Acute risk factors for suicide attempts and death: prospective findings from the STEP-BD study.
Acute risk factors for suicide attempts and death: prospective findings from the STEP-BD study.
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DOI：
10.1111/bdi.12397
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发表时间：
2016-06
影响因子：
5.4
通讯作者：
Zarate CA
中科院分区：
文献类型：
--
作者：
Ballard ED;Vande Voort JL;Luckenbaugh DA;Machado-Vieira R;Tohen M;Zarate CA
不幸的是，自杀在精神病学实践中很常见，但很难预测。这项研究试图评估双相情感障碍精神科门诊患者在自杀行为前的几个月中哪些临床症状增加。数据来自双相情感障碍系统治疗强化计划(STEP-BD)试验。共纳入103名自杀未遂或自杀死亡的受试者；其余受试者中随机抽取15%的样本(n=427)作为对照样本。对自杀行为的五个急性危险因素中的每一个都进行了自杀行为前六个月的线性混合模型。参与者在每次访问时使用临床监测表(CMF)评估以下自杀行为的潜在急性危险因素：自杀意念、兴趣丧失、焦虑、精神运动激动和高危行为。在从事自杀行为的个体中，这五种症状中的每一种总体上都有所增加(p<；0.05)。自杀意念和兴趣丧失的严重程度在自杀行为前的几个月显著增加(p<；0.001)。焦虑症在多个模型中显示出相似的效应大小。精神运动激越和高危行为在自杀行为发生前并未显著升高。在双相情感障碍的门诊患者中，自杀念头、兴趣丧失和焦虑(程度较轻)可能是自杀行为前四个月的急性自杀风险因素。有必要在前瞻性分析中进一步研究这些潜在的急性危险因素。
Suicide is unfortunately common in psychiatric practice, but difficult to predict. This study sought to assess which clinical symptoms increase in the months before suicidal behavior in a sample of psychiatric outpatients with bipolar disorder. Data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) trial were used. A total pf 103 participants who attempted suicide or died by suicide during the trial were included; a 15% random sample of the remaining participants (n = 427) was used as a comparison sample. Linear mixed models in the six months before suicidal behavior were conducted for each of five proposed acute risk factors for suicidal behavior. Participants were assessed using the Clinical Monitoring Form (CMF) at each visit for the following potential acute risk factors for suicidal behavior: suicidal ideation, loss of interest, anxiety, psychomotor agitation, and high-risk behavior. Each of the five symptoms was elevated overall in individuals who engaged in suicidal behavior (p < 0.05). The severity of both suicidal ideation and loss of interest significantly increased in the months before suicidal behavior (p < 0.001). Anxiety demonstrated comparable effect sizes across multiple models. Psychomotor agitation and high-risk behavior were not significantly elevated before suicidal behavior. Suicidal ideation, loss of interest and, to a lesser extent, anxiety may represent acute suicide risk factors up to four months before suicidal behavior in outpatients with bipolar disorder. Further investigation of these potential acute risk factors in prospective analyses is warranted.