Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 83, boulevard de l'Hôpital, 75013, Paris, France.
INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France.
Eur Child Adolesc Psychiatry. 2019 May;28(5):667-683. doi: 10.1007/s00787-018-1234-9. Epub 2018 Oct 6.
While many psychiatric disorders are associated with an increased risk for suicidal behaviors (SB) in children and adolescents, a few studies have explored the role of clinical symptoms based on a dimensional approach. Irritability is seen as a marker, a general psychopathology, and a symptom of both externalizing and internalizing disorders. In this review, we are interested in determining whether and how irritability can predict SB in youth. First, we reviewed consistencies and variation in the literature linking irritability to suicidal ideation (SI) and suicide attempt (SA). Second, based on the available models, we proposed specific mechanistic pathways, whereby irritability may modulate the risk for SB. Irritability has been found associated with SB both in cross-sectional and in longitudinal studies. The relation is consistent in different settings (i.e., general population and clinical settings) and across psychiatric disorders. The association is reduced but persists after adjusting for psychiatric disorder, including depression. On one hand, irritability constitutes a risk factor for SI via the onset of internalized disorder. On the other hand, irritable youth may be more prone to attempt suicide when experiencing SI. The measures for irritability were heterogeneous. A limited number of studies were designed to explore the role of mediators and/or moderators. Recognizing irritability in children and adolescents is a key issue with regards to suicide prevention.
虽然许多精神障碍与儿童和青少年自杀行为（SB）的风险增加有关，但少数研究已经探索了基于维度方法的临床症状的作用。易激惹被视为一种标志物、一种一般精神病理学，以及外在和内在障碍的症状。在这篇综述中，我们有兴趣确定易激惹是否以及如何可以预测青少年的 SB。首先，我们回顾了将易激惹与自杀意念（SI）和自杀企图（SA）联系起来的文献中的一致性和变异性。其次，根据现有的模型，我们提出了特定的机制途径，易激惹可能通过这些途径调节 SB 的风险。易激惹与 SB 无论是在横断面研究还是纵向研究中都有联系。这种关系在不同的环境（即一般人群和临床环境）和各种精神障碍中都是一致的。在调整了精神障碍，包括抑郁症后，这种关联虽然减弱但仍然存在。一方面，易激惹通过内化障碍的发作构成了 SI 的风险因素。另一方面，当易激惹的青少年经历 SI 时，他们更有可能试图自杀。易激惹的测量方法存在异质性。为数不多的研究旨在探索中介和/或调节因素的作用。识别儿童和青少年的易激惹是预防自杀的一个关键问题。
