Oquendo M A, Waternaux C, Brodsky B, Parsons B, Haas G L, Malone K M, Mann J J
MHCRC for the Study of Suicidal Behavior and the Stanley Foundation Center for Applied Neuroscience of Bipolar Disorders, Department of Neuroscience, New York State Psychiatric Institute, Columbia University, NY 10032, USA.
J Affect Disord. 2000 Aug;59(2):107-17. doi: 10.1016/s0165-0327(99)00129-9.
Bipolar Disorder is associated with a higher frequency of attempted suicide than most other psychiatric disorders. The reasons are unknown. This study compared bipolar subjects with a history of a suicide attempt to those without such a history, assessing suicidal behavior qualitatively and quantitatively, and examining possible demographic, psychopathologic and familial risk factors.
Patients (ages 18 to 75) with a DSM III-R Bipolar Disorder (n = 44) diagnosis determined by a structured interview for Axis I disorders were enrolled. Acute psychopathology, hopelessness, protective factors, and traits of aggression and impulsivity were measured. The number, method and degree of medical damage was assessed for suicide attempts, life-time.
Bipolar suicide attempters had more life-time episodes of major depression, and twice as many were in a current depressive or mixed episode, compared to bipolar nonattempters. Attempters reported more suicidal ideation immediately prior to admission, and fewer reasons for living even when the most recent suicide attempt preceded the index hospitalization by more than six months. Attempters had more lifetime aggression and were more likely to be male. However, attempters did not differ from nonattempters on lifetime impulsivity.
The generalizability of the results is limited because this is a study of inpatients with a history of suicide attempts. Patients with Bipolar I and NOS Disorders were pooled and a larger sample is needed to look at differences. We could not assess psychopathology immediately prior to the suicide attempt because, only half of the suicide attempters had made attempts in the six months prior to admission. Patients with current comorbid substance abuse were excluded. No suicide completers were studied.
Bipolar subjects with a history of suicide attempt experience more episodes of depression, and react to them by having severe suicidal ideation. Their diathesis for acting on feelings of anger or suicidal ideation is suggested by a higher level of lifetime aggression and a pattern of repeated suicide attempts.
双相情感障碍与自杀未遂的发生率高于大多数其他精神疾病相关。原因尚不清楚。本研究比较了有自杀未遂史的双相情感障碍患者与无此类病史的患者，定性和定量评估自杀行为，并研究可能的人口统计学、精神病理学和家族风险因素。
纳入通过轴I障碍结构化访谈确诊为DSM III-R双相情感障碍（n = 44）的患者（年龄18至75岁）。测量急性精神病理学、绝望感、保护因素以及攻击性和冲动性特征。评估自杀未遂的次数、方法和医疗损害程度，涵盖一生。
与无自杀未遂史的双相情感障碍患者相比，有自杀未遂史的患者一生中有更多的重度抑郁发作，当前处于抑郁或混合发作的人数是无自杀未遂史患者的两倍。自杀未遂者在入院前报告有更多自杀意念，即使最近一次自杀未遂发生在本次住院前六个月以上，其生活理由也更少。自杀未遂者一生中有更多攻击性，且更可能为男性。然而，自杀未遂者与无自杀未遂史者在一生冲动性方面无差异。
由于本研究是对有自杀未遂史的住院患者进行的，结果的普遍性有限。双相I型障碍和未特定型双相障碍患者合并在一起，需要更大样本量来研究差异。我们无法在自杀未遂前立即评估精神病理学情况，因为只有一半的自杀未遂者在入院前六个月内有过自杀行为。排除了当前合并物质滥用的患者。未研究自杀死亡者。
有自杀未遂史的双相情感障碍患者经历更多抑郁发作，并通过产生严重自杀意念对其作出反应。其因愤怒情绪或自杀意念而采取行动的素质表现为一生中有更高水平的攻击性以及反复自杀未遂模式。
