Apter Alan, Horesh Netta, Gothelf Doron, Zalsman Gil, Erlich Zippy, Soreni Noam, Weizman Abraham
Feinberg Child Study Center, Schneider Children's Medical Center of Israel, 14 Kaplan Street, Petach Tikva 49202, Israel.
J Affect Disord. 2003 Jul;75(2):181-9. doi: 10.1016/s0165-0327(02)00038-1.
To investigate the prevalence and correlations of suicidal behavior in obsessive compulsive disorder (OCD) among adolescent psychiatric inpatients.
A total of 348 adolescents, representing consecutive admissions to an adolescent inpatient unit, were assessed. Of these, 40 patients had OCD, 118 had schizophrenia, 59 had an affective disorder, 81 had a conduct disorder and 50 had an eating disorder. In addition, 87 normal community controls were assessed. All subjects were assessed for suicidal behavior by the Childhood Suicide Potential Scale (CSPS), for depression by the Beck Depression Inventory, for impulsiveness by the Impulse Control Scale, for anxiety by the State-Trait Anxiety Scale and for aggression by the Yudowsky Overt Aggression Scale.
All the psychiatrically ill subjects, including those with OCD, had high levels of depression, anxiety and impulsiveness, which were far higher than those of the controls. The rate of attempted suicide was, however, much lower in the OCD subjects. In addition, there was a significant inverse correlation between suicidal behavior levels on the CSPS and depression in the OCD subjects, while all other subjects showed the expected significant positive correlation between level of suicidal behavior and depression.
This study looked at a referred population and generalization to outpatient and community samples cannot be made. Distinguishing between the primary and the comorbid diagnosis is difficult and some findings are based on small sample size and therefore may be vulnerable to type I error.
Although suicidal ideation and depressive symptoms are common in OCD adolescent inpatients, they seem to be protected against suicide attempts. The inverse relationship between suicidal behavior and depression may mean that suicidal behavior is, in some ways, qualitatively different from that seen in other psychiatrically ill adolescents.
调查青少年精神科住院患者中强迫症（OCD）患者自杀行为的患病率及其相关性。
对连续入住青少年住院部的348名青少年进行了评估。其中，40例患有强迫症，118例患有精神分裂症，59例患有情感障碍，81例患有品行障碍，50例患有饮食障碍。此外，对87名正常社区对照者进行了评估。所有受试者均通过儿童自杀潜能量表（CSPS）评估自杀行为，通过贝克抑郁量表评估抑郁，通过冲动控制量表评估冲动性，通过状态-特质焦虑量表评估焦虑，通过尤多夫斯基公开攻击量表评估攻击性。
所有患有精神疾病的受试者，包括强迫症患者，抑郁、焦虑和冲动水平都很高，远高于对照组。然而，强迫症患者的自杀未遂率要低得多。此外，在强迫症患者中，CSPS上的自杀行为水平与抑郁之间存在显著的负相关，而所有其他受试者的自杀行为水平与抑郁之间呈现预期的显著正相关。
本研究观察的是转诊人群，无法推广到门诊和社区样本。区分原发性诊断和共病诊断很困难，一些研究结果基于小样本量，因此可能容易出现I型错误。
虽然自杀观念和抑郁症状在强迫症青少年住院患者中很常见，但他们似乎能避免自杀未遂。自杀行为与抑郁之间的负相关可能意味着，在某些方面，自杀行为在性质上与其他患有精神疾病的青少年不同。
