Department of Psychology, Harvard University, Cambridge, MA 02138, USA.
Mol Psychiatry. 2010 Aug;15(8):868-76. doi: 10.1038/mp.2009.29. Epub 2009 Mar 31.
Mental disorders are among the strongest predictors of suicide attempts. However, little is known regarding which disorders that are uniquely associated with suicidal behavior because of high levels of psychiatric comorbidity. We examined the unique associations between individual disorders and subsequent suicidal behavior (suicide ideation, plans and attempts) using data from the National Comorbidity Survey Replication, a nationally representative household survey of 9282 US adults. Results revealed that approximately 80% of suicide attempters in the United States have a temporally prior mental disorder. Anxiety, mood, impulse-control and substance use disorders all significantly predict subsequent suicide attempts in bivariate analyses (odds ratios (OR)=2.7-6.7); however, these associations decrease substantially in multivariate analyses controlling for comorbidity (OR=1.5-2.3) but remain statistically significant in most cases. Disaggregation of the observed effects reveals that depression predicts suicide ideation, but not suicide plans or attempts among those with ideation. Instead, disorders characterized by severe anxiety/agitation (for example, post-traumatic stress disorder) and poor impulse control (for example, conduct disorder, substance use disorders) predict which suicide ideators who go on to make a plan or attempt. These results advance understanding of the unique associations between mental disorders and different forms of suicidal behavior. Future research must further delineate the mechanisms through which people come to think about suicide and progress from suicidal thoughts to attempts.
精神障碍是自杀企图的最强预测因素之一。然而，由于精神共病率高，对于哪些障碍与自杀行为有独特的关联，人们知之甚少。我们利用来自国家共病调查再抽样（National Comorbidity Survey Replication）的数据，对美国 9282 名成年人进行了一项全国代表性的家庭调查，研究了个体障碍与随后的自杀行为（自杀意念、计划和尝试）之间的独特关联。结果显示，美国约 80%的自杀未遂者在之前曾患有精神障碍。焦虑、情绪、冲动控制和物质使用障碍在双变量分析中均显著预测随后的自杀企图（比值比（OR）=2.7-6.7）；然而，在多变量分析中控制共病后，这些关联显著降低（OR=1.5-2.3），但在大多数情况下仍具有统计学意义。对观察到的效应进行细分表明，抑郁预测自杀意念，但对有自杀意念者的自杀计划或尝试没有影响。相反，严重焦虑/烦躁（例如，创伤后应激障碍）和冲动控制差（例如，品行障碍、物质使用障碍）的障碍预测哪些自杀意念者会制定计划或尝试自杀。这些结果增进了对精神障碍与不同形式自杀行为之间独特关联的理解。未来的研究必须进一步阐明人们如何考虑自杀以及从自杀意念发展到尝试自杀的机制。
