Hassan Ahmed N, Stuart Elizabeth A, De Luca Vincenzo
Group for Suicide Studies, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Canada.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Schizophr Res. 2016 Oct;176(2-3):572-577. doi: 10.1016/j.schres.2016.05.012. Epub 2016 May 25.
In this study, we evaluated the effect of several types of childhood trauma on lifetime suicide attempt in patients with schizophrenia spectrum disorders.
We interviewed 361 participants with schizophrenia. Childhood trauma was collected using the Childhood Trauma Questionnaire (CTQ). Suicidal attempts were confirmed using subjective and objective validated scales. We applied an observational study design using propensity scores to match individuals with history of childhood trauma to those without past history of trauma. We used logistic regression models to estimate the effect of each type of childhood maltreatment on suicidal attempts controlling for demographics and known suicidal risk factors.
In our sample, 39.1% of the subjects had lifetime suicide attempt. After matching the two groups and controlling for demographics and clinical confounders, total trauma score and the majority of childhood maltreatment subtypes predicted suicide attempt (odds ratios ranged from 1.74 to 2.49 with p-values ranging from 0.001 to 0.02). Physical neglect was not significantly associated with suicide attempt in our sample (p=0.94).
Childhood maltreatment is confirmed to be a strong independent risk factor for suicidal attempts in schizophrenia. The risk is probably aggravated by the development of depressive symptoms and feeling of hopelessness in the adult life. Early screening and modified psychosocial treatment are recommended for psychotic individuals with trauma history.
在本研究中，我们评估了几种类型的童年创伤对精神分裂症谱系障碍患者终身自杀未遂的影响。
我们对361名精神分裂症患者进行了访谈。使用儿童创伤问卷（CTQ）收集童年创伤情况。使用主观和客观验证量表确认自杀未遂情况。我们采用倾向得分匹配的观察性研究设计，将有童年创伤史的个体与无创伤史的个体进行匹配。我们使用逻辑回归模型来估计每种类型的童年虐待对自杀未遂的影响，并控制人口统计学因素和已知的自杀风险因素。
在我们的样本中，39.1%的受试者有过终身自杀未遂经历。在匹配两组并控制人口统计学因素和临床混杂因素后，总创伤得分以及大多数童年虐待亚型可预测自杀未遂（优势比范围为1.74至2.49，p值范围为0.001至0.02）。在我们的样本中，身体忽视与自杀未遂无显著关联（p = 0.94）。
童年虐待被证实是精神分裂症患者自杀未遂的一个强大独立危险因素。成年期抑郁症状和绝望感的出现可能会加剧这种风险。建议对有创伤史的精神病患者进行早期筛查和改良的心理社会治疗。
