Viner Rebecca, Patten Scott B, Berzins Sandra, Bulloch Andrew G M, Fiest Kirsten M
Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, Canada.
Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, Canada; Department of Psychiatry and Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada.
J Psychosom Res. 2014 Apr;76(4):312-6. doi: 10.1016/j.jpsychores.2013.12.010. Epub 2014 Jan 2.
To estimate the prevalence, incidence and determinants of suicidal ideation in the multiple sclerosis (MS) population.
A sample of 188 subjects were randomly selected from a community-based MS clinic registry and participated in as many as 13 interviews over 6 months. Thoughts of "being better off dead" or of "harming oneself" were assessed using item 9 on the Patient Health Questionnaire, Brief (PHQ-9).
At baseline, the 2-week period prevalence of suicidal ideation was 8.3%. Over the course of 6 months, 22.1% of respondents reported having such thoughts at least once. Survival analysis incorporating baseline PHQ-8 scores as a covariate confirmed that being age 65 and over (HR=4.3, 95% CI 1.7-11.3) and having lower quartile self-efficacy ratings (HR=3.5, 95% CI 1.5-8.2) predicted suicidal ideation. Lower levels of task-oriented coping (treated as a continuous variable) also predicted suicidal ideation after adjustment for depressive symptoms (p=0.015), as did self-reported bladder or bowel symptoms (HR=2.6, 95% CI 1.1-6.0) and difficulties with speaking and swallowing (HR=2.9, 95% CI 1.3-6.8). Associations with MS symptoms were not confounded by depressive symptoms.
This study identified several potentially modifiable factors that may be useful for preventing suicide in people with MS.
评估多发性硬化症（MS）患者自杀意念的患病率、发病率及相关决定因素。
从一个基于社区的MS诊所登记处随机抽取188名受试者，在6个月内参与多达13次访谈。使用患者健康问卷简表（PHQ-9）中的第9项评估“觉得死了更好”或“伤害自己”的想法。
在基线时，自杀意念的2周患病率为8.3%。在6个月的时间里，22.1%的受访者报告至少有过一次此类想法。将基线PHQ-8评分作为协变量的生存分析证实，65岁及以上（HR=4.3，95%CI 1.7-11.3）以及自我效能感评分处于较低四分位数（HR=3.5，95%CI 1.5-8.2）可预测自杀意念。在对抑郁症状进行调整后，较低水平的任务导向型应对方式（视为连续变量）也可预测自杀意念（p=0.015），自我报告的膀胱或肠道症状（HR=2.6，95%CI 1.1-6.0）以及说话和吞咽困难（HR=2.9，95%CI 1.3-6.8）同样如此。与MS症状的关联不受抑郁症状的混淆。
本研究确定了几个可能可改变的因素，这些因素可能有助于预防MS患者自杀。
