University of Michigan, School of Social Work, Ann Arbor, MI, USA.
University of Michigan, School of Social Work, Ann Arbor, MI, USA.
J Psychiatr Res. 2019 Sep;116:166-171. doi: 10.1016/j.jpsychires.2019.06.014. Epub 2019 Jun 18.
Suicide is a leading cause of preventable death in the United States and worldwide, with symptoms of depression and psychosis relating to increases in risk for ideation, attempt, and completion. This study examined moderating effects of depression in the relationships between three categories of psychotic symptoms (experiencing only hallucinations, only delusions, and both hallucinations and delusions) and suicidal ideation. Data (n = 12,195) were obtained from the cross-sectional Collaborative Psychiatric Epidemiology Surveys data which include large general population-based samples of households in the United States. Data were examined using Structural Equation Modeling (SEM) in Mplus 8. Approximately 19% of the sample met criteria for major depression and 13% reported having the experience of suicidal ideation. Only 16% of the sample reported having a diagnosis of schizophrenia and/or a psychotic disorder. Depression functioned as a moderator and among those who experienced depression, increases in all psychotic symptom categories significantly related to increased likelihood of experiencing suicidal ideation. Among those who were not depressed, increases in two psychotic symptom categories (only hallucinations and both hallucinations and delusions) were significantly related to greater likelihood of experiencing suicidal ideation. Findings emphasize the high-risk for ideation among individuals who experience hallucinations or delusions, with the cumulative effect of experiencing both hallucinations and delusions being most harmful in relation to the likelihood of experiencing suicidal ideation; particularly so among those who were depressed. Assessment of risk factors for suicidal ideation is imperative given its relationship to the potential of suicide attempt and/or completion.
自杀是美国和全球可预防死亡的主要原因,抑郁和精神病症状与观念、尝试和完成自杀的风险增加有关。本研究检验了抑郁在三种精神病症状类别(仅经历幻觉、仅妄想和幻觉和妄想都有)与自杀意念之间关系中的调节作用。数据(n=12195)来自横断面协作精神病流行病学调查数据,其中包括美国大量基于人群的家庭总体样本。使用 Mplus 8 中的结构方程模型(SEM)对数据进行了检查。大约 19%的样本符合重性抑郁的标准,13%报告有自杀意念。只有 16%的样本报告有精神分裂症和/或精神病的诊断。抑郁是一个调节因素,在经历抑郁的人中,所有精神病症状类别的增加都与自杀意念发生的可能性增加显著相关。在没有抑郁的人中,两种精神病症状类别的增加(仅幻觉和幻觉与妄想都有)与自杀意念发生的可能性显著相关。研究结果强调了经历幻觉或妄想的个体观念风险较高,同时经历幻觉和妄想的累积效应与经历自杀意念的可能性关系最密切;对于那些抑郁的人来说更是如此。鉴于自杀意念与自杀企图和/或完成的潜在关系,对自杀意念的风险因素进行评估至关重要。