Association Between Psychotic Experiences and Subsequent Suicidal Thoughts and Behaviors: A Cross-National Analysis From the World Health Organization World Mental Health Surveys.
Association Between Psychotic Experiences and Subsequent Suicidal Thoughts and Behaviors: A Cross-National Analysis From the World Health Organization World Mental Health Surveys.
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DOI：
10.1001/jamapsychiatry.2017.2647
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发表时间：
2017-11-01
期刊：
影响因子：
25.8
通讯作者：
World Health Organization World Mental Health Survey Collaborators
中科院分区：
文献类型：
--
作者：
Bromet EJ;Nock MK;Saha S;Lim CCW;Aguilar-Gaxiola S;Al-Hamzawi A;Alonso J;Borges G;Bruffaerts R;Degenhardt L;de Girolamo G;de Jonge P;Florescu S;Gureje O;Haro JM;He Y;Hu C;Karam EG;Kovess-Masfety V;Lee S;Lepine JP;Mneimneh Z;Navarro-Mateu F;Ojagbemi A;Posada-Villa J;Sampson NA;Scott KM;Stagnaro JC;Viana MC;Xavier M;Kessler RC;McGrath JJ;World Health Organization World Mental Health Survey Collaborators
基于社区的研究将精神病经历（PE）与自杀想法和行为（STBs）的风险增加联系起来。然而，目前尚不清楚这些关联是否在整个生命过程中有所不同，或者精神障碍（STBs之前）是否促成了这些关联。研究PE和随后的STB之间的时间关联，以及精神障碍（STB的前因）对这些关联的影响。对来自世界卫生组织世界精神卫生调查（WMH）的19个国家的33，370名成年受访者进行了PE，STB（构思，计划和尝试）和21种DSM-IV精神障碍的评估。离散时间生存分析用于研究PE与随后发生的STB的相关性。伴有PE的STB的患病率和频率，以及比值比和95%CI。在纳入的33370名参与者中，在PE患者（n = 2488）中，自杀意念、计划和企图的终生患病率（SE）分别为28.5%（1.3）、10.8%（0.7）和10.2%（0.7）。有1次或多次PE的受试者在调整了先前或干预性精神障碍后，随后发生STB的几率增加了2倍（自杀意念：比值比，2.2; 95%CI，1.8-2.6;自杀计划：比值比，2.1; 95%CI，1.7-2.6;自杀企图：比值比，1.9; 95%CI，1.5-2.5）。有显着的剂量-反应关系的PE类型与随后的STBs的数量持续调整后的精神障碍。尽管PE是所有生命阶段随后STB发作的重要预测因子，但在12岁及以下的个体中相关性最强。校正既往精神障碍后，与既往PE相关的终生自杀意念、计划和尝试的总体人群归因风险比例分别为5.3%、5.7%和4.8%。PE与整个生命过程中随后发生STB的几率升高相关，这不能用先前的精神障碍来解释。这些结果强调了在设计用于预测STB的筛选工具中包括有关PE的信息的重要性。
Community-based studies have linked psychotic experiences (PEs) with increased risks of suicidal thoughts and behaviors (STBs). However, it is not known if these associations vary across the life-course or if mental disorders (antecedent to the STBs) contribute to these associations. To examine the temporal association between PEs and subsequent STBs across the life span as well as the influence of mental disorders (antecedent to the STBs) on these associations. A total of 33,370 adult respondents across 19 countries from the WHO World Mental Health (WMH) Surveys were assessed for PEs, STBs (ideation, plans, and attempts), and 21 DSM-IV mental disorders. Discrete-time survival analysis was used to investigate the associations of PEs with subsequent onsets of STBs. Prevalence and frequency of STBs with PEs, and odds ratios and 95%CIs. Of 33 370 included participants, among those with PEs (n = 2488), the lifetime prevalence (SE) of suicidal ideation, plans, and attempts was 28.5%(1.3), 10.8%(0.7), and 10.2%(0.7), respectively. Respondents with 1 or more PEs had 2-fold increased odds of subsequent STBs after adjusting for antecedent or intervening mental disorders (suicidal ideation: odds ratio, 2.2; 95%CI, 1.8-2.6; suicide plans: odds ratio, 2.1; 95%CI, 1.7-2.6; and suicide attempts: odds ratio, 1.9; 95%CI, 1.5-2.5). There were significant dose-response relationships of number of PE types with subsequent STBs that persisted after adjustment for mental disorders. Although PEs were significant predictors of subsequent STB onset across all life stages, associations were strongest in individuals 12 years and younger. After adjustment for antecedent mental disorders, the overall population attributable risk proportions for lifetime suicidal ideation, plans, and attempts associated with temporally prior PEs were 5.3%, 5.7%, and 4.8%, respectively. PEs are associated with elevated odds of subsequent STBs across the life-course that cannot be explained by antecedent mental disorders. These results highlight the importance of including information about PEs in screening instruments designed to predict STBs.
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