A prospective study of the paradoxical relationship between impulsivity and lethality of suicide attempts
A prospective study of the paradoxical relationship between impulsivity and lethality of suicide attempts
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DOI：
10.4088/jcp.v62n07a11
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发表时间：
2001-07-01
影响因子：
5.3
通讯作者：
de Leon, J
中科院分区：
文献类型：
--
作者：
Baca-García, E;Diaz-Sastre, C;de Leon, J
背景：生物学研究表明，较低的5-羟色胺能活性与更大的自杀致命性和冲动的个性特征有关。这些结果可能导致这样的结论，即尝试中的冲动应该与更大的杀伤力相关。然而，Klerman对表皮病自杀研究的回顾表明，冲动和致命性之间存在相反的关系。这种看似矛盾的冲动和致命性之间的关系，在大量具有代表性的自杀未遂临床样本中并未被探讨。1996年至1998年，在西班牙马德里的一家综合医院对478名自杀未遂的人进行了研究。冲动是通过结合Beck的自杀意向量表的两个项目(对企图的积极准备和预谋程度)来测量的，如文献中所述。结果：超过一半的尝试是冲动的(55%，95%的可信区间，51%到59%)，大约四分之一的尝试有中等程度的冲动(28%；95%的可信区间，24%到3.2%)，大约六分之一的尝试不是冲动的(17%，95%的可信区间，13%到2.1%)。自杀未遂的冲动性和致死性呈负相关(x(2)=62.639，df=6，p<；.0001)。最冲动的自杀行为往往导致较低的发病率，而不那么冲动的自杀企图往往导致更多的癫痫。结论：如果冲动和致命性之间的反向关系在其他具有代表性的样本中重复，将需要新的研究来澄清自杀行为的临床维度(致命性、作为一种状态的冲动和作为一种人格特征的冲动)与生物相关性(特别是血清素能功能)之间的复杂交互作用。
Background: Biological studies suggest that lower serotonergic activity is associated with both greater suicide lethality and impulsive personality traits. These results may lead to the conclusion that impulsivity in the attempt should be associated with greater lethality. However, Klerman's review of epiderniologic suicide studies suggests an inverse relationship between impulsivity and lethality. This seemingly paradoxical relationship between impulsivity and lethality has not been explored in large representative clinical samples of suicide attempts.Method. During 1996 to 1998, 478 individuals who attempted suicide were studied in a general hospital in Madrid, Spain. Impulsivity was measured as described in the literature by combining 2 items of Beck's Suicidal Intent Scale (active preparation for attempt and degree of premeditation). Lethality of the attempt was assigned 1 of 4 levels according to the need for medical and/or psychiatric treatment.Results: More than half of the attempts were impulsive (55%; 95% confidence interval [CI], 51% to 59%), approximately one fourth of the attempts had an intermediate level of impulsivity (28%; 95% CI, 24% to 3.2%), and approximately one sixth of the attempts were not impulsive (17%,95% CI, 13% to 2 1%). There was an inverse association between the impulsivity and lethality of the suicide attempt chi (2) = 62.639, df = 6, p < .0001). The most impulsive attempts tended to result in less morbidity, while the less impulsive attempts tended to be more lethal.Conclusion: If the inverse relationship between impulsivity and lethality is replicated in other large and representative samples, new studies will be needed to clarify the complex interactions between the clinical dimensions (lethality, impulsivity as a state, and impulsivity as a personality trait) and the biological correlates (particularly serotonergic function) of suicidal behavior.