Prospective study of clinical predictors of suicidal acts after a major depressive episode in patients with major depressive disorder or bipolar disorder
Prospective study of clinical predictors of suicidal acts after a major depressive episode in patients with major depressive disorder or bipolar disorder
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DOI：
10.1176/appi.ajp.161.8.1433
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发表时间：
2004-08-01
影响因子：
17.7
通讯作者：
Mann, JJ
中科院分区：
文献类型：
--
作者：
Oquendo, MA;Galfalvy, H;Mann, JJ
目的：探讨基于过去自杀行为相关因素的应激-素质模型对自杀行为的预测潜力。在这个模型中，自杀行为是由压力源引发的，比如生活事件或在自杀冲动倾向的背景下发生的严重抑郁发作。这种素质表现为对压力源和/或侵略性/冲动特征的存在产生更悲观的倾向。通过对重度抑郁发作患者进行为期2年的随访，确定过去自杀行为的临床相关性是否能预测自杀行为，来测试该素质的预测潜力。方法：对患有DSM-III-R重度抑郁障碍或双相情感障碍的患者（N=308）在就诊时进行评估，以治疗重度抑郁发作。研究入组后2年内自杀行为的潜在预测因素通过与既往自杀行为的关联来确定，并采用Cox比例风险回归分析进行检验。此外，生成悲观和攻击/冲动因素，并采用Cox比例风险回归分析对其预测能力进行检验。结果：未来自杀行为的三个最有力的预测因素是自杀企图史、抑郁严重程度的主观评价和吸烟，每一个都对未来的风险有叠加效应。悲观因素和攻击/冲动因素均能预测自杀行为，且各因素均表现出叠加效应。结论：除了获得自杀行为史外，临床医生可能会发现评估患者当前的悲观水平、攻击/冲动特征以及与物质使用障碍（包括尼古丁相关障碍）的共病，有助于识别重度抑郁症后有自杀行为风险的患者。干预措施，如积极的药物治疗预防，以防止抑郁症状的复发或复发，可以保护这些高危个体免于未来的自杀行为。
Objective: The authors investigated the predictive potential of a stress-diathesis model for suicidal behavior based on correlates of past suicidal acts. in this model, suicidal acts are precipitated by stressors such as life events or a major depressive episode in the setting of a propensity for acting on suicidal urges. This diathesis is expressed as the tendency to develop more pessimism in response to a stressor and/or the presence of aggressive/impulsive traits. The predictive potential of the diathesis was tested by determining whether clinical correlates of past suicidal behavior predict suicidal acts during a 2-year follow-up of patients with a major depressive episode.Method: Patients with DSM-III-R major depressive disorder or bipolar disorder (N=308) were assessed at presentation for treatment of a major depressive episode. Potential predictors of suicidal acts in the 2 years after study enrollment were identified on the basis of an association with previous suicidal behavior and were tested by using Cox proportional hazards regression analysis. in addition, pessimism and aggression/impulsivity factors were generated, and their predictive ability was tested by using Cox proportional hazards regression analysis.Results: The three most powerful predictors of future suicidal acts were a history of suicide attempt, subjective rating of the severity of depression, and cigarette smoking, each of which had an additive effect on future risk. The pessimism and aggression/impulsivity factors both predicted suicidal acts, and each factor showed an additive effect.Conclusions: In addition to obtaining a history of suicidal behavior, clinicians may find it useful to assess patients' current level of pessimism, aggressive/impulsive traits, and comorbidity with substance use disorders, including nicotine-related disorders, to help identify patients at risk for suicidal behavior after major depression. Interventions such as aggressive pharmacotherapeutic prophylaxis to prevent relapse or recurrence of depressive symptoms may protect such at-risk individuals from future suicidal behavior.