VISN 2 Mental Illness Research Education and Clinical Center (MIRECC), Bronx, NY, USA.
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Suicide Life Threat Behav. 2021 Jun;51(3):572-585. doi: 10.1111/sltb.12744. Epub 2021 Mar 5.
Growing evidence suggests emotion reactivity-sensitivity and intensity of emotional experience-may represent a diathesis for suicide risk. However, our understanding of its ability to differentiate risk for suicidal ideation (SI) from suicide attempt (SA) is limited.
This study compares Veterans with SI (n = 81) to Veterans with SA (n = 177) history on factors relevant to emotion reactivity to determine which variable(s) best differentiate groups. Variables examined are multimodal: (a) self-report: childhood trauma, combat exposure; (b) clinician-assessed: non-suicidal self-injury (NSSI), structured diagnostic interview of psychopathology; and (c) psychophysiological: affect-modulated startle (AMS; proxy for amygdala reactivity and emotion reactivity) to unpleasant pictures was examined in a subset (n = 90).
SA history was independently predicted by NSSI history, MDD, PTSD, and SUD diagnosis. Childhood trauma and combat exposure did not differentiate groups. The composite risk index demonstrated good accuracy (AUC=0.71, sensitivity=0.90, specificity=0.49). Only AMS independently predicted SA history when added to the model and accuracy was improved (AUC=0.82, sensitivity=0.85, specificity=0.56).
NSSI history, MDD, PTSD, and SUD diagnosis may be salient risk factors for this population. However, emotion reactivity is a more parsimonious predictor of SA history among Veterans suggesting it is an important treatment target among Veterans with SI.
越来越多的证据表明，情绪反应性——即情绪体验的敏感性和强度——可能是自杀风险的易患因素。然而，我们对其区分自杀意念（SI）和自杀未遂（SA）风险的能力的理解是有限的。
本研究将有 SI（n=81）病史的退伍军人与有 SA（n=177）病史的退伍军人进行比较，比较与情绪反应性相关的因素，以确定哪些变量能最好地区分两组。检查的变量是多模式的：（a）自我报告：儿童期创伤，战斗暴露；（b）临床评估：非自杀性自我伤害（NSSI），精神病理学的结构化诊断访谈；和（c）心理生理学：在一个亚组（n=90）中检查到不愉快图片的情绪调节性 startle（AMS；杏仁核反应性和情绪反应性的代理）。
SA 病史可独立预测 NSSI 病史、MDD、PTSD 和 SUD 诊断。儿童期创伤和战斗暴露不能区分组群。复合风险指数具有良好的准确性（AUC=0.71，敏感性=0.90，特异性=0.49）。当将 AMS 添加到模型中时，它可独立预测 SA 病史，并且准确性得到提高（AUC=0.82，敏感性=0.85，特异性=0.56）。
NSSI 病史、MDD、PTSD 和 SUD 诊断可能是该人群的重要风险因素。然而，情绪反应性是退伍军人 SA 病史的更简约预测因子，这表明它是有 SI 退伍军人的重要治疗目标。
