Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Psychiatry, Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, Texas, USA.
Depress Anxiety. 2021 Jan;38(1):57-66. doi: 10.1002/da.23095. Epub 2020 Oct 10.
This report evaluates whether anger attacks (sudden uncharacteristic bouts of anger that are associated with autonomic arousal and/or aggression) in patients with major depressive disorder (MDD) are associated with elevated suicidal ideation (SI; active suicidal thoughts and plans).
Participants of Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) study who completed Massachusetts General Hospital Anger Attack Questionnaire (AAQ) at baseline were included (n = 293). Levels of SI (suicidal thoughts factor of Concise Health Risk Tracking) were compared at baseline with generalized linear models, and during Stage 1 (baseline-to-week-8) and Stage 2 (week-8-to-week-16) with repeated-measures mixed model analyses. Covariates included age, sex, race, ethnicity, site, and treatment arm.
At baseline, participants with (n = 109) versus without anger attacks (n = 184) had higher levels of SI (Cohen's d effect size [d] = 1.20). Those with ≥9 anger attacks in the past month had significantly higher SI than those with 1-2 (d = 1.21), 3-4 (d = 1.48), and 5-8 (d = 0.94) anger attacks in the past month. Furthermore, participants with anger attacks at baseline reported higher SI at each post-baseline visit (both Stages 1 and 2) of EMBARC study (d = 0.39-0.77; all p < .05). Associations between anger attacks and SI were significant even after controlling for irritability, hostility, anxious arousal, depression, suicide propensity, and self-reported pain at baseline and lifetime suicidal tendencies. Similar results were found in participants with aggressive behaviors.
Anger attacks in outpatients with MDD may be associated with chronically elevated SI. Clinical Trials Registration: Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care for Depression (EMBARC); NCT01407094; https://clinicaltrials.gov/ct2/show/NCT01407094.
本报告评估了伴有自主唤醒和/或攻击行为的重度抑郁障碍（MDD）患者的愤怒发作（突然出现的不典型愤怒发作）是否与升高的自杀意念（SI；主动自杀想法和计划）相关。
纳入了参加建立临床治疗中抗抑郁反应的调节因子和生物标志物（EMBARC）研究、并在基线时完成了马萨诸塞州总医院愤怒发作问卷（AAQ）的患者（n=293）。采用广义线性模型比较基线时的 SI 水平，采用重复测量混合模型分析比较第 1 阶段（基线至第 8 周）和第 2 阶段（第 8 周至第 16 周）的 SI 水平。协变量包括年龄、性别、种族、民族、地点和治疗组。
在基线时，有（n=109）与无愤怒发作（n=184）的患者相比，SI 水平更高（Cohen's d 效应量[d] = 1.20）。过去 1 个月有≥9 次愤怒发作的患者与过去 1-2 次（d=1.21）、3-4 次（d=1.48）和 5-8 次（d=0.94）愤怒发作的患者相比，SI 更高。此外，基线时有愤怒发作的患者在 EMBARC 研究的每次随访（第 1 和第 2 阶段）后报告的 SI 更高（d=0.39-0.77；均 P<.05）。即使在基线时控制易激惹、敌意、焦虑唤醒、抑郁、自杀倾向和自我报告的疼痛以及终生自杀倾向后，愤怒发作与 SI 之间的关联仍然显著。在有攻击行为的患者中也发现了类似的结果。
伴有 MDD 的门诊患者的愤怒发作可能与慢性升高的 SI 相关。
建立临床治疗中抗抑郁反应的调节因子和生物标志物研究（EMBARC）；NCT01407094；https://clinicaltrials.gov/ct2/show/NCT01407094。
