Liu Xianchen, Gentzler Amy L, George Charles J, Kovacs Maria
Health Outcomes Research, Lilly Research Laboratories-DC 4123, Indianapolis, IN 46285, USA.
J Clin Psychiatry. 2009 May;70(5):644-52. doi: 10.4088/jcp.07m03895.
Although individuals' responses to their depressed mood are hypothesized to play an important role in the development and maintenance of depression, how these responses might impact the likelihood of suicidal behavior in mood disorders remains largely unexplored. The goal of the current study was to examine whether maladaptive responses to depressed mood are associated with suicide attempts in adults with a history of childhood-onset mood disorder (COMD).
Participants included 223 young adult probands with COMD meeting DSM-III or DSM-IV criteria for major depressive disorder or bipolar disorder and 112 controls without a history of psychiatric disorders. All participants were recruited between 1996 and 2004. Probands were followed for 6 to 99 months (median = 32 months). The Responses Styles Questionnaire was used to assess 2 adaptive (distraction and problem solving) and 2 maladaptive (dangerous activity and rumination) ways of coping with depressed mood.
Compared to controls, COMD probands scored significantly higher on maladaptive response styles and lower on adaptive styles. Compared to their COMD peers, probands with a history of suicide attempt were less likely to report using distracting activities to manage their depressed mood. However, COMD probands who engaged in dangerous activities in response to depressed mood were more likely to attempt suicide during the follow-up period (hazard ratio = 1.8, 95% CI = 1.2 to 2.8).
One of the pathways to suicide attempt in mood disorders may involve maladaptive responses to depressed mood. The assessment of how depressed individuals manage their dysphoric moods, therefore, should be considered an important aspect of treatment and prevention of suicidal behavior.
尽管假设个体对抑郁情绪的反应在抑郁症的发生和维持中起重要作用，但这些反应如何影响情绪障碍中自杀行为的可能性在很大程度上仍未得到探索。本研究的目的是检验对抑郁情绪的适应不良反应是否与有儿童期起病情绪障碍（COMD）病史的成年人的自杀未遂有关。
参与者包括223名符合DSM-III或DSM-IV标准的患有重度抑郁症或双相情感障碍的COMD青年成人先证者，以及112名无精神疾病史的对照者。所有参与者均在1996年至2004年期间招募。先证者随访6至99个月（中位数 = 32个月）。使用应对方式问卷评估应对抑郁情绪的2种适应性方式（分心和解决问题）和2种适应不良方式（危险行为和沉思）。
与对照组相比，COMD先证者在适应不良应对方式上得分显著更高，在适应方式上得分更低。与他们的COMD同龄人相比，有自杀未遂史的先证者报告使用分心活动来管理抑郁情绪的可能性较小。然而，因抑郁情绪而从事危险行为的COMD先证者在随访期间更有可能自杀未遂（风险比 = 1.8，95%置信区间 = 1.2至2.8）。
情绪障碍中自杀未遂的途径之一可能涉及对抑郁情绪的适应不良反应。因此，评估抑郁个体如何管理其烦躁情绪应被视为自杀行为治疗和预防的一个重要方面。
