Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite 901, New Haven, CT 06511, USA.
School of Medicine, University of Washington, 1959 Pacific St NE, Seattle, WA 98105, USA.
Psychoneuroendocrinology. 2022 May;139:105691. doi: 10.1016/j.psyneuen.2022.105691. Epub 2022 Feb 17.
Suicide is a complex public health problem that is the result of a number of intertwined biopsychosocial factors. The diathesis-stress model suggests that suicide is the result of an interaction between genetic vulnerability and environmental stressors. Chronic stress and trauma contribute to biologic adaptations, including hypothalamus-pituitary-adrenal axis dysregulation, that contribute to the degradation of regulatory mechanisms and promote wear and tear the body, represented by allostatic load (AL). AL has been associated with a number of negative outcomes, including mental health problems and suicide. Fortunately, there are pharmacological and non-pharmacological interventions that are effective at reducing AL and reversing its effects. Thus, AL may provide a construct for supporting early risk identification, prevention, and treatment of suicide. AL biomarkers that are amenable to measurable change, effective treatments to reduce AL and perhaps help prevent suicide, and how to best tailor them to the individual and societal levels are important avenues of therapeutic inquiry.
自杀是一个复杂的公共卫生问题，是多种相互交织的生物心理社会因素共同作用的结果。素质-应激模型表明，自杀是遗传易感性和环境应激源相互作用的结果。慢性应激和创伤会导致生物适应性改变，包括下丘脑-垂体-肾上腺轴失调，这会导致调节机制的退化，并促进身体的磨损，表现为全身适应综合征（AL）。AL 与许多负面结果有关，包括心理健康问题和自杀。幸运的是，有一些药物和非药物干预措施可以有效地降低 AL 并逆转其影响。因此，AL 可能为支持自杀的早期风险识别、预防和治疗提供了一个构建。可衡量变化的 AL 生物标志物、有效降低 AL 的治疗方法，也许有助于预防自杀，以及如何最好地将其针对个体和社会层面进行调整，这些都是治疗探索的重要途径。
