Toward a clinical model of suicidal behavior in psychiatric patients.
Toward a clinical model of suicidal behavior in psychiatric patients.
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DOI：
10.1176/ajp.156.2.181
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发表时间：
1999-02
期刊：
影响因子：
--
通讯作者：
J. Mann;C. Waternaux;G. Haas;K. Malone
中科院分区：
文献类型：
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作者：
J. Mann;C. Waternaux;G. Haas;K. Malone
目的：自杀企图的危险因素很少在一种以上的精神疾病中得到全面的研究，这就妨碍了对精神疾病诊断中不同推定危险因素的相对重要性和可推广性的估计。作者对患有情绪障碍、精神病和其他诊断的患者进行了自杀企图的研究。他们的目标是确定跨越诊断界限的自杀行为风险因素的普遍性和相对重要性，并开发一个假设的、解释的和预测的自杀行为模型，该模型随后可以在前瞻性研究中进行测试。方法：连续招募347例14-72岁的患者（51%为男性，68%为白种人）进入大学精神病院进行研究。结构化临床访谈产生轴I和轴II诊断。评估了终生自杀行为、攻击和冲动特征、急性精神病理的客观和主观严重程度、发育和家族史以及过去的药物滥用或酒精中毒。结果：184例有过自杀企图的患者和没有过自杀企图的患者，其抑郁或精神状态的严重程度并无明显差异。然而，自杀未遂者报告的主观抑郁得分较高，自杀意念得分较高，生存理由较少。企图者一生中攻击性和冲动性的比例也更高。共病边缘型人格障碍、吸烟、过去的药物使用障碍或酗酒、自杀行为家族史、头部受伤和童年虐待史在自杀企图者中更为常见。结论：作者提出了一个应激素质模型，其中自杀行为的风险不仅由精神疾病（应激源）决定，而且由素质决定。这种素质可能反映在倾向于经历更多的自杀意念和更冲动，因此，更有可能采取自杀的感觉。提出了前瞻性研究来检验这一模型。
OBJECTIVE Risk factors for suicide attempts have rarely been studied comprehensively in more than one psychiatric disorder, preventing estimation of the relative importance and the generalizability of different putative risk factors across psychiatric diagnoses. The authors conducted a study of suicide attempts in patients with mood disorders, psychoses, and other diagnoses. Their goal was to determine the generalizability and relative importance of risk factors for suicidal acts across diagnostic boundaries and to develop a hypothetical, explanatory, and predictive model of suicidal behavior that can subsequently be tested in a prospective study. METHOD Following admission to a university psychiatric hospital, 347 consecutive patients who were 14-72 years old (51% were male and 68% were Caucasian) were recruited for study. Structured clinical interviews generated axis I and axis II diagnoses. Lifetime suicidal acts, traits of aggression and impulsivity, objective and subjective severity of acute psychopathology, developmental and family history, and past substance abuse or alcoholism were assessed. RESULTS Objective severity of current depression or psychosis did not distinguish the 184 patients who had attempted suicide from those who had never attempted suicide. However, higher scores on subjective depression, higher scores on suicidal ideation, and fewer reasons for living were reported by suicide attempters. Rates of lifetime aggression and impulsivity were also greater in attempters. Comorbid borderline personality disorder, smoking, past substance use disorder or alcoholism, family history of suicidal acts, head injury, and childhood abuse history were more frequent in suicide attempters. CONCLUSIONS The authors propose a stress-diathesis model in which the risk for suicidal acts is determined not merely by a psychiatric illness (the stressor) but also by a diathesis. This diathesis may be reflected in tendencies to experience more suicidal ideation and to be more impulsive and, therefore, more likely to act on suicidal feelings. Prospective studies are proposed to test this model.