Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
Bipolar Disord. 2013 Aug;15(5):496-506. doi: 10.1111/bdi.12088. Epub 2013 Jun 5.
Suicide is a significant cause of mortality in patients with major affective disorders (MAD), and suicidal behavior and MAD co-aggregate in families. However, the transmission of suicidal behavior is partially independent from that of MAD. We analyzed the lifetime prevalence of completed and attempted suicides in a large sample of families with bipolar disorder (BD), its relation to family history of MAD and BD, and the contribution of clinical and treatment factors to the risk of suicidal behavior.
We studied 737 families of probands with MAD with 4919 first-degree relatives (818 affected, 3948 unaffected, and 153 subjects with no information available). Lifetime psychiatric diagnoses and suicidal behavior in first-degree relatives were assessed using semi-structured interviews, family history methods, and reviews of clinical records. Cox proportional hazard and logistic regression models were used to investigate the role of clinical covariates in the risk of suicidal behavior, and in the prevalence of MAD and BD.
The estimated lifetime prevalence of suicidal behavior (attempted and completed suicides) in 737 probands was 38.4 ± 3.0%. Lithium treatment decreased suicide risk in probands (p = 0.007). In first-degree relatives, a family history of suicidal behavior contributed significantly to the joint risk of MAD and suicidal behavior (p = 0.0006).
The liability to suicidal behavior is influenced by genetic factors (particularly family history of suicidal behavior and MAD). Even in the presence of high genetic risk for suicidal behavior, lithium treatment decreases suicide rates significantly.
自杀是患有重性情感障碍（MAD）的患者的主要死亡原因，自杀行为和 MAD 在家族中共同聚集。然而，自杀行为的传递部分独立于 MAD。我们分析了在一大组双相障碍（BD）患者的家庭中，自杀行为的终生发生率及其与 MAD 和 BD 家族史的关系，以及临床和治疗因素对自杀行为风险的影响。
我们研究了 737 个 MAD 患者的家庭，共有 4919 名一级亲属（818 名受影响，3948 名未受影响，153 名亲属信息不可用）。使用半结构式访谈、家族史方法和临床记录回顾，评估一级亲属的终生精神科诊断和自杀行为。使用 Cox 比例风险和逻辑回归模型来研究临床协变量在自杀行为风险、MAD 和 BD 患病率中的作用。
737 名患者中自杀行为（企图和完成自杀）的估计终生患病率为 38.4±3.0%。锂治疗降低了患者的自杀风险（p=0.007）。在一级亲属中，自杀行为家族史对 MAD 和自杀行为的共同风险有显著贡献（p=0.0006）。
自杀行为的易感性受遗传因素的影响（特别是自杀行为和 MAD 的家族史）。即使存在自杀行为的高遗传风险，锂治疗也能显著降低自杀率。
