Baldessarini Ross J, Tondo Leonardo, Pinna Marco, Nuñez Nicholas, Vázquez Gustavo H
Director,International Consortium for Research on Mood and Psychotic Disorders,McLean Hospital; andProfessor,Department of Psychiatry,Harvard Medical School,USA.
Investigator,International Consortium for Research on Mood and Psychotic Disorders,McLean Hospital;Research Associate,Department of Psychiatry,Harvard Medical School,USA;Director,Lucio Bini Mood Disorders Centers,Italy; andInvestigator,Centre for Affective Disorders,Department of Psychological Medicine,Institute of Psychiatry,King's College,London,UK.
Br J Psychiatry. 2019 Jul 11:1-6. doi: 10.1192/bjp.2019.167.
Rates and risk factors for suicidal behaviour require updating and comparisons among mood disorders.AimsTo identify factors associated with suicidal risk in major mood disorders.
We considered risk factors before, during and after intake assessments of 3284 adults with/without suicidal acts, overall and with bipolar disorder (BD) versus major depressive disorder (MDD), using bivariate comparisons, multivariable regression modelling and receiver operating characteristic (ROC) analysis.
Suicidal prevalence was greater in BD versus MDD: ideation, 29.2 versus 17.3%; attempts, 18.8 versus 4.78%; suicide, 1.73 versus 0.48%; attempts/suicide ratio indicated similar lethality, 10.9 versus 9.96. Suicidal acts were associated with familial BD or suicide, being divorced/unmarried, fewer children, early abuse/trauma, unemployment, younger onset, longer illness, more dysthymic or cyclothymic temperament, attention-deficit hyperactivity disorder (ADHD), substance misuse, mixed features, hospital admission, percentage time unwell, less antidepressants and more antipsychotics and mood stabilisers. Logistic regression found five independent factors: hospital admission, more depression at intake, BD diagnosis, onset age ≤25 years and mixed features. These factors were more associated with suicidal acts in BD than MDD: percentage time depressed/ill, alcohol misuse, >4 pre-intake depressions, more dysthymic/cyclothymic temperament and prior abuse/trauma. ADHD and total years ill were similar in BD and MDD; other factors were more associated with MDD. By ROC analysis, area under the curve was 71.3%, with optimal sensitivity (76%) and specificity (55%) with any two factors.
Suicidal risks were high in mood disorders: ideation was highest with BD type II, attempts and suicides (especially violent) with BD type I. Several risk factors for suicidal acts differed between BD versus MDD patients.Declaration of interestNo author or immediate family member has financial relationships with commercial entities that might appear to represent potential conflicts of interest with the information presented.
自杀行为的发生率及风险因素需要更新，并在心境障碍之间进行比较。
确定主要心境障碍中与自杀风险相关的因素。
我们对3284名有或无自杀行为的成年人在入院评估前、期间和之后的风险因素进行了研究，总体上以及双相情感障碍（BD）与重度抑郁症（MDD）之间进行比较，采用双变量比较、多变量回归建模和受试者工作特征（ROC）分析。
BD患者的自杀患病率高于MDD患者：自杀观念，分别为29.2%和17.3%；自杀未遂，分别为18.8%和4.78%；自杀死亡，分别为1.73%和0.48%；自杀未遂/自杀死亡比显示致死率相似，分别为10.9和9.96。自杀行为与家族性BD或自杀、离婚/未婚、子女较少、早年受虐待/创伤、失业、发病年龄较小（<25岁）、病程较长、更具恶劣心境或环性心境气质、注意力缺陷多动障碍（ADHD）、物质滥用、混合特征、住院、不适时间百分比、较少使用抗抑郁药以及较多使用抗精神病药和心境稳定剂有关。逻辑回归发现五个独立因素：住院、入院时抑郁程度更高、BD诊断、发病年龄≤25岁和混合特征。这些因素在BD患者中比在MDD患者中与自杀行为的关联更强：抑郁/患病时间百分比、酒精滥用、入院前有>4次抑郁发作、更具恶劣心境/环性心境气质以及既往有虐待/创伤史。BD和MDD患者的ADHD及患病总年数相似；其他因素与MDD的关联更强。通过ROC分析，曲线下面积为71.3%，任意两个因素组合时具有最佳敏感性（76%）和特异性（55%）。
心境障碍患者的自杀风险较高：II型BD的自杀观念最高，I型BD的自杀未遂和自杀死亡（尤其是暴力自杀）最多。BD和MDD患者自杀行为的几个风险因素有所不同。
没有作者或其直系亲属与可能与所呈现信息存在潜在利益冲突的商业实体存在财务关系。
