Nakagawa Atsuo, Grunebaum Michael F, Oquendo Maria A, Burke Ainsley K, Kashima Haruo, Mann J John
Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY 10032, USA.
J Affect Disord. 2009 Jan;112(1-3):237-42. doi: 10.1016/j.jad.2008.03.021. Epub 2008 May 15.
Assessment of suicide plans is standard in acute psychiatric care, but there is a limited evidence base to guide this routine clinical practice. The purpose of this study was to investigate clinical correlates of suicide planning in depressed patients.
151 patients with major depressive disorder and a lifetime history of suicide attempt were studied. Subjects received a comprehensive evaluation including structured diagnostic interview for Axis I and II disorders, current symptoms, impulsivity, and systematic assessment of suicide planning prior to the most recent suicide attempt.
Seriousness of suicide attempt planning correlated with lethality of suicidal acts. Comorbid anxiety disorder and anxiety correlated with less suicide planning. Specifically, this negative correlation was with comorbid panic disorder. Planning did not correlate with severity of depression or aggressive/impulsive traits.
Cross-sectional design, retrospective recall of suicide planning data, limited applicability to completed suicide or other psychiatric disorders.
In major depression, comorbid panic disorder appears protective against more carefully planned, higher lethality suicide attempts. Surprisingly, severity of depression and aggressive impulsive traits do not predict planning or lethality of suicide attempts. We have previously reported that anxiety severity protects against the probability of a suicide attempt and now extend that observation to show there is protection against lethality of a suicide attempt. Treatment of anxiety without directly treating major depression may place patients at greater risk of suicidal behavior.
在急性精神科护理中，评估自杀计划是标准操作，但指导这一常规临床实践的证据基础有限。本研究的目的是调查抑郁症患者自杀计划的临床相关因素。
对151例有重度抑郁症且有过自杀未遂终生史的患者进行研究。受试者接受了全面评估，包括对轴I和轴II障碍的结构化诊断访谈、当前症状、冲动性，以及在最近一次自杀未遂前对自杀计划的系统评估。
自杀未遂计划的严重性与自杀行为的致死性相关。共病焦虑症和焦虑与较少的自杀计划相关。具体而言，这种负相关与共病惊恐障碍有关。计划与抑郁症的严重程度或攻击性/冲动性特质无关。
横断面设计、对自杀计划数据的回顾性回忆、对自杀死亡或其他精神障碍的适用性有限。
在重度抑郁症中，共病惊恐障碍似乎对更精心策划、致死性更高的自杀未遂有保护作用。令人惊讶的是，抑郁症的严重程度和攻击性冲动性特质并不能预测自杀未遂的计划或致死性。我们之前曾报道焦虑严重程度可预防自杀未遂的可能性，现在扩展该观察结果以表明其对自杀未遂致死性也有预防作用。在不直接治疗重度抑郁症的情况下治疗焦虑症可能会使患者面临更高的自杀行为风险。
