Psychiatry, Mount Sinai Beth Israel, New York, NY, USA.
Suicide Life Threat Behav. 2018 Oct;48(5):613-623. doi: 10.1111/sltb.12387. Epub 2017 Aug 22.
In recent years, there has been growing attention to the distinction between acute and long-term suicidal risk factors. We have previously characterized an acute, negative affect state, termed the suicide crisis syndrome (SCS), as a marker of near-term suicidal risk. Here, we test whether documented long-term risk factors (i.e., trait vulnerabilities), including perfectionism, impulsivity, chronic substance abuse, insecure attachment, poor social support, and childhood trauma, associate to suicidal phenomena through a pathway of the SCS. A sample of 207 psychiatric inpatients were administered a battery of eight scales, including the Suicide Trigger Scale (STS-3) as a measure of the SCS. While both STS-3 and all trait vulnerabilities were associated with lifetime suicidal ideation and attempts, only STS-3 was related to pre-admission suicide attempts. The STS-3 significantly mediated the effect of each trait vulnerability on lifetime suicidal phenomena (combining ideation and behavior), with the proportion of mediating effect ranging from .29 to .56. Reverse mediation analyses were only significant for insecure attachment, supporting a largely unidirectional mediation effect. The SCS appears to serve as an acute risk factor for suicidal behavior in psychiatric inpatients and may act as a mechanism by which long-term risk factors increase suicidal risk.
近年来，人们越来越关注急性和长期自杀风险因素之间的区别。我们之前已经将一种称为自杀危机综合征（SCS）的急性、负面情绪状态描述为近期自杀风险的标志物。在这里，我们测试了长期记录的风险因素（即特质脆弱性），包括完美主义、冲动、慢性物质滥用、不安全依恋、不良的社会支持和儿童期创伤，是否通过 SCS 的途径与自杀现象相关。一项对 207 名精神病住院患者的样本进行了八项量表的测试，包括自杀触发量表（STS-3）作为 SCS 的衡量标准。虽然 STS-3 和所有特质脆弱性都与终生自杀意念和尝试有关，但只有 STS-3 与入院前自杀尝试有关。STS-3 显著中介了每个特质脆弱性对终生自杀现象（包括意念和行为）的影响，中介效应的比例范围从.29 到.56。反向中介分析仅对不安全依恋有意义，支持主要是单向的中介效应。SCS 似乎是精神病住院患者自杀行为的急性风险因素，并且可能是长期风险因素增加自杀风险的机制。
