Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
JAMA Psychiatry. 2019 Feb 1;76(2):180-189. doi: 10.1001/jamapsychiatry.2018.3514.
IMPORTANCE: Recent research has highlighted that psychotic experiences are far more prevalent than psychotic disorders and associated with the full range of mental disorders. A particularly strong association between psychotic experiences and suicidal behavior has recently been noted. OBJECTIVE: To provide a quantitative synthesis of the literature examining the longitudinal association between psychotic experiences and subsequent suicidal ideation, suicide attempts, and suicide deaths in the general population. DATA SOURCES: We searched PubMed, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO from their inception until September 2017 for longitudinal population studies on psychotic experiences and subsequent suicidal ideation, suicide attempts, and suicide death. STUDY SELECTION: Two authors searched for original articles that reported a prospective assessment of psychotic experiences and suicidal ideation, suicide attempts, or suicide death in general population samples, with at least 1 follow-up point. DATA EXTRACTION AND SYNTHESIS: Two authors conducted independent data extraction. Authors of included studies were contacted for information where necessary. We assessed study quality using the Newcastle-Ottawa Quality Assessment Scale. We calculated pooled odds ratios using a random-effects model. A secondary analysis assessed the mediating role of co-occurring psychopathology. MAIN OUTCOMES AND MEASURES: Psychotic experiences and subsequent suicidal ideation, suicide attempts, and suicide death. RESULTS: Of a total of 2540 studies retrieved, 10 met inclusion criteria. These 10 studies reported on 84 285 participants from 12 different samples and 23 countries. Follow-up periods ranged from 1 month to 27 years. Individuals who reported psychotic experiences had an increase in the odds of future suicidal ideation (5 articles; n = 56 191; odds ratio [OR], 2.39 [95% CI,1.62-3.51]), future suicide attempt (8 articles; n = 66 967; OR, 3.15 [95% CI, 2.23-4.45]), and future suicide death (1 article; n = 15 049; OR, 4.39 [95% CI, 1.63-11.78]). Risk was increased in excess of that explained by co-occurring psychopathology: suicidal ideation (adjusted OR, 1.59 [95% CI, 1.09-2.32]) and suicide attempt (adjusted OR, 2.68 [95% CI, 1.71-4.21]). CONCLUSIONS AND RELEVANCE: Individuals with psychotic experiences are at increased risk of suicidal ideation, suicide attempts, and suicide death. Psychotic experiences are important clinical markers of risk for future suicidal behavior.
重要性:最近的研究强调,精神病性体验比精神病性障碍更为普遍,且与各种精神障碍都有关联。最近有研究指出,精神病性体验与自杀行为之间存在特别强烈的关联。 目的:提供一份文献综述,定量综合分析一般人群中精神病性体验与随后出现的自杀意念、自杀未遂和自杀死亡之间的纵向关联。 数据来源:我们检索了 PubMed、Excerpta Medica Database、Cumulative Index to Nursing and Allied Health Literature 和 PsycINFO,从其创立开始检索至 2017 年 9 月,以获取关于精神病性体验和随后出现的自杀意念、自杀未遂和自杀死亡的纵向人群研究。 研究选择:两位作者检索了原始文章,这些文章报告了一般人群样本中前瞻性评估精神病性体验以及随后出现的自杀意念、自杀未遂或自杀死亡的情况,且至少有 1 次随访。 数据提取和综合:两位作者进行了独立的数据提取。必要时,联系了纳入研究的作者以获取信息。我们使用纽卡斯尔-渥太华质量评估量表评估研究质量。我们使用随机效应模型计算了合并的优势比。二次分析评估了共病精神病理学的中介作用。 主要结果和措施:精神病性体验和随后出现的自杀意念、自杀未遂和自杀死亡。 结果:在总共检索到的 2540 篇研究中,有 10 篇符合纳入标准。这 10 项研究报告了来自 12 个不同样本和 23 个国家的 84285 名参与者的数据。随访期从 1 个月到 27 年不等。报告有精神病性体验的个体未来出现自杀意念的几率增加(5 项研究;n=56191;优势比[OR],2.39[95%置信区间,1.62-3.51])、未来自杀未遂的几率增加(8 项研究;n=66967;OR,3.15[95%置信区间,2.23-4.45])和未来自杀死亡的几率增加(1 项研究;n=15049;OR,4.39[95%置信区间,1.63-11.78])。这种风险的增加超过了共病精神病理学解释的范围:自杀意念(调整后的 OR,1.59[95%置信区间,1.09-2.32])和自杀未遂(调整后的 OR,2.68[95%置信区间,1.71-4.21])。 结论和相关性:有精神病性体验的个体自杀意念、自杀未遂和自杀死亡的风险增加。精神病性体验是未来自杀行为风险的重要临床标志物。
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