Gvion Yari, Levi-Belz Yossi
Bar-Ilan University, Ramat Gan, Israel.
Ruppin Academic Center, Emek Hefer, Israel.
Front Psychiatry. 2018 Mar 7;9:56. doi: 10.3389/fpsyt.2018.00056. eCollection 2018.
One of the main obstacles in studying suicide risk factors is the difference between cases in which the individual died by suicide and those in which the individual engaged in suicidal behavior. A promising strategy that overcomes this obstacle is the study of survivors of (SSA), i.e., an attempt that would have been lethal had it not been for the provision of rapid and effective emergency treatment. Serious suicide attempters are epidemiologically very much like those who died by suicide, and thus may serve as valid proxies for studying suicides. This paper aims to define the specific risk factors for SSAs by conducting a qualitative data synthesis of existing studies.
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic search of the literature in PubMed, ProQuest, and Psychlit electronic research-literature databases. Search terms were "serious" "OR" "near lethal," combined with the Boolean "AND" operator with "suicide*." In addition, we performed a manual search on Google Scholar for further studies not yet identified.
The preliminary search identified 683 citations. A total of 39 research reports that met the predefined criteria were analyzed. Mental pain, communication difficulties, decision-making impulsivity, and aggression, as well as several demographic variables, were found to be major risk factors for SSAs.
We found a variability of definitions for SSA that hamper the ability to draw a model for the risk factors and processes that facilitate it. Moreover, the role of suicide intent and planning in SSA is still unclear. Further studies should aim to clarify and refine the concepts and measures of SSA, thereby enabling more specific and concrete modeling of the psychological element in its formation.
SSA is a distinguishable phenomenon that needs to be addressed specifically within the scope of suicidal behavior. Interpersonal problems, as well as impulsivity and aggression, seem to facilitate SSA when mental pain serves as a secondary factor. Healthcare professionals should be aware of SSA, and familiar with its specific risk factors. Moreover, psychological and suicidal risk assessment should include a designated evaluation of these risk factors as part of intervention and prevention models for SSA.
研究自杀风险因素的主要障碍之一是个体自杀死亡案例与有自杀行为案例之间的差异。一种克服这一障碍的有前景的策略是对自杀未遂幸存者（SSA）进行研究，即若未提供迅速有效的紧急治疗就可能致命的自杀企图。严重自杀未遂者在流行病学上与自杀死亡者非常相似，因此可作为研究自杀的有效替代对象。本文旨在通过对现有研究进行定性数据综合分析来确定自杀未遂幸存者的具体风险因素。
按照系统评价和Meta分析的首选报告项目指南，我们在PubMed、ProQuest和Psychlit电子研究文献数据库中对文献进行了系统检索。检索词为“严重的”“或”“近乎致命的”，并与布尔运算符“与”及“自杀*”组合。此外，我们在谷歌学术上进行了手动检索以查找尚未发现的进一步研究。
初步检索确定了683条引文。共分析了39篇符合预定义标准的研究报告。发现精神痛苦、沟通困难、决策冲动性、攻击性以及若干人口统计学变量是自杀未遂幸存者的主要风险因素。
我们发现自杀未遂幸存者的定义存在差异，这妨碍了构建促进其发生的风险因素和过程模型的能力。此外，自杀意图和计划在自杀未遂幸存者中的作用仍不明确。进一步的研究应旨在澄清和完善自杀未遂幸存者的概念及测量方法，从而能够对其形成过程中的心理因素进行更具体、确切的建模。
自杀未遂幸存者是一种可区分的现象，需要在自杀行为范围内专门加以探讨。当精神痛苦作为次要因素时，人际问题以及冲动性和攻击性似乎会促使自杀未遂幸存者出现。医疗保健专业人员应了解自杀未遂幸存者情况，并熟悉其特定风险因素。此外，心理和自杀风险评估应包括对这些风险因素的专门评估，作为自杀未遂幸存者干预和预防模型的一部分。
