University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, USA. kenneth
Drug Alcohol Depend. 2012 Jan 1;120(1-3):155-61. doi: 10.1016/j.drugalcdep.2011.07.013. Epub 2011 Aug 10.
Stressful life events (SLEs) play a key role in suicidal behavior among adults with alcohol use disorders (AUD), yet there are meager data on the severity of SLEs preceding suicidal behavior or the timing of such events.
Patients in residential substance use treatment who made a recent suicide attempt (cases, n=101) and non-suicidal controls matched for site (n=101) were recruited. SLEs that occurred within 30 days of the attempt and on the day of the attempt in cases were compared to SLEs that occurred in the corresponding periods in controls. SLEs were categorized by type (interpersonal, non-interpersonal) and severity (major, minor) and were dated to assess timing. Degree of planning of suicide attempts was also assessed.
Major interpersonal SLEs conferred risk for a suicide attempt, odds ratio (95% CI)=5.50 (1.73, 17.53), p=0.005. Cases were also more likely to experience an SLE on the day of the attempt than on the corresponding day in controls, OR (95% CI)=6.05 (1.31, 28.02), p=0.021. However, cases that made an attempt on the day of a SLE did not make lower planned suicide attempts compared to other cases, suggesting that suicide attempts that are immediately preceded by SLEs cannot be assumed to be unplanned.
Results suggest the central importance of major interpersonal SLEs in risk among adults with AUD, a novel finding, and documents that SLEs may lead to suicide attempts within a short window of time (i.e., same day), a daunting challenge to prevention efforts.
在患有酒精使用障碍（AUD）的成年人中，应激性生活事件（SLEs）在自杀行为中起着关键作用，但关于自杀行为前 SLEs 的严重程度或这些事件的时间安排的数据很少。
招募了正在接受住宅物质使用治疗且最近有自杀企图的患者（病例，n=101）和按地点匹配的非自杀对照者（n=101）。病例中发生在企图自杀的 30 天内和当天的 SLEs 与对照者相应时期的 SLEs进行了比较。SLEs 按类型（人际间、非人际间）和严重程度（主要、次要）进行分类，并确定日期以评估时间安排。自杀企图的计划程度也进行了评估。
主要人际间 SLEs 使自杀企图的风险增加，优势比（95%CI）=5.50（1.73，17.53），p=0.005。与对照者相应日期相比，病例在企图自杀当天更有可能发生 SLE，OR（95%CI）=6.05（1.31，28.02），p=0.021。然而，在 SLE 当天进行尝试的病例与其他病例相比，其计划自杀的可能性并没有降低，这表明不能假设立即由 SLE 引发的自杀企图是无计划的。
结果表明，主要人际间 SLEs 在 AUD 成年人的风险中具有重要意义，这是一个新的发现，并证明 SLEs 可能会在很短的时间内导致自杀企图（即同一天），这对预防工作构成了严峻挑战。
