Sobanski Thomas, Peikert Gregor, Kastner Ulrich W, Wagner Gerd
Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, THUERINGEN-Kliniken GmbH, Saalfeld 07318, Germany.
Network for Suicide Prevention in Thuringia (NeST), Jena 07743, Germany.
World J Psychiatry. 2022 Sep 19;12(9):1115-1126. doi: 10.5498/wjp.v12.i9.1115.
Suicide is the 14 leading cause of death worldwide. It is responsible for 1%-5% of all mortality. This article highlights the latest developments in universal, selective, and indicated prevention strategies. Concerning universal suicide prevention, current research has shown that strategies such as restricting access to lethal means (, control of analgesics and hot-spots for suicide by jumping) and school-based awareness programs are most efficacious. Regarding selective prevention, substantial progress can be expected in psychological screening methods for suicidal behavior. The measurement of implicit cognition proved to be more valid in predicting future suicide attempts than classic clinical assessment. Latest developments are smartphone-based interventions and real-time monitoring of suicidal behavior. Great effort has been made to establish valid neurobiological screening methods (, genetic and epigenetic risk factors for suicide, hypothalamic-pituitary-adrenal axis) without yielding a major bre-akthrough. Potentially, multiple biomarkers rather than a single one are necessary to identify individuals at risk. With regard to indicated prevention in form of psychopharmacological treatment, recent pharmacoepidemiological studies and meta-analyses have supported a protective role of antidepressants, lithium, and clozapine. However, the data concerning a specific anti-suicidal effect of these drugs are currently not consistent. Promising results exist for ketamine in reducing suicidal ideation, independently of its antidepressant effect. Concerning psychotherapy, recent findings suggest that psychotherapeutic interventions specifically designed to prevent suicide re-attempts are most efficacious. Specifically, cognitive behavioral therapy and psychodynamic therapy approaches proved to decrease the number of suicide re-attempts significantly.
自杀是全球第14大死因。它占所有死亡人数的1%-5%。本文重点介绍了普遍预防、选择性预防和针对性预防策略的最新进展。关于普遍自杀预防，目前的研究表明，诸如限制获取致命手段（如控制镇痛药和跳楼自杀热点地区）以及基于学校的提高认识计划等策略最为有效。关于选择性预防，自杀行为的心理筛查方法有望取得实质性进展。事实证明，与传统临床评估相比，内隐认知测量在预测未来自杀企图方面更有效。最新进展包括基于智能手机的干预措施和对自杀行为的实时监测。人们已经做出了巨大努力来建立有效的神经生物学筛查方法（如自杀的遗传和表观遗传风险因素、下丘脑-垂体-肾上腺轴），但尚未取得重大突破。潜在地，识别有风险的个体可能需要多种生物标志物而非单一生物标志物。关于以心理药物治疗形式进行的针对性预防，最近的药物流行病学研究和荟萃分析支持了抗抑郁药、锂盐和氯氮平的保护作用。然而，目前关于这些药物特定抗自杀作用的数据并不一致。氯胺酮在降低自杀意念方面取得了有希望的结果，与其抗抑郁作用无关。关于心理治疗，最近的研究结果表明，专门设计用于预防自杀再次尝试的心理治疗干预最为有效。具体而言，认知行为疗法和心理动力疗法已被证明能显著减少自杀再次尝试的次数。
