Yen S, Shea M T, Sanislow C A, Skodol A E, Grilo C M, Edelen M O, Stout R L, Morey L C, Zanarini M C, Markowitz J C, McGlashan T H, Daversa M T, Gunderson J G
Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02906, USA.
Acta Psychiatr Scand. 2009 Sep;120(3):222-9. doi: 10.1111/j.1600-0447.2009.01366.x. Epub 2009 Mar 3.
To examine higher order personality factors of negative affectivity (NA) and disinhibition (DIS), as well as lower order facets of impulsivity, as prospective predictors of suicide attempts in a predominantly personality disordered sample.
Data were analyzed from 701 participants of the Collaborative Longitudinal Personality Disorders Study with available follow-up data for up to 7 years. Cox proportional hazards regression analyses was used to examine NA and DIS, and facets of impulsivity (e.g. urgency, lack of perseverance, lack of premeditation and sensation seeking), as prospective predictors of suicide attempts.
NA, DIS and all facets of impulsivity except for sensation seeking were significant in univariate analyses. In multivariate models which included sex, childhood sexual abuse, course of major depressive disorder and substance use disorders, only NA and lack of premeditation remained significant in predicting suicide attempts. DIS and the remaining impulsivity facets were not significant.
NA emerged as a stronger and more robust predictor of suicide attempts than DIS and impulsivity, and warrants greater attention in suicide risk assessment. Distinguishing between facets of impulsivity is important for clinical risk assessment.
在一个以人格障碍为主的样本中,研究消极情感性(NA)和抑制不足(DIS)的高阶人格因素,以及冲动性的低阶方面,作为自杀未遂的前瞻性预测因素。
对协作性纵向人格障碍研究的701名参与者的数据进行分析,这些参与者有长达7年的可用随访数据。采用Cox比例风险回归分析来研究NA和DIS,以及冲动性的各个方面(如冲动性、缺乏毅力、缺乏预谋和寻求刺激),作为自杀未遂的前瞻性预测因素。
在单变量分析中,NA、DIS以及除寻求刺激外的所有冲动性方面均具有显著性。在包含性别、童年期性虐待、重度抑郁症病程和物质使用障碍的多变量模型中,只有NA和缺乏预谋在预测自杀未遂方面仍然具有显著性。DIS和其余的冲动性方面不具有显著性。
与DIS和冲动性相比,NA是自杀未遂更强有力和更稳健的预测因素,在自杀风险评估中值得更多关注。区分冲动性的各个方面对于临床风险评估很重要。