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、低社会经济地位和5-羟色胺转运基因（5-HTTLPR）多态性是预测自杀风险增加的危险因素。然而，这些风险因素对自杀行为的解释价值是有限的。最近，人际自杀理论（ITS）被提出。它假设同时出现的挫败性归属（TB；不属于有价值群体的感觉）和感知负担（PB；成为他人负担的感觉）预示着自杀意愿。如果TB和PB与获得性自杀能力（AC）同时发生，则可以预测自杀企图。越来越多的研究已经发表，与该理论的假设相一致。然而，到目前为止，(a)没有重要的前瞻性研究，(b)没有发表的研究试图证明与已确定的生物心理社会风险因素相比，TB、PT和AC的增量预测能力。本研究的主要研究问题是，在控制既定的生物心理社会风险因素后，变量PB、TB和AC是否能预测自杀企图。在纵向设计中，我们进一步研究TB、PB和AC之间的前因、放大过程和正反馈回路，以及AC、疼痛感知和5-HTTLPR多态性之间的关系。整个项目持续30个月。在前瞻性设计中，我们的目标是在两周内招募N=260名因自杀企图或急性自杀倾向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）的患者。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进行评估。此外，疼痛感知（压力测量）和5-HTTLPR多态性（唾液样本）将被确定。患者将在6 （T1）、9 （T2）和12 （T3）个月后（T1-2个月电话访谈，T3个月家访，包括疼痛感觉评估）通过问卷和访谈对患者进行重新评估。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/相互相关方法（SPSS、AMOS、HLM、EGRET）。该项目将提供最重要的必要信息，以便更深入、更全面地了解基于ITS的自杀发展。该项目的结果将进一步对自杀念头和行为的风险评估、危机干预和治疗产生重要影响。

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.