McGirr Alexander, Renaud Johanne, Séguin Monique, Alda Martin, Turecki Gustavo
McGill Group for Suicide Studies, Douglas Hospital Research Center, McGill University, Montreal, Quebec, Canada.
J Clin Psychiatry. 2008 Jun;69(6):966-70. doi: 10.4088/jcp.v69n0612.
There is considerable debate as to whether suicide is more likely to occur early in the course of major depressive disorder or by cumulative risk, with an increasing risk with each subsequent major depressive episode (MDE). By considering the number of MDEs among representative suicides, we aimed to further investigate the relationship between suicide outcome and the course of major depressive disorder.
A psychological autopsy method with best informants was used to investigate 154 consecutive suicides who died in the context of a DSM-IV MDE. Proxy-based interviews were conducted by using the Structured Clinical Interview for DSM-III-R; the Structured Clinical Interview for DSM-IV Axis II; and a series of behavioral and personality-trait assessments. Second, 143 living depressed outpatients of comparable age to the suicide group were assessed for their history of MDEs. The study was conducted between 2000 and 2005.
The distribution of MDEs among depressed suicide completers was as follows: first MDE, 74.7%; second MDE, 18.8%; more than 2 MDEs, 6.5%. This distribution is compared to 32.9% of depressed living outpatients with a single MDE. Increased levels of hostility were associated with single MDE suicide completers. The anxious trait of harm avoidance increased among multiple MDE suicide completers. Alcohol abuse increased among first MDE suicide completers.
Suicide in major depressive disorder is most likely to occur during the first MDE, and this appears to be related to increased levels of the impulsive-aggressive diathesis.
关于自杀更有可能发生在重度抑郁症病程早期还是由累积风险导致，以及随着每一次后续重度抑郁发作（MDE）风险增加，存在相当多的争论。通过考虑代表性自杀案例中的MDE数量，我们旨在进一步研究自杀结局与重度抑郁症病程之间的关系。
采用最佳 informant 的心理解剖方法，对 154 例在 DSM-IV 重度抑郁发作背景下死亡的连续自杀案例进行调查。通过使用 DSM-III-R 的结构化临床访谈、DSM-IV 轴 II 的结构化临床访谈以及一系列行为和人格特质评估进行基于代理人的访谈。其次，对 143 名年龄与自杀组相当的现患抑郁症门诊患者的 MDE 病史进行评估。该研究于 2000 年至 2005 年进行。
抑郁自杀完成者中 MDE 的分布如下：首次 MDE，74.7%；第二次 MDE，18.8%；超过 2 次 MDE，6.5%。将此分布与有单次 MDE 的现患抑郁症门诊患者的 32.9%进行比较。敌意水平升高与单次 MDE 自杀完成者相关。多次 MDE 自杀完成者中避免伤害的焦虑特质增加。首次 MDE 自杀完成者中酒精滥用增加。
重度抑郁症中的自杀最有可能发生在首次 MDE 期间，这似乎与冲动攻击素质水平升高有关。
