Graduate School of Social Service, Fordham University, New York, NY, 10009, USA.
Department of Sociology, Harvard University, Cambridge, MA, USA.
Soc Psychiatry Psychiatr Epidemiol. 2020 Sep;55(9):1167-1177. doi: 10.1007/s00127-020-01841-9. Epub 2020 Feb 14.
Research has produced inconsistent results with respect to whether the association between psychotic experiences and suicidal behavior is independent of co-occurring clinical and socioenvironmental factors, despite substantial evidence linking the two phenomena. This study tests whether a comprehensive set of demographic, socioenvironmental, and clinical variables account for the statistical association between psychotic experiences and suicidal behaviors.
We utilized blocked multivariable logistic regression models to analyze the association between 12-month psychotic experiences and 12-month suicide behaviors (ideation, plan, and attempt) on a subsample (N = 2307) of the National Comorbidity Survey Replication. The models adjusted for socio-demographic characteristics, environmental factors in the form of childhood adversity, mental health service utilization, and psychiatric and substance abuse disorders.
Psychotic experiences were significantly associated with suicidal ideation, even after adjusting for socio-demographics, childhood adversity. However, the significant association between psychotic experiences and suicidal ideation was not robust to the inclusion of mental health service utilization and psychiatric disorders. There was no significant association between psychotic experiences and suicide plan. Psychotic experiences were associated with a significantly increased risk of reporting suicide attempts (OR 6.52; 95% CI 1.36-31.11), even after adjusting for the full set of variables.
Although psychotic experiences were not associated with suicidal ideation after statistical adjustments, psychotic experiences were associated with a significantly increased risk of suicide attempts after the inclusion of common risk factors and co-morbidities. Thus, psychotic experiences should be included in routine psychiatric assessments to identify the individuals most at risk for attempting suicide.
尽管有大量证据表明这两种现象之间存在关联，但有关精神病性体验与自杀行为之间的关联是否独立于同时存在的临床和社会环境因素，研究结果仍不一致。本研究旨在检验一组全面的人口统计学、社会环境和临床变量是否可以解释精神病性体验与自杀行为之间的统计学关联。
我们利用分块多变量逻辑回归模型，对国家共病调查再测样本（N=2307）中 12 个月的精神病性体验与 12 个月的自杀行为（意念、计划和尝试）之间的关联进行了分析。该模型调整了社会人口统计学特征、以儿童逆境形式存在的环境因素、心理健康服务的使用情况以及精神疾病和物质使用障碍。
即使在调整了社会人口统计学特征和儿童逆境后，精神病性体验仍与自杀意念显著相关。然而，精神病性体验与自杀意念之间的显著关联在纳入心理健康服务的使用情况和精神疾病后并不稳健。精神病性体验与自杀计划之间没有显著关联。精神病性体验与报告自杀尝试的风险显著增加相关（OR 6.52；95%CI 1.36-31.11），即使在调整了所有变量后也是如此。
尽管在统计调整后，精神病性体验与自杀意念无关，但在纳入常见风险因素和合并症后，精神病性体验与自杀尝试的风险显著增加相关。因此，精神病性体验应纳入常规精神评估中，以识别最有可能自杀的个体。
