1] Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA [2] Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France [3] INSERM UMR 894, Psychiatry and Neurosciences Center, Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France.
Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
Mol Psychiatry. 2015 Jun;20(6):718-26. doi: 10.1038/mp.2015.19. Epub 2015 May 18.
Most mental disorders, when examined independently, are associated with an elevated risk for suicide attempt. However, mental disorders often co-occur, and that co-occurrence is well explained by models where specific mental disorders are understood as manifestations of latent dimensions of psychopathology. To date, it remains unclear whether the risk of suicide attempt is due to specific mental disorders, to specific dimensions of psychopathology (that is, internalizing and externalizing dimensions), to a general psychopathology factor or to a combination of these explanations. In a large nationally representative prospective survey, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we used structural equation modeling to examine the shared and specific effects of Axis I and Axis II disorders on the occurrence of suicide attempts in the general population and among individuals with a lifetime history of suicidal ideation. Effects of mental disorders on the risk of suicide attempt were exerted almost exclusively through a general psychopathology factor representing the shared effect across all mental disorders. Effects of remitted psychiatric disorders on the risk of suicide attempt were fully mediated by current mental disorders. Similar patterns of associations were found in individuals with suicidal ideation. These results held when using different approaches to modeling psychiatric comorbidity. Our findings underscore the importance of adopting dimensional approaches to comorbidity in the study of suicidal behavior. Because mental disorders increase the risk of suicide attempt through a general psychopathology liability, this dimension should be considered as an important therapeutic target to substantially advance suicide prevention.
大多数精神障碍在单独检查时，与自杀企图的风险增加有关。然而，精神障碍经常同时发生，这可以通过特定精神障碍被理解为精神病理学潜在维度表现的模型来很好地解释。迄今为止，自杀企图的风险是由于特定的精神障碍、精神病理学的特定维度（即内化和外化维度）、一般精神病理学因素还是这些解释的组合，仍不清楚。在一项大型全国代表性前瞻性调查中，国家酒精和相关条件流行病学调查（NESARC），我们使用结构方程模型来检查轴 I 和轴 II 障碍在普通人群和有自杀意念史的个体中发生自杀企图的共同和特定影响。精神障碍对自杀企图风险的影响几乎完全是通过一般精神病理学因素来施加的，该因素代表所有精神障碍的共同影响。已缓解的精神障碍对自杀企图风险的影响完全由当前精神障碍介导。在有自杀意念的个体中也发现了类似的关联模式。当使用不同的精神障碍建模方法时，这些结果仍然成立。这些发现强调了在自杀行为研究中采用维度方法来研究共病的重要性。由于精神障碍通过一般精神病理学倾向增加自杀企图的风险，因此应该将该维度视为预防自杀的重要治疗目标。
