PRESS: Predictors of the development of suicidal thoughts and behaviors in a longitudinal design. An evaluation of the Interpersonal Theory of Suicidal Behavior

精神障碍、抑郁、绝望、社会经济地位低下和5-羟色胺转运体基因(5-HTTLPR)的多态性是预测自杀风险增加的危险因素。然而，这些危险因素对自杀行为的解释价值是有限的。最近，自杀的人际关系理论(ITS)被提出。它假设受挫的归属感(TB；感觉不是有价值的群体的一部分)和感知的负担(PB；感觉是他人的负担)同时出现预示着自杀的愿望。如果这样的话，TB和PB与后天获得的自杀能力(AC)一起发生，就可以预测自杀企图。越来越多的研究发表了与该理论的假设相一致的研究。然而，到目前为止，(A)没有重大的前瞻性研究可用，(B)没有发表任何研究，试图证明与既定的生物、心理和社会风险因素相比，结核病、PT和AC具有递增的预测能力。本研究的主要研究问题是，在控制已确定的生物、心理和社会危险因素时，变量PB、TB和AC是否可以预测自杀企图。我们进一步的目标是在纵向设计中研究TB、PB和AC之间的前置因素、扩增过程和正反馈环，以及AC、痛觉和5-HTTLPR多态之间的关系。整个项目为期30个月。在一项前瞻性设计中，我们的目标是招募N=260名患者，在他们因自杀未遂或急性自杀而被送入精神科或急诊病房(八个诊所和三个地方的一个急诊病房)后的两周内。患者的自杀想法和行为、精神障碍和危险因素将通过结构化访谈和问卷调查进行评估。此外，还将测定痛觉(压力测痛仪)和5-HTTLPR多态(唾液样本)。患者将在6个月(T1)、9个月(T2)和12个月(T3)后通过问卷和访谈进行重新评估(T1-2个电话访谈，T3家访包括疼痛感知评估)。数据分析将包括纵向数据的多水平分析、多变量方差分析、回归分析、结构方程模型和自相关/互相关方法(SPSS、AMOS、HLM、ERRET)。该项目将提供最重要的必要信息，以便能够更深入和更全面地了解基于智能交通运输系统的自杀事态发展。该项目的结果将进一步对风险评估、危机干预和自杀想法和行为的治疗产生重要影响。

Mental disorders, depression, hopelessness, low socio-economic status, and a polymorphism of the serotonin-transporter-gene (5-HTTLPR) are risk factors that predict heightened risk for suicide. However, these risk factors´ explanatory value for suicidal behavior is limited. Recently, the Interpersonal Theory of Suicide (ITS) has been proposed. It assumes that the simultaneous occurrence of Thwarted Belongingness (TB; the perception of not being part of a valued group) and Perceived Burdensomeness (PB; the perception of being a burden for others) predicts suicidal wishes. If then TB and PB occur together with the Acquired Capability for Suicide (AC) suicidal attempts may be predicted. An ever-growing number of studies has been published that are in concordance with the assumptions of the theory. Nevertheless, so far there are (a) no significant prospective studies available and (b) no studies have been published that try to prove the incremental predictive power of TB, PT and AC as compared to established biopsychosocial risk factors. The main research question of the present study is whether the variables PB, TB, and AC predict suicidal attempts when controlling for established biopsychosocial risk factors. We further aim to investigate antecedents, amplification processes and positive feedback loops between TB, PB, and AC and the relations between AC, pain perception and the 5-HTTLPR polymorphism in a longitudinal design. The entire project lasts 30 months. In a prospective design we aim to recruit N=260 patients within two weeks after they were admitted to a psychiatric or an emergency ward (eight clinics and one emergency ward at three places) because of suicidal attempt or acute suicidality. Patients´ suicidal thoughts and behaviors, mental disorders and risk factors will be assessed using structured interviews and questionnaires. Moreover, pain perception (pressure algometer) and the 5-HTTLPR polymorphism (saliva samples) will be determined. Patients will be re-assessed with questionnaires and interviews after 6 (T1), 9 (T2) and 12 (T3) months (T1-2 telephone interviews, T3 home visits including assessment of pain perception). Data analyses will include multilevel analyses for longitudinal data, multivariate analyses of variance, regression analyses, structural equation models and the auto-correlation/cross-correlation approach (SPSS, AMOS, HLM, EGRET). The project will provide the most important necessary information to allow for a deeper and more comprehensive understanding of suicidal developments based on the ITS. The results of the project will further bear important implications for risk assessment, crisis intervention and treatment of suicidal thoughts and behavior.