Nyberg Tommy, Hed Myrberg Ida, Omerov Pernilla, Steineck Gunnar, Nyberg Ullakarin
Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
PLoS One. 2016 Oct 3;11(10):e0164091. doi: 10.1371/journal.pone.0164091. eCollection 2016.
Parents who lose a child by suicide have elevated risks of depression. No clinical prediction tools exist to identify which suicide-bereaved parents will be particularly vulnerable; we aimed to create a prediction model for long-term depression for this purpose.
During 2009 and 2010 we collected data using a nationwide study-specific questionnaire among parents in Sweden who had lost a child aged 15-30 by suicide in years 2004-2007. Current depression was assessed with the Patient Health Questionnaire (PHQ-9) and a single question on antidepressant use. We considered 26 potential predictors assumed clinically assessable at the time of loss, including socio-economics, relationship status, history of psychological stress and morbidity, and suicide-related circumstances. We developed a novel prediction model using logistic regression with all subsets selection and stratified cross-validation. The model was assessed for classification performance and calibration, overall and stratified by time since loss.
In total 666/915 (73%) participated. The model showed acceptable classification performance (adjusted area under the curve [AUC] = 0.720, 95% confidence interval [CI] 0.673-0.766), but performed classification best for those at shortest time since loss. Agreement between model-predicted and observed risks was fair, but with a tendency for underestimation and overestimation for individuals with shortest and longest time since loss, respectively. The identified predictors include female sex (odds ratio [OR] = 1.84); sick-leave (OR = 2.81) or unemployment (OR = 1.64); psychological premorbidity debuting during the last 10 years, before loss (OR = 3.64), or more than 10 years ago (OR = 4.96); suicide in biological relatives (OR = 1.54); with non-legal guardianship during the child's upbringing (OR = 0.48); and non-biological parenthood (OR = 0.22) found as protective.
Our prediction model shows promising internal validity, but should be externally validated before application. Psychological premorbidity seems to be a prominent predictor of long-term depression among suicide-bereaved parents, and thus important for healthcare providers to assess.
因子女自杀而痛失孩子的父母患抑郁症的风险会升高。目前尚无临床预测工具来识别哪些经历子女自杀的父母会特别容易受到影响；我们旨在为此创建一个长期抑郁症的预测模型。
在2009年至2010年期间，我们通过一项全国性的特定研究问卷，收集了2004年至2007年期间在瑞典因子女自杀而失去15至30岁孩子的父母的数据。使用患者健康问卷（PHQ-9）和一个关于抗抑郁药使用的单一问题来评估当前的抑郁状况。我们考虑了26个在丧子之时假定可进行临床评估的潜在预测因素，包括社会经济状况、关系状态、心理压力和发病史以及与自杀相关的情况。我们使用带有所有子集选择和分层交叉验证的逻辑回归开发了一种新型预测模型。对该模型的分类性能和校准进行了评估，整体评估以及按丧子后的时间分层评估。
总共666/915（73%）的人参与了研究。该模型显示出可接受的分类性能（调整后的曲线下面积[AUC]=0.720，95%置信区间[CI]0.673 - 0.766），但对丧子时间最短的人群分类效果最佳。模型预测风险与观察到的风险之间的一致性尚可，但对于丧子时间最短和最长的个体，分别存在低估和高估的趋势。确定的预测因素包括女性（比值比[OR]=1.84）；病假（OR = 2.81）或失业（OR = 1.64）；在丧子前过去10年内首次出现心理疾病（OR = 3.64），或超过10年前首次出现（OR = 4.96）；有生物学亲属自杀（OR = 1.54）；在孩子成长期间没有法定监护权（OR = 0.48）；以及非亲生父母身份（OR = 0.22）被发现具有保护作用。
我们的预测模型显示出有前景的内部效度，但在应用前应进行外部验证。心理疾病史似乎是经历子女自杀的父母中长期抑郁症的一个突出预测因素，因此对医疗保健提供者进行评估很重要。
