National Institute of Psychiatry, Mexico City, Mexico.
J Affect Disord. 2010 Jul;124(1-2):98-107. doi: 10.1016/j.jad.2009.10.022. Epub 2009 Nov 18.
Prior studies have reported that psychiatric disorders are among the strongest predictors of suicidal behavior (i.e., suicide ideation, plans, and attempts). However, surprisingly little is known about the independent associations between each disorder and each suicidal behavior due to a failure to account for comorbidity.
This study used data from a representative sample of 5782 respondents participating in the Mexican National Comorbidity Survey (2001-2002) to examine the unique associations between psychiatric disorders and suicidality.
A prior psychiatric disorder was present in 48.8% of those with a suicide ideation and in 65.2% of those with an attempt. Discrete-time survival models adjusting for comorbidity revealed that conduct disorder and alcohol abuse/dependence were the strongest predictors of a subsequent suicide attempt. Most disorders predicted suicidal ideation but few predicted the transition from ideation to a suicide plan or attempt.
M-NCS is a household survey that excluded homeless and institutionalized people, and the diagnostic instrument used did not include an assessment of all DSM-IV disorders which would increase the comorbidity discussed here.
These results reveal a complex pattern of associations in which diverse psychiatric disorders impact different parts of the pathway to suicide attempts. These findings will help inform clinical and public health efforts aimed at suicide prevention in Mexico and other developing countries.
先前的研究报告称，精神障碍是自杀行为（即自杀意念、计划和尝试）最强的预测因素之一。然而，由于没有考虑到共病，每种精神障碍与每种自杀行为之间的独立关联，人们对其知之甚少。
本研究使用了参加 2001-2002 年墨西哥全国共病调查的 5782 名代表性受访者的数据，来研究精神障碍与自杀倾向之间的独特关联。
有自杀意念者中，先前存在精神障碍的比例为 48.8%，有自杀企图者中这一比例为 65.2%。对共病进行调整的离散时间生存模型显示，品行障碍和酒精滥用/依赖是随后自杀企图的最强预测因素。大多数精神障碍都预示着自杀意念，但很少有精神障碍预示着从意念到自杀计划或尝试的转变。
M-NCS 是一项家庭调查，排除了无家可归者和被收容者，且使用的诊断工具没有评估所有 DSM-IV 障碍，这将增加此处讨论的共病。
这些结果揭示了一种复杂的关联模式，其中不同的精神障碍影响到自杀企图途径的不同部分。这些发现将有助于为墨西哥和其他发展中国家的预防自杀的临床和公共卫生工作提供信息。
