Division of Psychiatry, Imperial College, London, UK.
Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK.
Personal Ment Health. 2022 May;16(2):111-119. doi: 10.1002/pmh.1543. Epub 2022 Apr 1.
Two hundred ten patients with anxiety and depressive disorders were followed up over 30 years. Personality status was assessed at baseline using the Personality Assessment Schedule (PAS), an instrument that classifies personality disorder in a similar way to the new ICD-11 classification. Assessments of suicidal behaviour were made at 5, 12 and 30 years and suicidal thoughts at 12 and 30 years and analysed by personality status, clinical diagnosis and scores on the General Neurotic Syndrome Scale, a combined diagnosis of mixed anxiety depression and personality dysfunction. Suicide attempts were most frequent in the first 5 years of the study and reduced over time. Baseline personality status was the best predictor of suicide attempts at 5 years (no personality disorder 29.3%, personality disorder 51.6%, p = 0.006), and at 12 years (no personality disorder 11.9%, personality disorder 25.7%, p = 0.042), but no important differences were found at 30 years, when comorbid mental state disorder was the strongest predictor (p < 0.001). Similar but less marked findings were found for the general neurotic syndrome. It is concluded that the presence of personality disorder is a robust predictor of suicidal behaviour in the shorter term but in the long-term comorbid pathology is a better predictor.
二百一十名焦虑和抑郁障碍患者接受了 30 多年的随访。人格状况在基线时使用人格评估表（PAS）进行评估，该工具以类似于新 ICD-11 分类的方式对人格障碍进行分类。自杀行为的评估在 5、12 和 30 年进行，自杀意念在 12 和 30 年进行，并根据人格状况、临床诊断和综合焦虑抑郁及人格功能障碍诊断的一般神经症量表评分进行分析。自杀企图在研究的前 5 年最为频繁，随着时间的推移而减少。基线人格状况是 5 年时自杀企图的最佳预测指标（无人格障碍 29.3%，人格障碍 51.6%，p=0.006），12 年时也是如此（无人格障碍 11.9%，人格障碍 25.7%，p=0.042），但 30 年时没有发现重要差异，此时合并的精神状态障碍是最强的预测指标（p<0.001）。一般神经症也有类似但不太明显的发现。结论是，人格障碍的存在是短期自杀行为的一个强有力的预测指标，但长期来看，合并的病理是更好的预测指标。
