McGirr Alexander, Renaud Johanne, Seguin Monique, Alda Martin, Benkelfat Chawki, Lesage Alain, Turecki Gustavo
McGill Group for Suicide Studies, Douglas Hospital Research Center, McGill University, 6875 LaSalle Blvd., Montreal, QC, Canada H4H 1R3.
J Affect Disord. 2007 Jan;97(1-3):203-9. doi: 10.1016/j.jad.2006.06.016. Epub 2006 Jul 18.
It is unclear whether certain DSM-IV depressive symptoms are more prevalent among individuals who die in the context of a major depressive episode and those who do not, whether this is associated with proximal or distal suicide risk, and whether depressive symptoms cluster to indicate suicide risk.
A psychological autopsy method with best informants was used to investigate DSM-IV depressive symptoms among 156 suicides who died in the context of a major depressive episode and 81 major depressive controls.
Suicides' depressive symptoms were more likely to include weight or appetite loss, insomnia, feelings of worthlessness or inappropriate guilt as well as recurrent thoughts of death or suicidal ideation. Fatigue and difficulties concentrating or indecisiveness were less prevalent among depressed suicides. These associations were independent of concomitant axis I and II psychopathology. The concomitant presence of (a) fatigue as well as impaired concentration or indecisiveness and (b) weight or appetite gain and hypersomnia was associated with decreased suicide risk. Inter-episode symptom concordance suggests that insomnia is an immediate indicator of suicide risk, while weight or appetite loss and feelings of worthlessness or guilt are not.
This study employed proxy-based interviews.
We found that discrete DSM-IV depressive symptoms and clusters of depressive symptoms help differentiate depressed individuals who die by suicide and those who do not. Moreover, some DSM-IV depressive symptoms are associated with an immediate risk for suicide, while others may result from an etiology of depression common to suicide without directly increasing suicide risk.
目前尚不清楚某些《精神疾病诊断与统计手册》第四版（DSM-IV）中的抑郁症状在死于重度抑郁发作的个体和未死于重度抑郁发作的个体中是否更为普遍，这是否与近期或远期自杀风险相关，以及抑郁症状是否聚集以表明自杀风险。
采用向最佳知情者进行心理解剖的方法，对156例死于重度抑郁发作的自杀者和81例重度抑郁对照者的DSM-IV抑郁症状进行调查。
自杀者的抑郁症状更可能包括体重或食欲下降、失眠、无价值感或不适当的内疚感以及反复出现的死亡念头或自杀意念。疲劳以及注意力难以集中或犹豫不决在抑郁自杀者中不太常见。这些关联独立于同时存在的轴I和轴II精神病理学。同时存在（a）疲劳以及注意力受损或犹豫不决和（b）体重或食欲增加以及嗜睡与自杀风险降低相关。发作间期症状一致性表明，失眠是自杀风险的直接指标，而体重或食欲下降以及无价值感或内疚感则不是。
本研究采用基于代理的访谈。
我们发现，离散的DSM-IV抑郁症状和抑郁症状群有助于区分死于自杀的抑郁个体和未死于自杀的抑郁个体。此外，一些DSM-IV抑郁症状与直接的自杀风险相关，而其他症状可能源于自杀常见的抑郁病因，而不会直接增加自杀风险。
