Department of Psychology, Harvard University.
Department of Psychology, Florida State University.
J Abnorm Psychol. 2018 Feb;127(2):139-149. doi: 10.1037/abn0000317.
Prior research has shown that most known risk factors for suicide attempts in the general population actually predict suicide ideation rather than attempts among ideators. Yet clinical interest in predicting suicide attempts often involves the evaluation of risk among patients with ideation. We examined a number of characteristics of suicidal thoughts hypothesized to predict incident attempts in a retrospective analysis of lifetime ideators (N = 3,916) drawn from a large (N = 29,982), representative sample of United States Army soldiers. The most powerful predictors of first nonfatal lifetime suicide attempt in a multivariate model controlling for previously known predictors (e.g., demographics, mental disorders) were: recent onset of ideation, presence and recent onset of a suicide plan, low controllability of suicidal thoughts, extreme risk-taking or "tempting fate," and failure to answer questions about the characteristics of one's suicidal thoughts. A predictive model using these risk factors had strong accuracy (area under the curve [AUC] = .93), with 66.2% of all incident suicide attempts occurring among the 5% of soldiers with highest composite predicted risk. This high concentration of risk in this retrospective study suggests that a useful clinical decision support model could be constructed from prospective data to identify those with highest risk of subsequent suicide attempt. (PsycINFO Database Record
先前的研究表明，大多数在普通人群中预测自杀未遂的已知风险因素实际上预测的是自杀意念，而不是意念者的自杀未遂。然而，预测自杀未遂的临床兴趣通常涉及对有自杀意念的患者进行风险评估。我们在对来自一个大型（N=29982）代表性美国陆军士兵样本中的终身意念者（N=3916）进行的回顾性分析中，研究了一些假设可以预测自杀意念事件发生的自杀想法特征。在一个多变量模型中，控制了先前已知的预测因素（例如人口统计学、精神障碍），对首次非致命性终生自杀未遂最有力的预测因素是：意念的近期发作、自杀计划的存在和近期发作、自杀想法的低可控制性、极端冒险或“听天由命”、以及未能回答有关自杀想法特征的问题。使用这些风险因素的预测模型具有很强的准确性（曲线下面积[AUC]为.93），所有自杀意念事件中有 66.2%发生在具有最高综合预测风险的 5%的士兵中。这项回顾性研究中风险的高度集中表明，可以从前瞻性数据构建有用的临床决策支持模型，以识别那些有后续自杀企图风险最高的患者。
