Anxiety disorders and suicidal behaviours in adolescence and young adulthood: findings from a longitudinal study
Anxiety disorders and suicidal behaviours in adolescence and young adulthood: findings from a longitudinal study
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DOI：
10.1017/s0033291706009147
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发表时间：
2007-03-01
影响因子：
6.9
通讯作者：
Horwood, L. John
中科院分区：
文献类型：
--
作者：
Boden, Joseph M.;Fergusson, David M.;Horwood, L. John
背景资料。这项研究的目的是在控制了可观察到的和未观察到的混淆来源后，估计焦虑障碍对自杀行为增加的影响程度。数据来自克赖斯特彻奇健康与发展研究(CHDS)，这是一项对1000多名参与者进行的长达25年的纵向研究。使用焦虑障碍[恐惧症、广泛性焦虑症(GAD)、惊恐障碍]、重度抑郁(MD)、物质使用障碍、品行/反社会人格障碍、应激性生活事件、失业、自杀意念/企图等指标，对16-18、18-21和21-25岁被试的焦虑障碍和自杀行为之间的关系进行随机和固定效应回归模型拟合。焦虑症与自杀意念/企图密切相关。任何单一的焦虑障碍使自杀意念增加7-96倍[95%可信区间5-69-11-13]，并使自杀企图增加5.85倍(95%可信区间3-66-9-32)。对共生精神障碍、未观察到的固定混杂因素和生活压力的控制降低了这些关联[自杀意念优势比(OR)2-80，95%可信区间1-71-4-58；自杀未遂发生率比(IRR)1-90，95%可信区间1-07-3-39]。自杀行为的发生率也随着焦虑症的数量增加而增加。对人群归因风险的估计表明，焦虑症占队列中自杀人数的7%-10%。焦虑症可能是自杀的风险因素，即使在控制了混淆之后也是如此，多重焦虑症的风险会增加。焦虑障碍的管理可能是降低人口自杀率战略的重要组成部分。
Background. The aim of this study was to estimate the extent to which anxiety disorders contribute to an increase in suicidal behaviour after controlling for both observed and non-observed sources of confounding.Method. Data were collected from the Christchurch Health and Development Study (CHDS), a 25-year longitudinal study of over 1000 participants. Measures of anxiety disorders [phobia, generalized anxiety disorder (GAD), panic disorder], major depression (MD), substance use disorders, conduct/antisocial personality disorder, stressful life events, unemployment, and suicidal ideation/attempts for subjects aged 16-18, 18-21 and 21-25 years were used to fit random and fixed effects regression models of the associations between anxiety disorders and suicidal behaviours.Results. Anxiety disorders were strongly associated with suicidal ideation/attempts. Any single anxiety disorder increased the odds of suicidal ideation by 7-96 times [95 % confidence interval (CI) 5-69-11-13] and increased the rate of suicide attempts by 5.85 times (95 % CI 3-66-9-32). Control for co-occurring mental disorders, non-observed fixed confounding factors and life stress reduced these associations [suicidal ideation odds ratio (OR) 2-80, 95% CI 1-71-4-58; suicide attempts incidence rate ratio (IRR) 1-90, 95 % CI 1-07-3-39]. Rates of suicidal behaviour also increased with the number of anxiety disorders. Estimates of the population attributable risk suggested that anxiety disorders accounted for 7-10 % of the suicidality in the cohort.Conclusions. Anxiety disorders may be a risk factor for suicidality, even after controlling for confounding, with risks increasing with multiple anxiety disorders. Management of anxiety disorders may be an important component in strategies to reduce population rates of suicide.