Proximal psychiatric risk factors for suicidality in youth - The Great Smoky Mountains Study
Proximal psychiatric risk factors for suicidality in youth - The Great Smoky Mountains Study
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DOI：
10.1001/archpsyc.63.9.1017
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发表时间：
2006-09-01
影响因子：
--
通讯作者：
Angold, Adrian
中科院分区：
文献类型：
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作者：
Foley, Debra L.;Goldston, David B.;Angold, Adrian
上下文：精神障碍是自杀倾向的主要危险因素，但其阳性预测值较低。目的：描述与焦虑、抑郁、破坏性行为和物质使用障碍相关的自杀倾向的近端风险，并检验是否存在独立于精神病理学严重程度的区分高危青年的关键障碍组合。设计：大烟山研究，美国东南部9至16岁儿童和青少年的代表性样本。从1993年到2000年，受试者和他们的父母多次接受采访，了解受试者最近的精神病和自杀史。设置：青年流行病学样本。参与者：样本包括1420名个体受试者，在8波数据收集中有6676条记录。主要结果测量：自杀意念、自杀计划、自杀企图、自杀倾向。风险最大的是与当前抑郁伴焦虑（特别是广泛性焦虑障碍）（比值比，468.53）或抑郁伴破坏性障碍（主要是ODD [对立违抗性障碍]）（比值比，222.94）相关。除非有共病，焦虑和物质使用障碍与自杀倾向没有密切关系。抑郁相关损害的严重程度，在某些情况下，总的症状负荷解释了与所有精神病特征相关的风险，除了抑郁和焦虑，特别是GAD（调整的比值比，50.16）。由联邦家庭指南定义的损伤和贫困的严重程度都是独立的风险因素，与精神病学特征无关。没有可诊断疾病的自杀青年有阈下（主要是破坏性）障碍，残疾的关系困难，或精神症状没有相关的immortation.Conclusions：严重程度的精神障碍相关的损害和总症状负荷解释了大多数与当前精神疾病相关的自杀倾向的风险。只有抑郁症加广泛性焦虑症的歧视，在独立的精神病理学的严重程度的风险青年。
Context: Psychiatric disorder is a major risk factor for suicidality but has poor positive predictive value.Objectives: To characterize proximal risks for suicidality associated with anxiety, depressive, disruptive behavior, and substance use disorders, and to test whether there are critical combinations of disorders that discriminate at-risk youth independent of severity of psychopathology.Design: The Great Smoky Mountains Study, a representative sample of children and adolescents aged 9 to 16 years from the southeastern United States. Subjects and their parents were interviewed on multiple occasions from 1993 to 2000 about the subjects' recent psychiatric and suicidal history.Setting: An epidemiological sample of youth.Participants: The sample included 1420 individual subjects with 6676 records across 8 waves of data collection.Main Outcome Measures: Wanting to die, suicidal ideation, suicide plans, or suicide attempt during the past 3 months.Results: Eleven broad psychiatric profiles discriminated suicidal youth. Risk was greatest in association with current depression plus anxiety (specifically GAD [generalized anxiety disorder]) (odds ratio, 468.53) or depression plus a disruptive disorder (primarily ODD [oppositional-defiant disorder]) (odds ratio, 222.94). Unless comorbid, anxiety and substance use disorders were not proximally associated with suicidality. The severity of symptom-related impairment and, in some cases, total symptom load explained risk associated with all psychiatric profiles except depression plus anxiety, specifically GAD (adjusted odds ratio, 50.16). Severity of impairment and poverty defined by federal guidelines for families were both independent risk factors, irrespective of psychiatric profile. Suicidal youth without diagnosable disorders had subthreshold (mostly disruptive) disorders, disabling relationship difficulties, or psychiatric symptoms without associated impairment.Conclusions: Severity of symptom-related impairment and total symptom load explained most of the risk for suicidality associated with current psychiatric disorders. Only depression plus GAD discriminated at-risk youth independent of severity of psychopathology.