Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.
J Clin Psychiatry. 2020 Feb 11;81(2):19m12866. doi: 10.4088/JCP.19m12866.
The cognitive theory of suicide postulates that hopelessness is an essential precondition for suicidal ideation in patients with depressive disorder . However, the explanatory power and predictive value of hopelessness for suicidal ideation remain uncertain.
From 1997 to 2007, patients with depressive disorder who were cohorts from the Vantaa Depression Studies (n = 406) completed the Scale for Suicide Ideation (SSI), Beck Hopelessness Scale (BHS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Perceived Social Support Scale-Revised (PSSS-R), and Eysenck Personality Inventory-Q (EPI-Q) at baseline, 6 and 18 months, and 5 years. We conducted a mixed-effects generalized linear regression and clustered receiver-operating characteristics analysis to test how well BDI and BHS predict severe suicidal ideation within and between patients.
BHS predicted clinically significant suicidal ideation (odds ratio [OR] = 2.8), explaining 13.1% of between-patient and and 3.5% of within-patient variance of SSI. Adjusting for the fixed effect of BDI removed a substantial part of the effect of BHS on SSI (adjusted OR = 1.38, P = .018). BAI moderated the effect of BHS on SSI, whereas EPI-Q and PSSS-R did not. BDI detected suicidal ideation more accurately (area under the receiver-operating characteristics curve [AUC] = 0.846) than BHS (AUC = 0.754).
In patients with depressive disorder, hopelessness explains suicidal ideation, but largely because it covaries with depressive symptoms. The role of hopelessness as a central determinant of suicidal ideation in depression may have been overestimated. Symptoms of anxiety moderate the association between hopelessness and suicidal ideation. Severity of depressive symptoms may predict suicidal ideation more accurately than hopelessness.
自杀的认知理论假设，绝望是抑郁障碍患者自杀意念的一个重要前提。然而，绝望对自杀意念的解释力和预测价值仍不确定。
1997 年至 2007 年，来自范塔抑郁研究的队列患者（n=406）在基线、6 个月和 18 个月以及 5 年时完成自杀意念量表（SSI）、贝克绝望量表（BHS）、贝克抑郁量表（BDI）、贝克焦虑量表（BAI）、修订后的领悟社会支持量表（PSSS-R）和艾森克人格问卷-Q（EPI-Q）。我们进行了混合效应广义线性回归和聚类受试者工作特征分析，以测试 BDI 和 BHS 如何在患者内和患者间预测严重自杀意念。
BHS 预测了临床显著的自杀意念（优势比[OR]=2.8），解释了 SSI 中 13.1%的患者间差异和 3.5%的患者内差异。调整 BDI 的固定效应后，BHS 对 SSI 的影响大部分被消除（调整后的 OR=1.38，P=.018）。BAI 调节了 BHS 对 SSI 的影响，而 EPI-Q 和 PSSS-R 没有。BDI 比 BHS 更准确地检测到自杀意念（受试者工作特征曲线下面积[AUC]=0.846）（AUC=0.754）。
在抑郁障碍患者中，绝望解释了自杀意念，但这在很大程度上是因为它与抑郁症状相关。绝望作为抑郁障碍患者自杀意念的核心决定因素的作用可能被高估了。焦虑症状的严重程度调节了绝望与自杀意念之间的关联。抑郁症状的严重程度可能比绝望更准确地预测自杀意念。
