Hazlett Erin A, Blair Nicholas J, Fernandez Nicolas, Mascitelli Kathryn, Perez-Rodriguez M Mercedes, New Antonia S, Goetz Raymond R, Goodman Marianne
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Psychophysiology. 2016 Oct;53(10):1524-34. doi: 10.1111/psyp.12698. Epub 2016 Jul 5.
Recent studies demonstrate that veterans exhibit higher suicide risk compared with the general U.S.
A prior suicide attempt is a well-documented predictor of suicide death. Despite increased attention to clinical risk factors of suicide and efforts to develop psychosocial interventions to reduce suicide risk, the underlying biological factors that confer this risk are not well understood. This study examined affect-modulated startle (AMS) during a series of intermixed unpleasant, neutral, and pleasant pictures in a sample of 108 demographically-matched veterans at low (passive ideators: n = 26) and high risk (active ideators: n = 29; single attempters: n = 28; and multiple attempters: n = 25) for suicide based on the Columbia Suicide Severity Rating Scale. An exploratory aim involved a longitudinal component in a subset of the high-risk sample that went on to participate in a randomized 6-month clinical trial. We investigated whether baseline AMS predicts a subsequent suicide attempt at 12-month follow-up. Compared with the other three groups, multiple attempters showed greater startle potentiation during unpleasant pictures and deficient overall startle habituation from early to later trials. The groups did not differ in startle during neutral or pleasant pictures, or self-reported picture valence. Greater startle during unpleasant pictures was associated with greater emotion dysregulation as measured by the Difficulties in Emotion Regulation Scale and a future suicide attempt assessed prospectively at 12-month follow-up. These findings suggest that startle potentiation during unpleasant pictures in multiple-suicide attempters is a promising psychophysiological biomarker of suicide risk and underscore the clinical importance of targeting emotion dysregulation in the treatment of patients at-risk for suicide.
近期研究表明，与美国普通人群相比，退伍军人自杀风险更高。
既往自杀未遂是自杀死亡的一个有充分记录的预测因素。尽管对自杀的临床风险因素关注度增加，且努力开发心理社会干预措施以降低自杀风险，但导致这种风险的潜在生物学因素仍未得到充分理解。本研究在108名人口统计学匹配的退伍军人样本中，基于哥伦比亚自杀严重程度评定量表，在一系列混合了不愉快、中性和愉快图片的过程中检查了情感调节惊跳（AMS）。一个探索性目标涉及高危样本子集中的纵向部分，该子集继续参与了一项为期6个月的随机临床试验。我们调查了基线AMS是否能预测12个月随访时随后的自杀未遂情况。与其他三组相比，多次自杀未遂者在看到不愉快图片时表现出更大的惊跳增强，并且从早期到后期试验总体惊跳习惯化不足。在看到中性或愉快图片时的惊跳以及自我报告的图片效价方面，各组之间没有差异。不愉快图片期间更大的惊跳与通过情绪调节困难量表测量的更大情绪失调以及12个月随访时前瞻性评估的未来自杀未遂相关。这些发现表明，多次自杀未遂者在看到不愉快图片时的惊跳增强是自杀风险一个有前景的心理生理生物标志物，并强调了在治疗有自杀风险的患者时针对情绪失调的临床重要性。
