Florida State University, USA.
Florida State University, USA.
Psychiatry Res. 2015 Mar 30;226(1):316-27. doi: 10.1016/j.psychres.2015.01.008. Epub 2015 Jan 15.
Nearly all mental disorders increase suicide risk; however, some better predict ideation versus attempts. The interpersonal theory of suicide provides a framework to understand these relationships, via the constructs of thwarted belongingness, perceived burdensomeness, and acquired capability. The current study examined the relationships between various mental disorders and theory constructs among 997 adult outpatients, controlling for sex and age. Disorders generally symptomatically associated with social withdrawal or potential liability to others (i.e., depressive and bipolar disorders, social phobia, borderline personality disorder, schizophrenia and other psychotic disorders, certain drug dependence) were uniquely positively associated with thwarted belongingness and perceived burdensomeness. Disorders associated with potential exposure to painful and provocative events (i.e., posttraumatic stress disorder, schizophrenia and other psychotic disorders, certain drug use) were associated with increased acquired capability. Notably, alcohol use disorders, attention-deficit/hyperactivity disorder subtypes, and panic/agoraphobia were negatively associated with thwarted belongingness or perceived burdensomeness; avoidant personality disorder, and certain anxiety disorders and drug use disorders, were associated with decreased acquired capability. Importantly, disorders associated with both thwarted belongingness and perceived burdensomeness may place individuals at greatest risk for suicide if acquired capability develops. Implications for comorbidity and suicide risk assessment and treatment are discussed.
几乎所有的精神障碍都会增加自杀风险；然而，有些障碍更能预测自杀意念与自杀企图。自杀的人际关系理论通过归属感缺失、被感知的累赘感和习得的能力这三个结构来提供一个理解这些关系的框架。本研究通过控制性别和年龄，在 997 名成年门诊患者中检验了各种精神障碍与理论结构之间的关系。与社交退缩或可能对他人造成潜在伤害（即抑郁和双相情感障碍、社交恐惧症、边缘型人格障碍、精神分裂症和其他精神病性障碍、某些药物依赖）相关的障碍与归属感缺失和被感知的累赘感呈独特的正相关。与潜在暴露于痛苦和挑衅性事件相关的障碍（即创伤后应激障碍、精神分裂症和其他精神病性障碍、某些药物使用）与习得的能力增加相关。值得注意的是，酒精使用障碍、注意缺陷/多动障碍亚型、惊恐/广场恐怖症与归属感缺失或被感知的累赘感呈负相关；回避型人格障碍以及某些焦虑障碍和药物使用障碍与习得的能力下降相关。重要的是，如果个体发展出习得的能力，那么与归属感缺失和被感知的累赘感相关的障碍可能会使个体面临最大的自杀风险。讨论了合并症和自杀风险评估和治疗的意义。
