Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark.
J Clin Psychiatry. 2019 Jul 16;80(4):18m12575. doi: 10.4088/JCP.18m12575.
Suicidal ideation is a frequent and difficult-to-treat clinical challenge among patients with major depressive disorder (MDD). However, little is known regarding the differential development during antidepressant treatment and whether some patients may suffer from persistent suicidal ideation.
Among 811 patients with Schedules for Clinical Assessment in Neuropsychiatry (SCAN)-verified MDD from 2004-2007 assessed weekly for 12 weeks of escitalopram or nortriptyline antidepressant treatment, we applied item response theory to integrate a suicidality score based on 3 rating scales. We performed latent growth mixture modeling analysis to empirically identify trajectories. Multinomial logistic regression analyses estimated associations with potential predictors.
We identified 5 distinct classes of suicidal ideation. The Persistent-low class (53.7%) showed no suicidal ideation whereas the Persistent-high class (9.8%) had high suicidal ideation throughout 12 weeks. Two classes showed a fluctuating course: the Fluctuating class (5.2%) ended at a low level of suicidal ideation, whereas the Slow-response-relapse class (4.8%) initially responded slowly but then experienced a large increase to a high level of suicidal ideation after 12 weeks. The Fast-response class (26.5%) had a high baseline severity similar to the Persistent-high class but responded quickly within a few weeks and remained at a low level. Previous suicide attempts and higher mood symptom severity were associated with worse suicidal ideation trajectories, whereas living with a partner showed a trend toward better response.
Approximately 1 of 5 patients with MDD showed high or fluctuating suicidal ideation despite antidepressant treatment. Studies should investigate whether suicidal ideation may persist for longer periods and more targeted treatment possibilities.
ISRCTN identifier: ISRCTN03693000.
自杀意念是重度抑郁症（MDD）患者中常见且难以治疗的临床挑战。然而，对于抗抑郁治疗期间的差异发展以及某些患者是否可能持续存在自杀意念，知之甚少。
我们对 2004 年至 2007 年期间接受过 SCAN 验证的 MDD 患者 811 例进行了评估，每周评估 12 周的依他普仑或去甲替林抗抑郁治疗，我们应用项目反应理论，根据 3 个评定量表整合了自杀意念评分。我们进行了潜在增长混合模型分析，以实证识别轨迹。多变量逻辑回归分析估计了与潜在预测因子的关联。
我们确定了 5 种不同类别的自杀意念。持续低类（53.7%）没有自杀意念，而持续高类（9.8%）在 12 周内一直存在高自杀意念。有两个类表现出波动的病程：波动类（5.2%）以低水平的自杀意念结束，而缓慢反应-复发类（4.8%）最初反应缓慢，但在 12 周后自杀意念急剧增加至高水平。快速反应类（26.5%）基线严重程度与持续高类相似，但在数周内迅速反应并保持在低水平。既往自杀未遂和更高的情绪症状严重程度与更差的自杀意念轨迹相关，而与伴侣同住则表现出更好反应的趋势。
大约 1/5 的 MDD 患者尽管接受了抗抑郁治疗，但仍存在高或波动的自杀意念。研究应调查自杀意念是否可能持续更长时间以及更有针对性的治疗可能性。
ISRCTN 标识符：ISRCTN03693000。
