Self-injurious thoughts and behaviors that differentiate soldiers who attempt suicide from those with recent suicide ideation.
Self-injurious thoughts and behaviors that differentiate soldiers who attempt suicide from those with recent suicide ideation.
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DOI：
10.1002/da.23016
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发表时间：
2020-08
影响因子：
7.4
通讯作者：
Ursano, Robert J.
中科院分区：
文献类型：
--
作者：
Naifeh, James A.;Nock, Matthew K.;Dempsey, Catherine L.;Georg, Matthew W.;Bartolanzo, Danielle;Ng, Tsz Hin Hinz;Aliaga, Pablo A.;Dinh, Hieu M.;Fullerton, Carol S.;Mash, Holly B. Herberman;Kao, Tzu-Cheg;Sampson, Nancy A.;Wynn, Gary H.;Zaslavsky, Alan M.;Stein, Murray B.;Kessler, Ronald C.;Ursano, Robert J.
自杀企图（SA）与自杀意念（SI）的风险在临床上很重要，但很难区分。我们研究了是否有自我伤害的思想和行为（SITBs）的历史区分最近SA的士兵与当前/最近SI的非尝试士兵。使用独特的病例对照设计，我们管理相同的问卷（评估历史的SITBs和心理社会变量），以代表美国陆军士兵最近住院的SA（n=132）和士兵从相同的陆军设施报告30天SI，但没有尝试（n=125）。逻辑回归分析检查是否SITBs区分的构想者和构想者后，控制先前确定的协变量。在对系统性无反应进行加权并控制性别、教育、创伤后应激障碍和间歇性爆发性障碍的单独模型中，SA与自杀计划和/或行为意图的历史呈正相关且显著相关（OR=12.1 [95%CI=3.6-40.4]），在意念最差的一周内难以控制自杀念头（OR=3.5 [95%CI=1.1-11.3]）和非自杀性自伤（NSSI）（OR=4.9 [95%CI=1.3-18.0]）。在结合这些SITB和协变量的完整模型中，曲线下面积为0.87。基于预测风险的最高阈值的敏感性为24.7%，特异性为99.8%，阳性预测值为97.5%。自杀计划/意图的历史，难以控制的想法，和NSSI区分最近SA的士兵与当前/最近SI的独立的社会人口特征和精神障碍。需要进行纵向研究，以确定这些因素是否与从SI到SA的短期过渡有前瞻性关联。
Risk for suicide attempt (SA) versus suicide ideation (SI) is clinically important and difficult to differentiate. We examined whether history of self-injurious thoughts and behaviors (SITBs) differentiates soldiers with a recent SA from non-attempting soldiers with current/recent SI. Using a unique case-control design, we administered the same questionnaire (assessing history of SITBs and psychosocial variables) to representative U.S. Army soldiers recently hospitalized for SA (n=132) and soldiers from the same Army installations who reported 30-day SI but did not make an attempt (n=125). Logistic regression analyses examined whether SITBs differentiated attempters and ideators after controlling for previously identified covariates. In separate models that weighted for systematic nonresponse and controlled for gender, education, posttraumatic stress disorder, and intermittent explosive disorder, SA was positively and significantly associated with history of suicide plan and/or intention to act (OR=12.1 [95%CI=3.6–40.4]), difficulty controlling suicidal thoughts during the worst week of ideation (OR=3.5 [95%CI=1.1–11.3]), and nonsuicidal self-injury (NSSI) (OR=4.9 [95%CI=1.3–18.0]). Area under the curve was 0.87 in a full model that combined these SITBs and covariates. The top ventile based on predicted risk had sensitivity of 24.7%, specificity of 99.8%, and positive predictive value of 97.5%. History of suicide plan/intention, difficult to control ideation, and NSSI differentiate soldiers with recent SA from those with current/recent SI independent of socio-demographic characteristics and mental disorders. Longitudinal research is needed to determine whether these factors are prospectively associated with the short-term transition from SI to SA.
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