Howarth Emma J, O'Connor Daryl B, Panagioti Maria, Hodkinson Alexander, Wilding Sarah, Johnson Judith
Clinical Psychology Training Programme, University of Leeds, Leeds, United Kingdom.
School of Psychology, University of Leeds, Leeds, United Kingdom.
J Affect Disord. 2020 Apr 1;266:731-742. doi: 10.1016/j.jad.2020.01.171. Epub 2020 Jan 28.
Stressful life events are a risk factor for suicidal ideation and behaviour, but the strength and nature of this association is unclear. This review examined the prospective relationship between stressful life events and subsequent suicidal ideation and behaviours.
Five databases were searched from inception to April 2019. Eligible studies included observational, quantitative longitudinal cohort studies with adult or adolescent samples. A random-effects meta-analysis model was used to examine the prospective relationship between stressful life events and subsequent suicidal ideation and behaviours. Sub-group analyses examined moderating factors.
Eight studies were identified in the systematic review, and seven studies comprising 2,639 participants were included in the meta-analysis. Six studies investigated suicidal ideation and one investigated suicidal behaviours. Stressful life events were associated with a 37% higher odds of subsequently reported suicidal ideation and behaviours combined (Odds Ratio (OR): 1.37, 95% CI: 1.10 to 1.70), and a 45% increased risk for suicidal ideation (OR: 1.45, 95% CI: 1.20 to 1.75). This association was stronger in males, young adults, and studies with shorter term follow-up.
The analyses indicated statistical heterogeneity was high (I2 = 76. 48, 95% CI: 55.0 to 87.7%) and there was evidence of publication bias.
Stressful life events were shown to increase the risk of subsequently reported suicidal ideation and behaviours. These findings suggest that the experience of stressful life events should be incorporated into clinical suicide risk assessments and suicide interventions could include a component on developing resilience and adaptive coping to stressful life events.
生活应激事件是自杀意念和行为的一个风险因素，但这种关联的强度和性质尚不清楚。本综述研究了生活应激事件与随后的自杀意念和行为之间的前瞻性关系。
检索了五个数据库，检索时间从建库至2019年4月。符合条件的研究包括针对成人或青少年样本的观察性、定量纵向队列研究。采用随机效应荟萃分析模型来研究生活应激事件与随后的自杀意念和行为之间的前瞻性关系。亚组分析考察了调节因素。
在系统评价中识别出8项研究，荟萃分析纳入了7项研究，共2639名参与者。6项研究调查了自杀意念，1项研究调查了自杀行为。生活应激事件与随后报告的自杀意念和行为合并发生的几率高37%（优势比（OR）：1.37，95%置信区间：1.10至1.70），自杀意念风险增加45%（OR：1.45，95%置信区间：1.20至1.75）。这种关联在男性、年轻人以及随访期较短的研究中更强。
分析表明统计异质性较高（I2 = 76.48，95%置信区间：55.0至87.7%），并且有证据表明存在发表偏倚。
生活应激事件被证明会增加随后报告的自杀意念和行为的风险。这些发现表明，生活应激事件的经历应纳入临床自杀风险评估，自杀干预可包括一个关于培养应对生活应激事件的复原力和适应性应对方式的组成部分。
