Andersén Mikael, Birgegård Andreas
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
Int J Eat Disord. 2017 Aug;50(8):970-978. doi: 10.1002/eat.22730. Epub 2017 Jun 5.
Eating disorders (ED) are prevalent, serious illnesses with elevated mortality, mainly attributable to suicide. Predictors of suicidality include binge/purge symptomatology, impulsivity, and psychiatric comorbidity, as well as personality factors. Recent research has also shown self-image (the Structural Analysis of Social Behavior, SASB, model) to predict manifest suicide attempts in ED, and the study explored suicide risk prediction to increase knowledge of warning signs and intervention targets.
Participants were adult ED patients registered in the Stepwise clinical database (N = 1537) with anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), or other specified feeding and eating disorder (OSFED). The SASB self-image questionnaire was used in stepwise regressions to predict 12-month suicidal ideation, both self- and clinician-rated, in models both excluding and including baseline clinical variables.
Validation analyses showed fair correspondence between outcome variables as well as with suicide attempts. Different variables predicted suicidality in different diagnoses, over and above baseline clinical variables in all but one regression model. Low Self-protection was important in AN and BN, high Self-control in AN, and high Letting go of the self in BN. For BED, self-blame explained variance, and in OSFED, lack of self-love.
Findings are in line with research showing differential self-image-based prediction of important outcomes in ED, with noteworthy consistencies across diagnoses and suicidality variables. Strengths included the large sample, and limitations pertained to measures, attrition and Type II error risk. Replication is needed, but findings are consistent with some previous work and offers clinical and research implications.
饮食失调（ED）是常见的严重疾病，死亡率较高，主要归因于自杀。自杀倾向的预测因素包括暴饮暴食/清除症状、冲动性、精神共病以及人格因素。最近的研究还表明自我形象（社会行为结构分析，SASB，模型）可预测饮食失调患者明显的自杀企图，本研究探讨自杀风险预测以增加对警示信号和干预目标的认识。
参与者为在逐步临床数据库中登记的成年饮食失调患者（N = 1537），患有神经性厌食症（AN）、神经性贪食症（BN）、暴饮暴食症（BED）或其他特定的喂养和饮食失调（OSFED）。SASB自我形象问卷用于逐步回归分析，以预测在排除和纳入基线临床变量的模型中，自我评定和临床医生评定的12个月自杀意念。
验证分析表明结果变量之间以及与自杀企图之间具有合理的对应关系。在除一个回归模型外的所有模型中，不同变量在不同诊断中预测自杀倾向，超出基线临床变量。低自我保护在神经性厌食症和神经性贪食症中很重要，高自我控制在神经性厌食症中很重要，高自我放弃在神经性贪食症中很重要。对于暴饮暴食症，自责可解释差异，而在其他特定的喂养和饮食失调中，缺乏自爱可解释差异。
研究结果与表明基于不同自我形象预测饮食失调重要结果的研究一致，在诊断和自杀倾向变量方面具有显著的一致性。优点包括样本量大，局限性涉及测量、损耗和II型错误风险。需要进行重复研究，但研究结果与之前的一些工作一致，并具有临床和研究意义。
