Department of Psychology, Harvard University, Cambridge, Massachusetts 02138, USA.
JAMA Psychiatry. 2013 Mar;70(3):300-10. doi: 10.1001/2013.jamapsychiatry.55.
CONTEXT: Although suicide is the third leading cause of death among US adolescents, little is known about the prevalence, correlates, or treatment of its immediate precursors, adolescent suicidal behaviors (ie, suicide ideation, plans, and attempts). OBJECTIVES: To estimate the lifetime prevalence of suicidal behaviors among US adolescents and the associations of retrospectively reported, temporally primary DSM-IV disorders with the subsequent onset of suicidal behaviors. DESIGN: Dual-frame national sample of adolescents from the National Comorbidity Survey Replication Adolescent Supplement. SETTING: Face-to-face household interviews with adolescents and questionnaires for parents. PARTICIPANTS: A total of 6483 adolescents 13 to 18 years of age and their parents. MAIN OUTCOME MEASURES: Lifetime suicide ideation, plans, and attempts. RESULTS: The estimated lifetime prevalences of suicide ideation, plans, and attempts among the respondents are 12.1%, 4.0%, and 4.1%, respectively. The vast majority of adolescents with these behaviors meet lifetime criteria for at least one DSM-IV mental disorder assessed in the survey. Most temporally primary (based on retrospective age-of-onset reports) fear/anger, distress, disruptive behavior, and substance disorders significantly predict elevated odds of subsequent suicidal behaviors in bivariate models. The most consistently significant associations of these disorders are with suicide ideation, although a number of disorders are also predictors of plans and both planned and unplanned attempts among ideators. Most suicidal adolescents (>80%) receive some form of mental health treatment. In most cases (>55%), treatment starts prior to onset of suicidal behaviors but fails to prevent these behaviors from occurring. CONCLUSIONS: Suicidal behaviors are common among US adolescents, with rates that approach those of adults. The vast majority of youth with suicidal behaviors have preexisting mental disorders. The disorders most powerfully predicting ideation, though, are different from those most powerfully predicting conditional transitions from ideation to plans and attempts. These differences suggest that distinct prediction and prevention strategies are needed for ideation, plans among ideators, planned attempts, and unplanned attempts.
背景：尽管自杀是美国青少年的第三大死因，但对于其直接前体——青少年自杀行为（即自杀意念、计划和尝试）的流行率、相关性或治疗方法知之甚少。 目的：估计美国青少年一生中自杀行为的发生率，以及回顾性报告的、时间上主要的 DSM-IV 障碍与随后发生自杀行为之间的关联。 设计：来自国家共病调查再版青少年补充调查的双框架全国青少年样本。 地点：青少年面对面的家庭访谈和父母的问卷调查。 参与者：共 6483 名 13 至 18 岁的青少年及其父母。 主要观察指标：终生自杀意念、计划和尝试。 结果：受访者中自杀意念、计划和尝试的终生患病率分别为 12.1%、4.0%和 4.1%。绝大多数有这些行为的青少年符合调查中评估的至少一种 DSM-IV 精神障碍的终生标准。根据回顾性发病年龄报告，大多数时间上主要的（基于回顾性发病年龄报告）恐惧/愤怒、痛苦、破坏性行为和物质障碍显著预测随后自杀行为的发生风险增加。这些障碍与自杀意念的关联最为一致，尽管许多障碍也是意向者计划和计划和非计划尝试的预测因素。大多数有自杀想法的青少年（>80%）接受某种形式的心理健康治疗。在大多数情况下（>55%），治疗开始于自杀行为之前，但未能防止这些行为的发生。 结论：自杀行为在美国家庭中很常见，其发生率接近成年人。大多数有自杀行为的青少年都有先前存在的精神障碍。尽管预测意念的最有力的障碍与预测从意念到计划和尝试的条件转变的最有力障碍不同。这些差异表明，对于意念、意向者的计划、有计划的尝试和无计划的尝试，需要有不同的预测和预防策略。
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