有得到更有力的治疗比nonabutters.Conclusions：抗抑郁药治疗抑郁症患者是显着不足，即使在自杀未遂者，已知自杀行为的风险较高。这一缺陷削弱了自然主义研究中测量抗抑郁药抗自杀作用的能力。需要对抗抑郁药的对照研究来评估其对自杀行为的影响。
Objective: Suicide attempts predict repeat attempts and suicide completion. Major depression requiring hospitalization is a risk factor for suicidal acts, particularly in the 2 years following discharge. The authors prospectively studied the adequacy of antidepressant treatment and its impact on suicidal acts in the 2 years after hospitalization for major depression.Method: Patients (N=136) with major depression were interviewed at 3 months, 1 year, and 2 years after admission. At each interview, the presence of major depression and suicidal acts and the adequacy of antidepressant treatment were assessed. Cox's proportional hazards analysis with time-varying covariates was used to model the risk of a suicide attempt during the follow-up period.Results: Major depression in the follow-up period increased the risk of a suicide attempt sevenfold. For each suicide attempt in a subject's history, the risk for an attempt in the follow-up period increased by 30%. Antidepressant treatment during the follow-up period was mostly inadequate. Consequently, a relationship between adequacy of antidepressant treatment during follow-up and the risk of a suicide attempt could not be found. Furthermore, subjects with a history of a suicide attempt at baseline were not treated more vigorously than nonattempters.Conclusions: Antidepressant treatment of depressed patients is strikingly inadequate, even in suicide attempters, known to be at higher risk for suicidal acts. This deficiency undermines the ability to measure the antisuicidal effects of antidepressants in naturalistic studies. Controlled studies of antidepressants are needed to evaluate effects on suicidal acts.