Laura Palagini, MD, Psychiatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Italy, Via Roma 67, 56100, Pisa, Italy.
Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa; Azienda Ospedaliera Universitaria Pisana (AUOP), Pisa, Italy.
J Clin Psychiatry. 2021 Jan 19;82(2):20m13371. doi: 10.4088/JCP.20m13371.
To examine the role of chronobiological dysrhythmicity in suicidal ideation and behaviors and its relation with hopelessness.
One hundred twenty-seven patients (77 females, mean age of 47.4 ± 12.5 years) with a major depressive episode and bipolar disorder (BD) type I or II (according to Structured Clinical Interview for DSM-5 assessment) were recruited in 2019 and assessed for depressive and manic symptoms (Beck Depression Inventory-II, Young Mania Rating Scale) and with the Biological Rhythms Interview of Assessment in Neuropsychiatry, Beck Hopelessness Scale, and Scale for Suicide Ideation. Univariate regression and mediation analyses were performed.
Forty-one patients (32.3%) showed clinically significant suicidal ideation and were more frequently affected by BD type I (P = .029) with mixed features (P = .022). Compared to nonsuicidal individuals, they had significantly more depressive symptoms (P = .019), higher emotional component of hopelessness (P = .037), and higher dysrhythmicity of sleep (P = .009), activities (P = .048), and social life (P = .019). Passive and active suicidal ideation and suicidal plans were best predicted by dysrhythmicity of sleep and social life. Dysrhythmicity of sleep and social life mediated the direct effect of depressive symptoms on passive and active suicidal ideation and also of active ideation on suicidal plans. The emotional component of hopelessness was related to dysrhythmicity of social life and mediated its effect on suicidal plans (P = .010).
Chronobiological alterations directly contributed to passive and active suicidal ideation and to suicidal preparation, with a key role of dysrhythmicity of sleep, activities, and social life. Chronobiological alterations also impacted the emotional component of hopelessness, hence indirectly contributing to suicidal ideations and plans. These findings call for the systematic screening of these dysrhythmicity dimensions when considering suicidal risk in individuals with BD.
探讨生物节律紊乱在自杀意念和行为中的作用及其与绝望感的关系。
2019 年共招募了 127 名患有重性抑郁发作和双相情感障碍（BD）I 型或 II 型（根据 DSM-5 结构临床访谈评估）的患者（77 名女性，平均年龄 47.4±12.5 岁），并评估了他们的抑郁和躁狂症状（贝克抑郁量表 II 版、杨氏躁狂评定量表）以及神经精神科的生物节律访谈评估、贝克绝望量表和自杀意念量表。进行了单变量回归和中介分析。
41 名患者（32.3%）出现了临床显著的自杀意念，且更常受 BD I 型（P=.029）和混合特征（P=.022）的影响。与非自杀者相比，他们的抑郁症状明显更严重（P=.019），绝望感的情绪成分更高（P=.037），睡眠（P=.009）、活动（P=.048）和社会生活（P=.019）的节律紊乱更严重。被动和主动自杀意念和自杀计划最好由睡眠和社会生活节律紊乱来预测。睡眠和社会生活节律紊乱中介了抑郁症状对被动和主动自杀意念的直接影响，以及主动意念对自杀计划的影响。绝望感的情绪成分与社会生活节律紊乱有关，并中介了其对自杀计划的影响（P=.010）。
生物节律改变直接导致了被动和主动自杀意念以及自杀准备，睡眠、活动和社会生活节律紊乱起关键作用。生物节律改变还影响了绝望感的情绪成分，从而间接影响了自杀意念和计划。这些发现呼吁在考虑 BD 患者的自杀风险时，系统筛查这些节律紊乱维度。
