Suicide and attempted suicide in bipolar disorder: A systematic review of risk factors
Suicide and attempted suicide in bipolar disorder: A systematic review of risk factors
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DOI：
10.4088/jcp.v66n0604
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发表时间：
2005-06-01
影响因子：
5.3
通讯作者：
Harriss, L
中科院分区：
文献类型：
--
作者：
Hawton, K;Sutton, L;Harriss, L
目的：通过对国际文献的系统回顾，确定双相情感障碍患者自杀和非致命性自杀行为的主要危险因素。数据来源：通过MEDLINE的电子检索识别研究（1966年-2003年12月），EMBASE（1980- 2003年12月），PsycINFO（1872年-2003年11月）和生物学文摘（1985- 2003年12月）使用索引和自由文本检索词检索双相情感障碍、双相抑郁、躁狂抑郁、躁狂和情感障碍;与自残、自伤、自杀、自杀未遂、自残、自残、自毒和自割等术语相结合;与风险、病例对照、队列、比较、纵向和随访研究术语相结合。研究选择：纳入的研究包括双相情感障碍患者的队列、病例对照和横断面调查，其中自杀（13项研究）或自杀未遂（23项研究）被报告为结局。选定的研究还使用了诊断工具，包括DSM，国际疾病分类和研究诊断标准。数据综合：荟萃分析的因素报告，在超过我的研究确定了自杀的主要危险因素为以前的自杀企图和绝望。非致命性自杀行为的主要危险因素包括自杀家族史、双相情感障碍的早期发作、抑郁症状的程度、情感发作的严重程度增加、混合情感状态的存在、快速循环、共病轴I障碍以及酒精或药物滥用。双相情感障碍患者自杀行为的预防应包括在评估和治疗中注意这些危险因素，包括在决定是否开始专门针对降低自杀风险的治疗时。
Objective: To determine the main risk factors for suicide and nonfatal suicidal behavior in patients with bipolar disorder through a systematic review of the international literature.Data Sources: Studies were identified through electronic searches of MEDLINE (1966-December 2003), EMBASE (1980-December 2003), PsycINFO (1872-November 2003), and Biological Abstracts (1985-Decernber 2003) using index and free-text search terms for bipolar disorder, bipolar depression, manic depression, mania, and affective disorders; combined with terms for self-harm, self-injury, suicide, attempted suicide, automutilation, selfmutilation, self-poisoning, and self-cutting; and combined with terms for risk, case control, cohort, comparative, longitudinal, and follow-up studies. No language restrictions were applied to the search.Study Selection: Included Studies were cohort, case-control, and cross-sectional investigations of patients with bipolar disorder in which suicide (13 studies) or attempted suicide (23 studies) was reported as an outcome. The selected studies also used diagnostic tools including the DSM, International Classification of Diseases, and Research Diagnostic Criteria.Data Synthesis: Meta-analysis of factors reported in more than I study identified the main risk factors for suicide as a previous suicide attempt and hopelessness. The main risk factors for nonfatal suicidal behavior included family history of suicide, early onset of bipolar disorder, extent of depressive symptoms, increasing severity of affective episodes, the presence of mixed affective states, rapid cycling, comorbid Axis I disorders, and abuse of alcohol or drugs.Conclusions: Prevention Of Suicidal behavior in patients with bipolar disorder should include attention to these risk factors in assessment and treatment, including when deciding whether to initiate treatment aimed specifically at reducing suicide risk.