Department of Psychiatry, University of California, San Francisco.
J Abnorm Psychol. 2013 Aug;122(3):879-90. doi: 10.1037/a0032769. Epub 2013 Jul 8.
Models of suicidal behavior that assess the interplay of multiple risk factors are needed to better identify at-risk individuals during periods of elevated risk, including following psychiatric hospitalization. This study investigated contributions of facets of anger, gender, and sexual victimization to risk for suicide attempts after hospital discharge. Psychiatric patients (N = 748; ages 18-40; 44% female) recruited from 3 inpatient facilities were assessed during hospitalization and every 10 weeks during the year following discharge as part of the MacArthur Violence Risk Assessment Study. Multiple logistic regression models with facets of anger (disposition toward physiological arousal, hostile cognitions, and angry behavior) from the Novaco Anger Scale (Novaco, 1994), gender, and childhood sexual victimization history were used to predict suicide attempts in the year following hospital discharge. Facets of anger differentially predicted suicide attempts as a function of gender and sexual victimization history, over and above the variance accounted for by symptoms of depression, anxiety, and recent suicide attempts. In men, greater disposition toward angry behavior predicted an overall greater likelihood of a suicide attempt in the year following hospital discharge, particularly among men with childhood sexual victimization. In women with a history of childhood sexual victimization, physiological arousal predicted suicide attempts. Results indicate that facets of anger are relevant predictors of suicide attempts following hospital discharge for psychiatric patients with a history of childhood sexual victimization. Further, results suggest that incorporating gender and victimization history into models of risk for suicide can help clarify relationships between anger and self-directed violence.
需要评估多种风险因素相互作用的自杀行为模型，以便在高风险时期更好地识别高危个体，包括在精神病院出院后。本研究调查了愤怒、性别和性受害的各个方面对出院后自杀企图风险的贡献。该研究从 3 家住院机构招募了 748 名年龄在 18 至 40 岁之间的精神病患者（44%为女性），作为 MacArthur 暴力风险评估研究的一部分，在住院期间和出院后每 10 周进行评估。采用 Novaco 愤怒量表（Novaco，1994）中的愤怒方面（生理唤醒倾向、敌意认知和愤怒行为）、性别和童年性受害史的多个逻辑回归模型，预测出院后一年内的自杀企图。愤怒的各个方面根据性别和性受害史的不同，预测自杀企图，这超过了抑郁、焦虑和近期自杀企图症状所解释的差异。在男性中，愤怒行为倾向越大，出院后一年内自杀企图的总体可能性越大，尤其是在有童年性受害史的男性中。对于有童年性受害史的女性，生理唤醒预测自杀企图。结果表明，对于有童年性受害史的精神病患者，愤怒的各个方面是出院后自杀企图的相关预测因素。此外，结果表明，将性别和受害史纳入自杀风险模型，可以帮助澄清愤怒与自我伤害之间的关系。
