Correlates of suicidal behaviors and genetic risk among United States veterans with schizophrenia or bipolar I disorder.
Correlates of suicidal behaviors and genetic risk among United States veterans with schizophrenia or bipolar I disorder.
复制标题
患有精神分裂症或 I 型双相情感障碍的美国退伍军人自杀行为与遗传风险的相关性。
DOI：
10.1038/s41380-024-02472-1
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发表时间：
2024
影响因子：
11
通讯作者：
Malhotra,Anil
中科院分区：
文献类型：
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作者：
Bigdeli,TimB;Barr,PeterB;Rajeevan,Nallakkandi;Graham,DavidP;Li,Yuli;Meyers,JacquelynL;Gorman,BryanR;Peterson,RoseannE;Sayward,Frederick;Radhakrishnan,Krishnan;Natarajan,Sundar;Nielsen,DavidA;Wilkinson,AnnaV;Malhotra,Anil
被诊断患有精神分裂症（SCZ）或双相I型障碍（BPI）的人具有自我伤害行为、自杀意念和自杀行为（SB）的高风险。描述诊断的健康问题，既往药物治疗和多基因评分（PGS）之间的相关性有可能为风险分层提供信息。我们使用哥伦比亚自杀严重程度评定量表（C-SSRS）检查了在退伍军人健康管理局（VHA）接受治疗的3，942名SCZ和5，414名BPI患者的自我报告SB和意念。这些横断面数据与电子健康记录（EHR）相结合，并在终身诊断，治疗史，随访筛查和死亡率数据之间进行比较。使用相关性状的可用基因组数据构建PGS。进行全基因组关联研究以鉴定和优先化特定基因座。报告SB的退伍军人中只有20%有确凿的ICD-9/10 EHR代码。在既往无SB的患者中，超过20%的患者在随访时报告新发SB。SB与一系列额外的临床诊断相关，并与特定类别的精神药物治疗相关（例如，抗抑郁药、抗精神病药等）。外化行为、开始吸烟、自杀企图和重度抑郁症的PGS与SB相关。SB的GWAS没有产生显著的位点。在被诊断为精神疾病的个体中，自我报告的SB与几个EHR领域的临床变量密切相关。分析指出，后遗症的物质相关和精神科合并症的强相关的先前和随后的SB。尽管如此，过去的SB往往没有记录在健康记录，强调定期筛查的价值与直接，在人的评估，特别是在高风险的个人。
Persons diagnosed with schizophrenia (SCZ) or bipolar I disorder (BPI) are at high risk for self-injurious behavior, suicidal ideation, and suicidal behaviors (SB). Characterizing associations between diagnosed health problems, prior pharmacological treatments, and polygenic scores (PGS) has potential to inform risk stratification. We examined self-reported SB and ideation using the Columbia Suicide Severity Rating Scale (C-SSRS) among 3,942 SCZ and 5,414 BPI patients receiving care within the Veterans Health Administration (VHA). These cross-sectional data were integrated with electronic health records (EHRs), and compared across lifetime diagnoses, treatment histories, follow-up screenings, and mortality data. PGS were constructed using available genomic data for related traits. Genome-wide association studies were performed to identify and prioritize specific loci. Only 20% of the veterans who reported SB had a corroborating ICD-9/10 EHR code. Among those without prior SB, more than 20% reported new-onset SB at follow-up. SB were associated with a range of additional clinical diagnoses, and with treatment with specific classes of psychotropic medications (e.g., antidepressants, antipsychotics, etc.). PGS for externalizing behaviors, smoking initiation, suicide attempt, and major depressive disorder were associated with SB. The GWAS for SB yielded no significant loci. Among individuals with a diagnosed mental illness, self-reported SB were strongly associated with clinical variables across several EHR domains. Analyses point to sequelae of substance-related and psychiatric comorbidities as strong correlates of prior and subsequent SB. Nonetheless, past SB was frequently not documented in health records, underscoring the value of regular screening with direct, in-person assessments, especially among high-risk individuals.