Podlogar Matthew C, Rogers Megan L, Stanley Ian H, Hom Melanie A, Chiurliza Bruno, Joiner Thomas E
a Department of Psychology , Florida State University , Tallahassee , FL , USA.
Cogn Emot. 2018 Nov;32(7):1464-1477. doi: 10.1080/02699931.2017.1303452. Epub 2017 Mar 20.
Anxiety and depression diagnoses are associated with suicidal thoughts and behaviours. However, a categorical understanding of these associations limits insight into identifying dimensional mechanisms of suicide risk. This study investigated anxious and depressive features through a lens of suicide risk, independent of diagnosis. Latent class analysis of 97 depression, anxiety, and suicidality-related items among 616 psychiatric outpatients indicated a 3-class solution, specifically: (1) a higher suicide-risk class uniquely differentiated from both other classes by high reported levels of depression and anxious arousal; (2) a lower suicide-risk class that reported levels of anxiety sensitivity and generalised worry comparable to Class 1, but lower levels of depression and anxious arousal; and (3) a low to non-suicidal class that reported relatively low levels across all depression and anxiety measures. Discriminants of the higher suicide-risk class included borderline personality disorder; report of worthlessness, crying, and sadness; higher levels of anxious arousal and negative affect; and lower levels of positive affect. Depression and anxiety diagnoses were not discriminant between higher and lower suicide risk classes. This transdiagnostic and dimensional approach to understanding the suicidal spectrum contrasts with treating it as a depressive symptom, and illustrates the advantages of a tripartite model for conceptualising suicide risk.
焦虑和抑郁诊断与自杀念头及行为相关。然而，对这些关联的分类理解限制了对自杀风险维度机制识别的洞察力。本研究从自杀风险的角度调查焦虑和抑郁特征，而不考虑诊断。对616名精神科门诊患者中97项与抑郁、焦虑和自杀相关的项目进行潜在类别分析，结果显示有三种类别，具体如下：（1）一个较高自杀风险类别，其独特之处在于报告的抑郁和焦虑唤醒水平较高，与其他两个类别均有差异；（2）一个较低自杀风险类别，其报告的焦虑敏感性和广泛性担忧水平与第1类相当，但抑郁和焦虑唤醒水平较低；（3）一个低至无自杀风险类别，其在所有抑郁和焦虑测量指标上的报告水平相对较低。较高自杀风险类别的判别因素包括边缘性人格障碍；无价值感、哭泣和悲伤的报告；较高的焦虑唤醒水平和消极情绪；以及较低的积极情绪。抑郁和焦虑诊断在较高和较低自杀风险类别之间并无判别作用。这种理解自杀谱系的跨诊断和维度方法与将其视为抑郁症状的处理方式形成对比，并说明了三方模型在概念化自杀风险方面的优势。
