Bromet Evelyn J, Nock Matthew K, Saha Sukanta, Lim Carmen C W, Aguilar-Gaxiola Sergio, Al-Hamzawi Ali, Alonso Jordi, Borges Guilherme, Bruffaerts Ronny, Degenhardt Louisa, de Girolamo Giovanni, de Jonge Peter, Florescu Silvia, Gureje Oye, Haro Josep M, He Yanling, Hu Chiyi, Karam Elie G, Kovess-Masfety Viviane, Lee Sing, Lepine Jean-Pierre, Mneimneh Zeina, Navarro-Mateu Fernando, Ojagbemi Akin, Posada-Villa José, Sampson Nancy A, Scott Kate M, Stagnaro Juan C, Viana Maria C, Xavier Miguel, Kessler Ronald C, McGrath John J
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York.
Psychology Department, Harvard University, Cambridge, Massachusetts.
JAMA Psychiatry. 2017 Nov 1;74(11):1136-1144. doi: 10.1001/jamapsychiatry.2017.2647.
Community-based studies have linked psychotic experiences (PEs) with increased risks of suicidal thoughts and behaviors (STBs). However, it is not known if these associations vary across the life course or if mental disorders contribute to these associations.
To examine the temporal association between PEs and subsequent STBs across the life span as well as the influence of mental disorders (antecedent to the STBs) on these associations.
DESIGN, SETTING, AND PARTICIPANTS: A total of 33 370 adult respondents across 19 countries from the World Health Organization World Mental Health Surveys were assessed for PEs, STBs (ie, ideation, plans, and attempts), and 21 DSM-IV mental disorders. Discrete-time survival analysis was used to investigate the associations of PEs with subsequent onset of STBs.
Prevalence and frequency of STBs with PEs, and odds ratios and 95% CIs.
Of 33 370 included participants, among those with PEs (n = 2488), the lifetime prevalence (SE) of suicidal ideation, plans, and attempts was 28.5% (1.3), 10.8% (0.7), and 10.2% (0.7), respectively. Respondents with 1 or more PEs had 2-fold increased odds of subsequent STBs after adjusting for antecedent or intervening mental disorders (suicidal ideation: odds ratio, 2.2; 95% CI, 1.8-2.6; suicide plans: odds ratio, 2.1; 95% CI, 1.7-2.6; and suicide attempts: odds ratio, 1.9; 95% CI, 1.5-2.5). There were significant dose-response relationships of number of PE types with subsequent STBs that persisted after adjustment for mental disorders. Although PEs were significant predictors of subsequent STB onset across all life stages, associations were strongest in individuals 12 years and younger. After adjustment for antecedent mental disorders, the overall population attributable risk proportions for lifetime suicidal ideation, plans, and attempts associated with temporally prior PEs were 5.3%, 5.7%, and 4.8%, respectively.
Psychotic experiences are associated with elevated odds of subsequent STBs across the life course that cannot be explained by antecedent mental disorders. These results highlight the importance of including information about PEs in screening instruments designed to predict STBs.
基于社区的研究已将精神病性体验（PEs）与自杀念头和行为（STBs）风险增加联系起来。然而，尚不清楚这些关联在整个生命历程中是否存在差异，以及精神障碍是否会导致这些关联。
研究PEs与整个生命跨度中后续STBs之间的时间关联，以及精神障碍（先于STBs出现）对这些关联的影响。
设计、背景和参与者：来自世界卫生组织世界精神卫生调查的19个国家的33370名成年受访者接受了PEs、STBs（即念头、计划和企图）以及21种DSM-IV精神障碍的评估。采用离散时间生存分析来研究PEs与后续STBs发病之间的关联。
伴有PEs的STBs的患病率和频率，以及比值比和95%置信区间。
在33370名纳入的参与者中，有PEs的参与者（n = 2488）中，自杀念头、计划和企图的终生患病率（标准误）分别为28.5%（1.3）、10.8%（0.7）和10.2%（0.7）。在对先前或中间的精神障碍进行调整后。有1种或更多PEs的受访者后续发生STBs的几率增加了2倍（自杀念头：比值比，2.2；95%置信区间，1.8 - 2.6；自杀计划：比值比，2.1；95%置信区间），1.7 - 2.6；自杀企图：比值比，1.9；95%置信区间，1.5 - 2.5）。PEs类型数量与后续STBs之间存在显著的剂量反应关系，在对精神障碍进行调整后仍然存在。尽管PEs在所有生命阶段都是后续STB发病的重要预测因素，但在12岁及以下个体中关联最强。在对先前的精神障碍进行调整后，与先前的PEs相关的终生自杀念头、计划和企图的总体人群归因风险比例分别为5.3%、5.7%和4.8%。
精神病性体验与整个生命历程中后续STBs几率升高相关，这无法用先前的精神障碍来解释。这些结果凸显了在旨在预测STBs的筛查工具中纳入有关PEs信息的重要性。
