Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada.
J Psychiatr Res. 2010 Oct;44(13):817-26. doi: 10.1016/j.jpsychires.2010.01.003. Epub 2010 Feb 1.
No longitudinal study has examined risk factors for future suicide attempts in major depressive disorder in a nationally representative sample. The objective of this study was to investigate baseline sociodemographic characteristics, comorbid mental disorders, specific depressive symptoms, and previous suicidal behavior as potential risk factors for suicide attempts at 3 years follow-up. Data came from the national epidemiologic survey on alcohol and related conditions (NESARC), a large nationally representative longitudinal survey of mental illness in adults [Wave 1 (2001-2002); Wave 2 (2004-2005) n=34,653]. Logistic regression examined associations between risk factors present at Wave 1 and suicide attempts at Wave 2 (n=169) among individuals with major depressive disorder at baseline assessment (n=6004). Risk factors for incident suicide attempts at Wave 2 (n=63) were identified among those with major depressive disorder at Wave 1 and no lifetime history of suicide attempts (n=5170). Results revealed specific comorbid anxiety, personality, and substance use disorders to be associated with incident suicide attempts at Wave 2. Comorbid borderline personality disorder was strongly associated with suicide attempts in all models. Several comorbid disorders were strongly associated with suicide attempts at Wave 2 even after adjusting for previous suicidal behavior, notably posttraumatic stress disorder (adjusted odds ratio (AOR)=2.20; 95% confidence interval (95% CI) 1.27-3.83) and dependent personality disorder (AOR=4.43; 95% CI 1.93-10.18). These findings suggest that mental illness comorbidity confers an increased risk of future suicide attempts in major depressive disorder that is not solely accounted for by past suicidal behavior.
尚无纵向研究在全国代表性样本中检查过在重性抑郁障碍中未来自杀未遂的危险因素。本研究的目的是调查基线人口统计学特征、合并精神障碍、特定抑郁症状和既往自杀行为是否为 3 年随访时自杀未遂的潜在危险因素。数据来自全国酒精和相关条件流行病学调查(NESARC),这是一项针对成年人的大型全国代表性纵向精神疾病调查[第 1 波(2001-2002 年);第 2 波(2004-2005 年)n=34653]。逻辑回归检查了第 1 波存在的危险因素与基线评估时患有重性抑郁障碍者中第 2 波自杀未遂(n=169)之间的关联(n=6004)。在第 1 波时患有重性抑郁障碍且无终生自杀未遂史者(n=5170)中,确定了第 2 波发生自杀未遂的危险因素。结果显示,特定合并的焦虑、人格和物质使用障碍与第 2 波发生的自杀未遂有关。合并边缘型人格障碍与所有模型中的自杀未遂均密切相关。即使在调整了既往自杀行为后,几种合并障碍与第 2 波自杀未遂的关联仍很强,特别是创伤后应激障碍(调整后的优势比(AOR)=2.20;95%置信区间(95%CI)1.27-3.83)和依赖性人格障碍(AOR=4.43;95%CI 1.93-10.18)。这些发现表明,精神疾病合并症会增加重性抑郁障碍患者未来自杀未遂的风险,而不仅仅是由既往自杀行为引起的。
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