Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.
Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.
Eur Neuropsychopharmacol. 2020 Nov;40:4-16. doi: 10.1016/j.euroneuro.2020.09.004. Epub 2020 Sep 29.
Effective suicide prevention is hindered by a limited understanding of the natural progression and neurobiology of the suicidal process. Our objective was to characterize the duration of the suicidal process and its relation to possible determinants: time judgment and cognitive impulsivity. In four groups of adults of both sexes including recent suicide attempters (n = 57), suicidal ideators (n = 131), non-suicidal depressed controls (n = 51) and healthy controls (n = 48) we examined time estimation and production, impulsivity and other cognitive variables. Duration of the suicidal process was recorded in suicide attempters. The suicide process duration, suicide contemplation and action intervals, had a bimodal distribution, ∼40% of attempters took less than 5 min from decision to attempt. Time slowing correlated negatively with the suicidal action interval (time from the decision to kill oneself to suicide attempt) (p = .003). Individuals with suicide contemplation interval shorter than three hours showed increased time slowing, measured as shorter time production at 35 s (p = .011) and 43 s (p = .036). Delay discounting for rewards correlated with time estimation at 25 min (p = .02) and 90 s (p = .01). Time slowing correlated positively with suicidal ideation severity, independently of depression severity (p < .001). Perception of time slowing may influence both the intensity and the duration of the suicidal process. Time slowing may initially be triggered by intense psychological pain, then worsen the perception of inescapability in suicidal patients.
有效的自杀预防受到对自杀过程的自然进展和神经生物学的有限理解的阻碍。我们的目标是描述自杀过程的持续时间及其与可能的决定因素的关系：时间判断和认知冲动。我们在包括最近自杀未遂者（n=57）、自杀意念者（n=131）、非自杀性抑郁对照者（n=51）和健康对照者（n=48）的四个性别混合的成年组中检查了时间估计和产生、冲动和其他认知变量。自杀过程的持续时间记录在自杀未遂者中。自杀过程的持续时间、自杀沉思和行动间隔呈双峰分布，约 40%的尝试者从决定到尝试的时间少于 5 分钟。时间减缓与自杀行动间隔呈负相关（从决定自杀到自杀尝试的时间）（p=0.003）。沉思时间少于三小时的个体表现出时间减缓增加，表现为在 35 秒（p=0.011）和 43 秒（p=0.036）时的时间产生缩短。奖励的延迟折扣与 25 分钟时的时间估计（p=0.02）和 90 秒时的时间估计（p=0.01）相关。时间减缓与自杀意念严重程度呈正相关，与抑郁严重程度无关（p<0.001）。时间减缓的感知可能同时影响自杀过程的强度和持续时间。时间减缓可能最初是由强烈的心理痛苦引发的，然后会加重自杀患者的无法逃避感。
