Warren Alpert Medical School of Brown University, Providence, RI, USA.
Bradley Hospital, Riverside, RI, USA.
J Abnorm Child Psychol. 2018 Feb;46(2):355-363. doi: 10.1007/s10802-017-0293-6.
Suicidal ideation (SI) is a common presenting problem for psychiatric hospitalizations in adolescents and often persists following discharge. This study examines whether distinct trajectories of SI could be delineated following hospitalization and the risk factors most strongly related to these trajectories. Adolescents (N = 104; 76 females; 28 males) were followed for 6 months after discharge from inpatient or partial hospitalization. Semi-parametric group modeling identified SI trajectory group membership. In all, 33.7% of adolescents fell in a Subclinical SI group, 43.3% in a Declining SI group, and 23.1% in a Chronic SI group. Multinomial logistic regression was utilized to examine baseline predictors of group membership. Emotion dysregulation differentiated Chronic SI from Declining SI. In multivariate analyses, adolescents endorsing greater non-acceptance of emotional responses (OR =1.18) and more limited access to emotion regulation strategies (OR =1.12) were more likely to belong to the Chronic SI than Declining SI trajectory. Those in the Chronic SI group also had the greatest number of suicide attempts and hospitalizations in the 6 months post-discharge. These results suggest that clinicians should closely monitor and address emotion dysregulation when assessing suicide risk. Greater dysregulation may require more intensive services in order to have an effect on chronic SI.
自杀意念（SI）是青少年精神病住院的常见就诊问题，且常常在出院后持续存在。本研究旨在探讨住院后是否可以描绘出不同的 SI 轨迹，以及与这些轨迹最密切相关的风险因素。对 104 名青少年（76 名女性；28 名男性）进行了 6 个月的随访，随访时间为从住院或部分住院出院后。半参数组建模确定了 SI 轨迹组的成员。总的来说，33.7%的青少年属于亚临床 SI 组，43.3%属于 SI 下降组，23.1%属于慢性 SI 组。多变量逻辑回归用于检查组内成员的基线预测因素。情绪失调将慢性 SI 与 SI 下降区分开来。在多变量分析中，更不接受情绪反应（OR=1.18）和更有限地获得情绪调节策略（OR=1.12）的青少年更有可能属于慢性 SI 而不是 SI 下降轨迹。在慢性 SI 组中，在出院后 6 个月内自杀未遂和住院的人数也最多。这些结果表明，临床医生在评估自杀风险时应密切监测和解决情绪失调问题。更严重的失调可能需要更密集的服务，才能对慢性 SI 产生影响。
