McGill University, McGill Group for Suicide Studies, Douglas Hospital, Montreal, Quebec, Canada.
J Clin Psychiatry. 2013 Dec;74(12):1209-16. doi: 10.4088/JCP.12m08180.
Available information on risk for suicide completion in females is limited and often extrapolated from studies conducted in males. However, the validity of extending to females risk factors identified among male suicide cases is unclear. In this study, we aimed to investigate clinical and behavioral risk factors for suicide among female depressed patients and compare them to similar factors among male depressed patients.
We identified 201 suicide completers (160 male and 41 female) who died during an episode of major depressive disorder (MDD). Cases were compared to 127 living patients with MDD (88 male and 39 female). All subjects were characterized for Axis I and II diagnoses using the Structured Clinical Interview for DSM-IV Axis I Disorders and Structured Clinical Interview for DSM-IV Axis II Personality Disorders according to the DSM-IV, as well as behavioral and temperament dimensions using proxy-based interviews. The primary outcome was measures of impulsive and impulsive-aggressive behaviors.
Compared to controls, male, but not female suicide cases had higher levels of impulsive aggression (P < .05). Nonimpulsive aggression differentiated both female (P < .05) and male (P < .01) suicide cases from controls. However, nonimpulsive aggression and impulsive aggression were correlated constructs in males (r = 0.297; P < .001), yet uncorrelated among females (r = 0.121; P = .390). Established risk factors for suicide, such as alcohol and substance dependence, cluster B disorders, and elevated hostility and aggression, were replicated in the pooled-sex analyses, and, though not statistically significant in discriminating between suicide cases and controls by gender, maintained strong group differences.
Males and females share many risk factors for suicide in MDD, yet alcohol dependence is much more specific though less sensitive among depressed females. Nonimpulsive aggression is part of a diathesis for suicide in females, which is distinct from the well-characterized impulsive aggression that is consistently reported in a portion of male suicide cases.
关于女性自杀完成风险的可用信息有限，并且通常是从男性研究中推断出来的。然而，将男性自杀病例中确定的风险因素扩展到女性是否有效尚不清楚。在这项研究中，我们旨在调查女性抑郁患者自杀的临床和行为风险因素，并将其与男性抑郁患者的类似因素进行比较。
我们确定了 201 名自杀死亡者（160 名男性和 41 名女性），这些人在重度抑郁症（MDD）发作期间死亡。将病例与 127 名仍在世的 MDD 患者（88 名男性和 39 名女性）进行比较。所有受试者均根据 DSM-IV 采用DSM-IV 轴 I 和 II 诊断的结构临床访谈进行了轴 I 和 II 诊断的特征描述，以及使用基于代理的访谈进行了行为和气质维度的特征描述。主要结局是冲动和冲动攻击行为的衡量标准。
与对照组相比，男性而非女性自杀者的冲动攻击水平更高（P<.05）。非冲动攻击可区分女性（P<.05）和男性（P<.01）自杀者与对照组。然而，非冲动攻击和冲动攻击在男性中是相关的结构（r = 0.297；P<.001），而在女性中则不相关（r = 0.121；P =.390）。自杀的既定危险因素，如酒精和物质依赖、B 群障碍以及升高的敌意和攻击性，在男女混合分析中得到了复制，尽管在按性别区分自杀者和对照组方面没有统计学意义，但仍保持了强烈的群体差异。
男性和女性在 MDD 中具有许多自杀风险因素，但酒精依赖在女性抑郁患者中更为特异性，尽管不如男性自杀患者中报告的冲动攻击那样敏感。非冲动攻击是女性自杀易感性的一部分，与在一部分男性自杀病例中始终报告的特征明显的冲动攻击不同。
