Taiminen T, Huttunen J, Heilä H, Henriksson M, Isometsä E, Kähkönen J, Tuominen K, Lönnqvist J, Addington D, Helenius H
Department of Psychiatry, University of Turku Central Hospital, Rak. 9, III krs., TKS, Kunnallissairaalantie 20, FIN-20700 Turku, Finland.
Schizophr Res. 2001 Mar 1;47(2-3):199-213. doi: 10.1016/s0920-9964(00)00126-2.
Estimations about the lifetime risk of suicide in schizophrenia vary between 4 and 10%. At present, there does not exist a suicide risk scale developed particularly for schizophrenic patients. The aims of the present study were to: (1) develop a clinically useful semi-structured scale for the estimation of short-term suicide risk among schizophrenic patients, and (2) to carry out an initial validation of the scale.
A 25-item Schizophrenia Suicide Risk Scale (SSRS) was constructed on the base of the literature. The SSRS scores of 69 living schizophrenic patients (LS group) were compared with the scores of 69 schizophrenic suicides (SS group) whose data had been collected previously from The Finnish nationwide and representative psychological autopsy study. Internal consistency of the SSRS was evaluated with Cronbach alpha. The most important SSRS items predicting suicide were identified with a logistic regression analysis. Sensitivity, specificity, positive predictive value, and negative predictive value of the SSRS in predicting suicide with various cut-off scores were calculated.
In the final logistic regression model, the following SSRS items significantly predicted suicide: suicide plans communicated to someone during the past 3 months; one or more previous suicide attempts; loss of professional skills demanding job; depression observed during an interview; and suicide plans communicated during an interview. With high cut-off scores the specificity of the SSRS became satisfactory, but the sensitivity dropped below 32%. Internal consistency of the anamnestic history of the SSRS was low, which suggests that anamnestic risk factors for suicide in schizophrenia are multifactorial. Internal consistency of the interview-based items was high, and present state risk factors seemed to consist of two separate factors, depression-anxiety and irritability.
The SSRS may be clinically useful in identifying schizophrenic patients with a particularly high risk for suicide. However, the SSRS seems not to be a practical screening instrument for suicide risk in schizophrenia, and it is probably impossible to construct a suicide risk scale with both high sensitivity and high specificity in this disorder.
关于精神分裂症患者终身自杀风险的估计在4%至10%之间。目前，尚无专门为精神分裂症患者开发的自杀风险量表。本研究的目的是：（1）开发一种临床上有用的半结构化量表，用于评估精神分裂症患者的短期自杀风险；（2）对该量表进行初步验证。
在文献基础上构建了一个包含25个条目的精神分裂症自杀风险量表（SSRS）。将69例存活的精神分裂症患者（LS组）的SSRS得分与69例精神分裂症自杀患者（SS组）的得分进行比较，后者的数据来自芬兰全国性且具有代表性的心理解剖学研究。用Cronbach α评估SSRS的内部一致性。通过逻辑回归分析确定预测自杀的最重要的SSRS条目。计算了SSRS在不同截断分数下预测自杀的敏感性、特异性、阳性预测值和阴性预测值。
在最终的逻辑回归模型中，以下SSRS条目显著预测自杀：在过去3个月内与他人交流过自杀计划；有一次或多次既往自杀未遂；丧失需要专业技能的工作；访谈中观察到的抑郁；以及访谈中交流过的自杀计划。截断分数较高时，SSRS的特异性令人满意，但敏感性降至32%以下。SSRS既往病史部分的内部一致性较低，这表明精神分裂症患者自杀的既往风险因素是多因素的。基于访谈条目的内部一致性较高，当前状态风险因素似乎由两个独立因素组成，即抑郁-焦虑和易怒。
SSRS在识别自杀风险特别高的精神分裂症患者方面可能具有临床实用性。然而，SSRS似乎不是精神分裂症自杀风险的实用筛查工具，在这种疾病中可能无法构建一种兼具高敏感性和高特异性的自杀风险量表。
