Diaconu Gabriel, Turecki Gustavo
McGill Group for Suicide Studies, Douglas Hospital Research Centre, McGill University, Montréal, Québec, Canada H4H 1R3.
J Affect Disord. 2007 Dec;104(1-3):203-9. doi: 10.1016/j.jad.2007.03.006. Epub 2007 Apr 17.
The relation between panic disorder and suicidal behavior has been surrounded by perennial controversy. A significant number of reports suggest that PD is associated with suicidal behavior. Alternatively, it has been proposed that comorbid depression may account for the increased suicidality identified in this population.
A total of n=474 consecutive psychiatric outpatient subjects were assessed for Axes I and II psychopathology and personality traits, as well as suicidal behavior, using structured interviews.
Approximately half of the sample (n=250) reported suicidal ideation, either lifetime or during the 6 months prior to evaluation. In total, 200 subjects reported a history of suicide attempts. When comorbidity with depressive disorders (DD) was not taken into account, patients with Panic Disorder (PD) did not differ from those with a primary diagnosis of depressive disorder in terms of age, current or lifetime suicide ideation or number of suicide attempts. After separating the group characterized by PD comorbid with DD, PD only subjects had significantly lower number of suicide attempts compared to either DD (p<0.01) or comorbid PD-DD (p<0.05). Similar levels of SI were noted between PD, DD and PD-DD, both current and lifetime. Suicide attempters with PD, DD or both did not differ in terms of suicide intent or lethality. They were also similar on impulsivity, aggressive behavior and state-trait anxiety measures.
Cross-sectional design, the limited sample size in the PD only group, retrospectively collected data with the possibility of recall bias.
In this clinical outpatient sample, the association between panic disorder and suicidal behavior was primarily explained by comorbidity with depressive disorders. No differences were observed between different groups for measures of severity of the suicidal behavior. Physicians should be aware of these associations when assessing adults with panic disorder for suicidality.
惊恐障碍与自杀行为之间的关系长期以来一直存在争议。大量报告表明惊恐障碍与自杀行为有关。然而，也有人提出，共病的抑郁症可能是该人群自杀率增加的原因。
使用结构化访谈对总共n = 474名连续的精神科门诊患者进行了轴I和轴II精神病理学、人格特质以及自杀行为的评估。
大约一半的样本（n = 250）报告有自杀意念，无论是终生还是在评估前的6个月内。总共有200名受试者报告有自杀未遂史。在不考虑与抑郁症（DD）共病的情况下，惊恐障碍（PD）患者在年龄、当前或终生自杀意念或自杀未遂次数方面与原发性抑郁症诊断患者没有差异。在将以PD合并DD为特征的组分开后，仅患有PD的受试者的自杀未遂次数明显低于DD组（p < 0.01）或PD - DD共病组（p < 0.05）。在当前和终生的情况下，PD、DD和PD - DD组的自杀意念水平相似。患有PD、DD或两者的自杀未遂者在自杀意图或致死性方面没有差异。他们在冲动性、攻击行为和状态 - 特质焦虑测量方面也相似。
横断面设计，仅PD组样本量有限，数据为回顾性收集，可能存在回忆偏差。
在这个临床门诊样本中，惊恐障碍与自杀行为之间的关联主要由与抑郁症的共病来解释。不同组在自杀行为严重程度测量方面未观察到差异。医生在评估患有惊恐障碍的成年人的自杀倾向时应意识到这些关联。
