Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI, 02915, United States.
Neurosci Biobehav Rev. 2019 Apr;99:42-48. doi: 10.1016/j.neubiorev.2019.01.024. Epub 2019 Jan 24.
Not only is suicidal behavior strongly predicted by its past occurrence, but the risk for recurrence appears to increase with each subsequent attempt. The current paper discusses a potential explanation for this phenomenon, that suicide attempts may leave a residual psychological scar that heightens risk for future attempts. This possibility is evaluated against two alternatives: (i) risk for first and subsequent suicide attempts is accounted for by a shared diathesis pre-existing the first lifetime attempt, and (ii) different rates of developmental decline in risk factors account for differences in prospective number of attempts. In this discussion, a formalized conceptual framework of psychological scarring is presented, along with considerations of particular relevance to its study. Finally, the clinical implications of determining the processes underlying the association between suicide attempts and heightened risk for recurrence are discussed.
自杀行为不仅受到过去发生情况的强烈预测，而且每次后续尝试的复发风险似乎都在增加。本文讨论了这一现象的一个潜在解释，即自杀尝试可能会留下心理创伤，从而增加未来尝试的风险。这种可能性与两种替代方案进行了评估：（i）首次和随后的自杀尝试的风险由首次生命尝试之前存在的共同素质决定，以及（ii）风险因素的发展下降率不同，解释了尝试次数的差异。在这个讨论中，提出了一个心理创伤的形式化概念框架，并考虑了与该研究特别相关的因素。最后，讨论了确定自杀尝试与复发风险增加之间关联背后的过程对临床的影响。
