Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich, Pettenkoferstr. 8a/10, D-80336 Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Ingolstädter Landstr. 1, D-85764 Neuherberg, Germany.
Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich, Pettenkoferstr. 8a/10, D-80336 Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Ingolstädter Landstr. 1, D-85764 Neuherberg, Germany.
J Affect Disord. 2019 Mar 1;246:121-125. doi: 10.1016/j.jad.2018.12.029. Epub 2018 Dec 17.
Suicidal ideation is a common health concern in primary care. Attachment theory indicates that subjects with higher anxiety and/or avoidance may be more susceptible to suicidal ideation. Therefore, the aim of our study was to examine the association of attachment anxiety, avoidance, and suicidal ideation in middle-aged to elderly, chronically ill primary care patients.
The APRICARE Study comprised 207 patients aged 50-85 years with a minimum of three chronic diseases. Adult attachment, depressive symptoms and suicidal ideation were measured via the self-report questionnaires Experiences in Close Relationships-Revised (ECR-RD12) and Patient Health Questionnaire - 9 (PHQ-9). Univariable and adjusted associations of suicidal ideation with ECR-RD12-attachment anxiety, ECR-RD12-attachment avoidance, and ECR-RD12-insecure adult attachment were examined via logistic regression analyses.
Suicidal ideation was present in 13% of all patients. ECR-RD12-anxiety was significantly associated with suicidal ideation (OR = 1.88, CI 1.44-2.44), while ECR-RD12-avoidance was not associated. In patients with suicidal ideation, 85% were insecurely attached compared to 63% in those without suicidal ideation - thus the OR for suicidal ideation in insecurely attached patients was 3.33 (CI = 1.10-10.04) with securely attached patients as reference. Further variables associated with suicidal ideation were depressive symptomatology, living alone (especially in men) and obesity (especially in women).
The study was cross-sectional in design, and suicidal ideation was assessed using a single item self-report measure.
General practitioners should be aware of attachment styles in order to have a better chance to identify patients at risk for suicide.
自杀意念是初级保健中的一个常见健康问题。依恋理论表明，焦虑和/或回避程度较高的个体可能更容易产生自杀意念。因此，我们的研究目的是探讨中年至老年慢性疾病初级保健患者的依恋焦虑、回避和自杀意念之间的关系。
APRICARE 研究包括 207 名年龄在 50-85 岁、至少患有三种慢性病的患者。通过自我报告问卷亲密关系经历量表修订版（ECR-RD12）和患者健康问卷-9（PHQ-9）来测量成人依恋、抑郁症状和自杀意念。通过逻辑回归分析，检查自杀意念与 ECR-RD12-依恋焦虑、ECR-RD12-依恋回避和 ECR-RD12-成人依恋不安全感的单变量和调整后关联。
所有患者中有 13%存在自杀意念。ECR-RD12-焦虑与自杀意念显著相关（OR=1.88，CI 1.44-2.44），而 ECR-RD12-回避则没有关联。在有自杀意念的患者中，85%的人依恋不安全感，而没有自杀意念的患者中为 63%——因此，在不安全依恋患者中，自杀意念的 OR 为 3.33（CI=1.10-10.04），以安全依恋患者为参照。与自杀意念相关的其他变量包括抑郁症状、独居（尤其是男性）和肥胖（尤其是女性）。
该研究为横断面设计，自杀意念采用单一项目自我报告测量进行评估。
全科医生应该了解依恋风格，以便更好地识别有自杀风险的患者。
