Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: a meta-analysis of longitudinal studies.
Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: a meta-analysis of longitudinal studies.
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DOI：
10.1017/s0033291715001804
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发表时间：
2016-01
影响因子：
6.9
通讯作者：
Nock MK
中科院分区：
文献类型：
--
作者：
Ribeiro JD;Franklin JC;Fox KR;Bentley KH;Kleiman EM;Chang BP;Nock MK
自伤思想和行为(SITB)的历史一直被认为是未来自杀行为的最强预测因素之一。然而，文献中的明显差异引发了人们对这些联系的真实规模的质疑。这项研究的目的是检验SITB与随后的自杀意念、企图和死亡之间的联系的规模和临床效用。我们在PubMed、SqucINFO和Google Scholar上搜索到2014年12月发表的论文。纳入要求研究包括至少一项使用任何SITB变量预测自杀意念、未遂或死亡的纵向分析。我们确定了2179项纵向研究；172项符合纳入标准。最常见的结局是自杀未遂(47.80%)，其次是死亡(40.50%)和意念(11.60%)。中位随访期为52个月(平均值=82.52，S.D.=102.29)。总体预测较弱，概念的加权平均优势比(OR)为2.07[95%可信区间(CI)1.76-2.43]，尝试的加权平均优势比(OR)为2.14(95%可信区间2.00-2.30)，死亡的加权平均优势比(OR)为1.54(95%可信区间1.39-1.71)。对出版偏差进行调整后，估计进一步减少。诊断准确性分析显示可接受的特异度(86-87%)和较差的敏感度(10-26%)，曲线下面积略高于几率(0.60-0.62)。大多数风险因素产生的OR估计为2.0，没有风险因素超过4.5。无论样本严重程度、样本年龄组或随访时间长短，效果都是一致的。先前的SITB为后来的自杀想法和行为提供了风险。然而，它们在诊断准确率上只提供了比机会略有提高的效果。解决研究设计、评估和潜在机制方面的差距可能有助于改善自杀想法和行为的预测和预防。
A history of self-injurious thoughts and behaviors (SITBs) is consistently cited as one of the strongest predictors of future suicidal behavior. However, stark discrepancies in the literature raise questions about the true magnitude of these associations. The objective of this study is to examine the magnitude and clinical utility of the associations between SITBs and subsequent suicide ideation, attempts, and death. We searched PubMed, PsycInfo, and Google Scholar for papers published through December 2014. Inclusion required that studies include at least one longitudinal analysis predicting suicide ideation, attempts, or death using any SITB variable. We identified 2179 longitudinal studies; 172 met inclusion criteria. The most common outcome was suicide attempt (47.80%), followed by death (40.50%) and ideation (11.60%). Median follow-up was 52 months (mean = 82.52, s.d. = 102.29). Overall prediction was weak, with weighted mean odds ratios (ORs) of 2.07 [95% confidence interval (CI) 1.76–2.43] for ideation, 2.14 (95% CI 2.00–2.30) for attempts, and 1.54 (95% CI 1.39–1.71) for death. Adjusting for publication bias further reduced estimates. Diagnostic accuracy analyses indicated acceptable specificity (86–87%) and poor sensitivity (10–26%), with areas under the curve marginally above chance (0.60–0.62). Most risk factors generated OR estimates of <2.0 and no risk factor exceeded 4.5. Effects were consistent regardless of sample severity, sample age groups, or follow-up length. Prior SITBs confer risk for later suicidal thoughts and behaviors. However, they only provide a marginal improvement in diagnostic accuracy above chance. Addressing gaps in study design, assessment, and underlying mechanisms may prove useful in improving prediction and prevention of suicidal thoughts and behaviors.