Apter A, Kotler M, Sevy S, Plutchik R, Brown S L, Foster H, Hillbrand M, Korn M L, van Praag H M
Department of Psychiatry, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, N.Y.
Am J Psychiatry. 1991 Jul;148(7):883-7. doi: 10.1176/ajp.148.7.883.
This study was designed to identify variables that correlate with the risk of suicide in two patient groups that differ mainly in their level of expressed aggression.
Twenty-eight psychiatric patients with a history of violent behavior who were in a forensic psychiatric facility were tested and compared to 28 psychiatric inpatients without a history of violence who were admitted to a large municipal hospital. Measures used included a battery of self-report questionnaires, with acceptable reliability and validity, that provided indices of risk of suicide, risk of violence, impulsivity, anger, anxiety, and various mood states.
The two groups, matched on demographic variables and overall risk of suicide, differed significantly on the measured risk of violence. The two groups showed similar patterns of correlations between risk of suicide and such variables as risk of violence, anger, fear, state and trait anxiety, lack of impulse control, suspiciousness, and rebelliousness. They differed in the correlation between suicide risk and depression. In the nonviolent patients there was a high correlation between risk of suicide and sadness; in the violent patients there was no correlation between these variables.
The low correlation between sadness and risk of suicide in the violent patients, and the low prevalence of affective disorder diagnoses in these patients compared to other patients, suggests that suicidal risk should be managed differently in highly violent patients than in others.
本研究旨在确定与两组主要在表达性攻击水平上存在差异的患者自杀风险相关的变量。
对28名有暴力行为史且在法医精神病设施中的精神病患者进行测试，并与28名无暴力史且入住大型市立医院的精神病住院患者进行比较。所使用的测量方法包括一系列自我报告问卷，这些问卷具有可接受的信度和效度，提供了自杀风险、暴力风险、冲动性、愤怒、焦虑及各种情绪状态指标。
两组在人口统计学变量和总体自杀风险上相匹配，但在测量的暴力风险上有显著差异。两组在自杀风险与暴力风险、愤怒、恐惧、状态焦虑和特质焦虑、缺乏冲动控制、猜疑和叛逆等变量之间呈现出相似的相关模式。它们在自杀风险与抑郁之间的相关性上存在差异。在非暴力患者中，自杀风险与悲伤之间存在高度相关性；在暴力患者中，这些变量之间不存在相关性。
暴力患者中悲伤与自杀风险之间的低相关性，以及与其他患者相比这些患者中情感障碍诊断的低患病率，表明与其他患者相比，高度暴力患者的自杀风险管理应有所不同。
