CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU, Montpellier, France.
Inserm, U1061 Montpellier, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.
Depress Anxiety. 2021 Jan;38(1):17-27. doi: 10.1002/da.23072. Epub 2020 Jul 11.
As almost all mental disorders are associated with increased suicidal-related behavior, anhedonia might be a trans-diagnostic dimension to target for suicide prevention.
For this 3-year-long prospective study, 2,839 outpatients with mood disorders were recruited. They were divided in: (a) two groups according to the occurrence or not of suicidal ideation during the follow-up, and (b) two groups according to the occurrence or not of suicide attempts during the follow-up. Anhedonia was assessed using a composite score (the French version of the 14-item Snaith-Hamilton Pleasure Scale and item 13 of the Quick Inventory of Depressive Symptomatology scale) at inclusion and at 6, 12, 24, and 36 months after inclusion.
Patients with mood disorders and anhedonia at least at one follow-up visit had a 1.4-fold higher risk of suicidal ideation (adjusted odds ratio = 1.35; 95% confidence interval [1.07, 1.70]), even after adjustment for confounding factors of suicide risk (i.e., bipolar or unipolar disorder, sex, age, marital status, education level, antidepressant intake, personal history of suicide attempt, at least one childhood trauma, and mean of the maximum depression score during the follow-up). Conversely, association between anhedonia and suicide attempt did not remain significant after adjustment.
The significant association between anhedonia and suicide ideation in patients with mood disorders stresses the need of targeting hedonia in mood disorders, and of research focusing on the position to pleasure in life through eudaimonia.
由于几乎所有精神障碍都与自杀相关行为的增加有关，快感缺失可能是预防自杀的跨诊断维度。
在这项为期 3 年的前瞻性研究中，招募了 2839 名心境障碍门诊患者。他们被分为：（a）根据随访期间是否出现自杀意念分为两组，（b）根据随访期间是否出现自杀企图分为两组。使用复合评分（14 项 Snaith-Hamilton 快感量表的法语版本和抑郁症状快速清单的第 13 项）在纳入时以及纳入后 6、12、24 和 36 个月时评估快感缺失。
至少在一次随访中出现快感缺失的心境障碍患者发生自杀意念的风险增加 1.4 倍（调整后的优势比=1.35；95%置信区间[1.07，1.70]），即使在调整了自杀风险的混杂因素（即双相或单相障碍、性别、年龄、婚姻状况、教育程度、抗抑郁药的使用、自杀企图的个人史、至少一次童年创伤和随访期间最大抑郁评分的平均值）后也是如此。相反，快感缺失与自杀企图之间的关联在调整后并不显著。
心境障碍患者快感缺失与自杀意念之间的显著关联强调了在心境障碍中针对快感缺失的必要性，以及通过幸福论研究关注生活中快乐的位置的必要性。
