Department of Psychiatry, Corentin Celton Hospital, Paris Descartes University, 4 parvis Corentin Celton; 92130 Issy-les-Moulineaux, France.
Regional Resource Center for Old Age Psychiatry (CRRPSA), Medical and University Department of Psychiatry and Addictions, APHP Center-Paris University, Paris, France.
J Clin Psychiatry. 2020 Apr 7;81(3):19m13017. doi: 10.4088/JCP.19m13017.
It remains unclear whether specific clinical factors contribute to heterogeneity in the timing of the onset of nonfatal suicidal behavior. This knowledge could have important implications for suicide prevention.
Using a nationally representative US adult sample, the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005; n = 34,629), we compared the characteristics of 4 different suicide attempter groups: those who first attempted (1) before 18 years, (2) from 18 to 34 years, (3) from 35 to 49 years, and (4) at 50 years or older. Specifically, DSM-IV psychiatric disorders that occurred before the first suicide attempt, childhood maltreatment experiences, parental history of psychiatric disorders, and sociodemographic characteristics were examined.
Most first nonfatal suicide attempts (85.3%) occurred before age 35 years. Compared with suicide attempts occurring from 18 to 34 years, suicide attempts occurring before 18 years were more strongly associated with childhood maltreatment and less strongly linked to lifetime prior psychiatric disorders, whereas first suicide attempts occurring at 35 years and older were more strongly associated with a prior lifetime history of substance use disorders, including alcohol use disorder and nicotine dependence, and mood disorders, including mania/hypomania and dysthymic disorder between 35 and 49 years and major depressive episode at 50 years and older (all P < .05).
These results suggest age differences in risk factors for first nonfatal suicide attempt. Improving early detection and treatment of psychiatric disorders and preventing childhood maltreatment may have broad benefits to reduce the burden of suicidal behavior at all ages.
特定的临床因素是否会导致非致命性自杀行为发生时间的异质性仍不清楚。这方面的知识对于预防自杀可能具有重要意义。
我们使用具有全国代表性的美国成年人样本，即第二次国家酒精与相关条件流行病学调查（2004-2005 年；n=34629），比较了 4 个不同自杀未遂者群体的特征：首次尝试自杀的人群分别为：（1）18 岁之前；（2）18-34 岁；（3）35-49 岁；（4）50 岁及以上。具体而言，我们检查了在首次自杀未遂之前发生的 DSM-IV 精神障碍、儿童期虐待经历、父母精神障碍史以及社会人口统计学特征。
大多数首次非致命性自杀尝试（85.3%）发生在 35 岁之前。与 18-34 岁之间发生的自杀未遂相比，18 岁之前发生的自杀未遂与儿童期虐待的关联更为强烈，与一生之前的精神障碍的关联较弱，而 35 岁及以上首次发生的自杀未遂与一生之前的物质使用障碍（包括酒精使用障碍和尼古丁依赖）和心境障碍（包括双相情感障碍和 35-49 岁之间的恶劣心境障碍以及 50 岁及以上的重性抑郁发作）之间的关联更强（所有 P 值均<0.05）。
这些结果表明，首次非致命性自杀尝试的风险因素存在年龄差异。改善对精神障碍的早期发现和治疗，并预防儿童期虐待，可能会广泛受益，从而降低各年龄段自杀行为的负担。
