Suicidal Behaviour Research Laboratory, School of Natural Sciences, University of Stirling, Stirling FK9 4LA, United Kingdom.
J Affect Disord. 2012 Dec 15;142(1-3):248-55. doi: 10.1016/j.jad.2012.04.035. Epub 2012 Sep 11.
Although suicide is a global public health concern with approximately one million people dying by suicide annually, our knowledge of the proximal risk mechanisms is limited. In the present study, we investigated the utility of two proximal mechanisms (goal disengagement and goal reengagement) in the prediction of hospital-treated self-harm repetition in a sample of suicide attempters.
Two hundred and thirty-seven patients hospitalised following a suicide attempt completed a range of clinical (depression, anxiety, hopelessness, suicidal ideation) and goal regulation measures (goal reengagement and disengagement) while in hospital. They were followed up two years later to determine whether they had been re-hospitalised with self-harm between baseline and the follow-up.
Self-harm hospitalisation in the past 10 years, suicidal ideation and difficulty reengaging in new goals independently predicted self-harm two years later. In addition, among younger people, having difficulty re-engaging in new goals further predicted self-harm re-hospitalisation when disengagement from existing unattainable goals was also low. Conversely, the deleterious impact of low reengagement in older people was elevated when goal disengagement was also high.
Only hospital-treated self-harm and suicide were recorded at follow-up, episodes of less medically serious self-harm were not recorded.
Suicidal behaviour is usefully conceptualised in terms of goal self-regulation following the experience of unattainable goals. Treatment interventions should target the self-regulation of goals among suicide attempters and clinicians should recognise that different regulation processes need to be addressed at different points across the lifespan.
尽管自杀是一个全球性的公共卫生问题，每年约有 100 万人自杀，但我们对近端风险机制的了解有限。在本研究中，我们调查了两个近端机制（目标脱离和目标重新投入）在预测自杀未遂者住院治疗的自我伤害复发中的作用。
237 名因自杀未遂而住院的患者在住院期间完成了一系列临床（抑郁、焦虑、绝望、自杀意念）和目标调节措施（目标重新投入和脱离）。两年后，他们的自我伤害复发情况被随访，以确定他们在基线和随访期间是否因自我伤害而再次住院。
过去 10 年的自我伤害住院、自杀意念和重新投入新目标的困难独立预测了两年后的自我伤害。此外，在年轻人中，当脱离现有无法实现的目标时，重新投入新目标的困难进一步预测了自我伤害再次住院的情况。相反，当目标脱离也很高时，老年人重新投入的负面影响会升高。
仅在随访时记录了经医院治疗的自我伤害和自杀，未记录不太严重的自我伤害发作。
自杀行为可以根据无法实现目标后的目标自我调节来进行概念化。治疗干预措施应针对自杀未遂者的目标自我调节，临床医生应认识到，在整个生命周期中，不同的调节过程需要在不同的时间点得到解决。
