Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.
Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland.
JAMA Psychiatry. 2019 Aug 1;76(8):826-833. doi: 10.1001/jamapsychiatry.2019.0248.
Clarification of the joint influence of familial patterns of suicide attempts and comorbid mental disorders can enhance the understanding and prevention of suicide attempts.
To investigate the familial patterns of suicide attempts and comorbid mental disorders and their associations in a 2-site family study of mood and anxiety disorders.
DESIGN, SETTING, AND PARTICIPANTS: Data were obtained from 2 parallel community-based family studies conducted in the United States (National Institute of Mental Health [NIMH] study) and in Lausanne, Switzerland (PsyCoLaus study), on the comorbidity of mood and anxiety disorders. The study sample comprised 1119 adult probands and 5355 first-degree relatives. Data were collected and analyzed from October 2004 to December 2016.
Lifetime suicide attempt and mental disorders in first-degree relatives, obtained through direct interviews or family history reports.
The study included 1119 adult probands (675 female [60.3%] and a mean [SD] age of 50 [12.0] years) and 5355 first-degree relatives (2752 female [51.4%] and a mean [SD] age of 52 [1.5] years). Of these participants, 90 (8.0%) of 1119 probands and 199 (3.7%) of 5355 relatives had a lifetime history of suicide attempt. Those with such a history had higher rates of all mental disorders, a greater number of disorders, and statistically significantly poorer current and lifetime global functioning. After adjustment for age and sex, a statistically significant association between suicide attempts in probands and in relatives was found at the NIMH site (OR, 2.6; 95% CI, 1.5-4.7), at the Lausanne site (OR, 3.1; 95% CI, 1.6-6.0), and in the combined data (OR, 2.9; 95% CI, 1.9-4.5). All mood disorder subtypes and substance use disorders were statistically significantly associated with suicide attempts. The familial association between lifetime suicide attempts in probands and relatives was not statistically significant for the combined sample (OR, 1.6; 95% CI, 1.0-2.7) after adjustment for comorbid conditions in probands and relatives. Social anxiety disorder in probands was associated with suicide attempts in relatives (OR, 2.4; 95% CI, 1.7-3.5) after controlling for comorbid mood, anxiety, and substance use disorders.
Familiality of suicide attempts appears to be explained by a history of mental disorders among those with suicide attempts; the novel finding of a common familial diathesis for suicide attempts and social anxiety, particularly in combination with mood disorders, has heuristic value for future research and may be a risk marker that can inform prevention efforts.
阐明自杀企图的家族模式和共患精神障碍的共同影响，可以增强对自杀企图的理解和预防。
在两项针对心境和焦虑障碍的基于社区的家族研究中，调查自杀企图和共患精神障碍的家族模式及其相关性。
设计、地点和参与者：数据来自美国国立精神卫生研究所（NIMH）研究和瑞士洛桑的 PsyCoLaus 研究中的两项平行的基于社区的家族研究，这些研究都涉及心境和焦虑障碍的共病。研究样本包括 1119 名成年先证者和 5355 名一级亲属。数据于 2004 年 10 月至 2016 年 12 月收集和分析。
通过直接访谈或家族史报告获得一级亲属的终生自杀企图和精神障碍。
研究包括 1119 名成年先证者（675 名女性[60.3%]，平均[SD]年龄为 50[12.0]岁）和 5355 名一级亲属（2752 名女性[51.4%]，平均[SD]年龄为 52[1.5]岁）。在这些参与者中，90 名（8.0%）先证者和 199 名（3.7%）一级亲属有自杀企图的终生病史。有这种病史的人所有精神障碍的发病率更高，障碍数量更多，当前和终生的总体功能明显更差。在调整年龄和性别后，在 NIMH 研究点（OR，2.6；95%CI，1.5-4.7）、在洛桑研究点（OR，3.1；95%CI，1.6-6.0）和合并数据中（OR，2.9；95%CI，1.9-4.5）发现先证者和亲属自杀企图之间存在统计学显著关联。所有心境障碍亚型和物质使用障碍与自杀企图均存在统计学显著关联。在调整先证者和亲属的共病情况后，在合并样本中，先证者和亲属的终生自杀企图的家族关联在统计学上不显著（OR，1.6；95%CI，1.0-2.7）。先证者的社交焦虑症与亲属的自杀企图相关（OR，2.4；95%CI，1.7-3.5），在控制共患心境、焦虑和物质使用障碍后。
自杀企图的家族性似乎可以用有自杀企图的人存在精神障碍的病史来解释；自杀企图和社交焦虑症的共同家族倾向的新发现，特别是与心境障碍结合在一起，对未来的研究具有启发价值，可能是一种风险标志物，可以为预防工作提供信息。
