Leverich Gabriele S, Altshuler Lori L, Frye Mark A, Suppes Trisha, Keck Paul E, McElroy Susan L, Denicoff Kirk D, Obrocea Gabriela, Nolen Willem A, Kupka Ralph, Walden Jörg, Grunze Heinz, Perez Sara, Luckenbaugh David A, Post Robert M
Stanley Foundation Bipolar Treatment Outcome Network, Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health, Biological Psychiatry Branch, Bethesda, MD 20892-1272, USA.
J Clin Psychiatry. 2003 May;64(5):506-15. doi: 10.4088/jcp.v64n0503.
Clinical factors related to suicide and suicide attempts have been studied much more extensively in unipolar depression compared with bipolar disorder. We investigated demographic and course-of-illness variables to better understand the incidence and potential clinical correlates of serious suicide attempts in 648 outpatients with bipolar disorder.
Patients with bipolar I or II disorder (DSM-IV criteria) diagnosed with structured interviews were evaluated using self-rated and clinician-rated questionnaires to assess incidence and correlates of serious suicide attempts prior to study entry. Clinician prospective ratings of illness severity were compared for patients with and without a history of suicide attempt.
The 34% of patients with a history of suicide attempts, compared with those without such a history, had a greater positive family history of drug abuse and suicide (or attempts); a greater personal history of early traumatic stressors and more stressors both at illness onset and for the most recent episode; more hospitalizations for depression; a course of increasing severity of mania; more Axis I, II, and III comorbidities; and more time ill on prospective follow-up. In a hierarchical logistic regression, a history of sexual abuse, lack of confidant prior to illness onset, more prior hospitalizations for depression, suicidal thoughts when depressed, and cluster B personality disorder remained significantly associated with a serious suicide attempt.
Our retrospective findings, supplemented by prospective follow-up, indicate that a history of suicide attempts is associated with a more difficult course of bipolar disorder and the occurrence of more psychosocial stressors at many different time domains. Greater attention to recognizing those at highest risk for suicide attempts and therapeutic efforts aimed at some of the correlates identified here could have an impact on bipolar illness-related morbidity and mortality.
与双相情感障碍相比，在单相抑郁中，与自杀及自杀未遂相关的临床因素得到了更广泛的研究。我们调查了人口统计学和疾病病程变量，以更好地了解648例双相情感障碍门诊患者中严重自杀未遂的发生率及潜在临床相关因素。
采用结构化访谈诊断为双相I型或II型障碍（DSM-IV标准）的患者，在研究入组前使用自评和临床医生评定问卷进行评估，以评估严重自杀未遂的发生率及相关因素。对有和没有自杀未遂史的患者的临床医生前瞻性疾病严重程度评定进行比较。
有自杀未遂史的患者中，34%与无此类病史的患者相比，有更高的药物滥用和自杀（或未遂）家族阳性史；有更多早期创伤性应激源的个人史，在疾病发作时和最近一次发作时有更多应激源；因抑郁住院次数更多；躁狂严重程度呈上升病程；有更多的轴I、II和III共病；在前瞻性随访中患病时间更长。在分层逻辑回归中，性虐待史、疾病发作前缺乏知己、更多的既往抑郁住院史、抑郁时的自杀念头以及B类人格障碍仍与严重自杀未遂显著相关。
我们的回顾性研究结果，加上前瞻性随访，表明自杀未遂史与双相情感障碍更困难的病程以及在许多不同时间域出现更多心理社会应激源有关。更加关注识别自杀未遂风险最高的人群，并针对此处确定的一些相关因素进行治疗努力，可能会对双相情感障碍相关的发病率和死亡率产生影响。
