Metaanalysis of Mood and Substance Use Disorders in Proximal Risk for Suicide Deaths
Metaanalysis of Mood and Substance Use Disorders in Proximal Risk for Suicide Deaths
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DOI：
10.1111/sltb.12422
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发表时间：
2019-02-01
影响因子：
3.2
通讯作者：
Brent, David A.
中科院分区：
文献类型：
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作者：
Conner, Kenneth R.;Bridge, Jeffrey A.;Brent, David A.
自杀的近端危险因素的证据是基于病例对照心理尸检研究，这些报告显示，情绪和物质使用障碍是世界范围内自杀死亡者中最常见的精神障碍，并与显著的风险相关。然而，风险的调节因素和与（非酒精）药物使用障碍相关的风险程度尚不清楚。通过全面检索，确定了30年来全球发表的35项病例对照心理尸检研究，并使用随机效应模型进行荟萃分析。重度抑郁症，比值比（95%置信区间）=9.14（5.53，15.09），药物使用障碍，OR（95% CI）=7.18（3.22，16.01），具有较大的效应量，以及其他结果。与其他地区相比，在女性比例较大的研究中以及在亚洲进行的研究中，与重度抑郁症相关的风险估计更高。没有证据表明发表偏倚或任何一项研究对结果产生不成比例的影响。与抑郁症相关的自杀风险似乎受性别和/或世界地区的影响。药物使用障碍是一个潜在的风险因素，说明了在临床风险评估中评估药物使用的重要性。
Evidence for proximal risk factors for suicide is based on case-control psychological autopsy studies, with these reports showing that mood and substance use disorders are the most prevalent mental disorders among suicide decedents worldwide and are associated with marked risk. However, moderators of risk and the degree of risk associated with (nonalcohol) drug use disorder are unknown. A comprehensive search was used to identify 35 case-control psychological autopsy studies published worldwide over a 30-year period that were metaanalyzed using random effects models. Major depression, odds ratio (95% confidence interval)=9.14 (5.53, 15.09), and drug use disorder, OR (95% CI)=7.18 (3.22, 16.01), had large effect sizes, among other results. Risk estimates associated with major depression were greater in studies with a larger proportion of women and those conducted in Asia compared with other regions. There was no evidence of publication bias or that any one study had a disproportionate impact on findings. Risk for suicide associated with major depression appears to be moderated by sex and/or world region. Drug use disorder is a potent risk factor, illustrating the importance of assessing drug use in clinical risk assessment.