Do Undiagnosed Suicide Decedents Have Symptoms of a Mental Disorder?
Do Undiagnosed Suicide Decedents Have Symptoms of a Mental Disorder?
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DOI：
10.1002/jclp.22498
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发表时间：
2017-12
影响因子：
3
通讯作者：
Chu C
中科院分区：
文献类型：
--
作者：
Joiner TE Jr;Buchman-Schmitt JM;Chu C
心理尸检研究一致报告，自杀死亡者中发现的精神障碍率低于100%。这意味着三种可能性：1）一部分自杀死者在死亡时没有精神障碍; 2）所有自杀死者都患有精神障碍，但是，由于方法的限制，有些人没有被发现;和/或3）未被发现的精神障碍的自杀死者显示出精神障碍的显著特征，可能是亚临床特征。在这篇手稿中，我们通过评估未被诊断的自杀死者和死亡时被诊断为精神障碍的自杀死者之间的症状和压力源的差异来研究这些可能性。我们回顾了130例社区自杀死亡者的案例研究，这些案例最初是在心理尸检研究中描述的。毫无例外，罗宾斯样本中的自杀死者要么患有明确诊断的精神障碍，要么表现出明显的精神障碍特征，即使是亚临床的精神障碍。未确诊和确诊的自杀死亡者在人口统计学、自杀方式暴力、自杀企图史、死亡前压力生活事件的数量和强度以及他们的死亡是否是谋杀自杀方面没有显著差异。虽然显然不是所有患有精神障碍的人都会死于自杀，但这些研究结果表明，所有死于自杀的人似乎至少表现出亚临床精神症状，其中绝大多数表现出突出的临床症状。我们的结论与临床意义和建议，为今后的研究。
Psychological autopsy studies consistently report that the rate of detected mental disorders among suicide decedents is below 100%. This implies three possibilities: 1) a subset of suicide decedents did not have a mental disorder at the time of death; 2) all suicide decedents suffered from a mental disorder, however, some were undetected due to methodological limitations; and/or 3) suicide decedents with an undetected mental disorder displayed significant and perhaps subclinical features of a mental disorder. In this manuscript, we examined these possibilities by evaluating the differences in symptoms and stressors between suicide decedents who were undiagnosed and those diagnosed with a mental disorder at the time of death. We reviewed 130 case studies of community-based suicide decedents originally described in psychological autopsy study. Without exception, suicide decedents in Robins’ sample suffered either from a clearly diagnosable mental disorder or displayed features indicative of a significant, even if subclinical, presentation of a mental disorder. Undiagnosed and diagnosed suicide decedents did not significantly differ with regards to demographics, violence of suicide method, suicide attempt history, the number and intensity of stressful life events preceding death, and whether their death was a murder-suicide. Although clearly not all who suffer from mental disorders will die by suicide, these findings imply that all who die by suicide appear to exhibit, at minimum, subclinical psychiatric symptoms with the great majority showing prominent clinical symptoms. We conclude with clinical implications and recommendations for future study.
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