Sun Ching-Fang, Mansuri Zeeshan, Trivedi Chintan, Vadukapuram Ramu, Reddy Abhishek
Department of Psychiatry, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States.
Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
Front Psychiatry. 2022 Nov 16;13:933524. doi: 10.3389/fpsyt.2022.933524. eCollection 2022.
Adolescents with a homicidal tendency is a growing concern in the United States. Studies in the past have showcased the relationship between homicidal ideation (HI) and psychiatric illnesses, but very limited information is available on the adolescent and inpatient population. We aim to evaluate the prevalence of demographic characteristics and psychiatric disorders in adolescents with and without HI.
Adolescent (age 12-17) population admitted to the hospital with the diagnosis of homicidal ideation was identified from the 2016-2018 National Inpatient Sample Dataset (NISD). Patients without HI were defined as the control group. The prevalence of psychiatric comorbidities between the groups was compared by applying the Rao-Scott adjusted chi-square test. We used multivariable logistic regression to generate odds ratio (OR) of homicidal ideation as an outcome; we adjusted age, sex, race, socioeconomic status, substance use disorders, alcohol use disorders, and psychiatric comorbidities.
A total of 18,935 patients (mean age: 14.5) with HI diagnosis were identified in this study. Majority of the patients were male subjects in the HI group compared to the control group (58.7 vs. 41.2%, < 0.001). Racially, HI was more prevalent in white race (56.0 vs. 52.6%, < 0.001) and black race (22.3 vs. 17.8%, < 0.001), compared to Hispanic race (14.9 vs. 21.3%, < 0.001). Major depression (Odds ratio [OR]: 2.66, < 0.001), bipolar disorder (OR: 3.52, < 0.001), anxiety disorder (OR: 1.85, < 0.001), ADHD, and other conduct disorders (OR: 4.01, < 0.001), schizophrenia (OR: 4.35, < 0.001) are strong predictors of HI. Suicidality was prevalent in 66.9% of patients with HI.
We found a higher prevalence of psychiatric illnesses such as depression, anxiety, and bipolar disorder in adolescents with homicidal ideation in the inpatient setting. White and black races were more prevalent in patients with homicidal ideation. Further large-scale longitudinal research studies are warranted to establish the correlation between psychiatric disorders and homicidal ideation among adolescents.
有杀人倾向的青少年在美国日益受到关注。过去的研究展示了杀人意念（HI）与精神疾病之间的关系，但关于青少年和住院患者群体的信息非常有限。我们旨在评估有和没有HI的青少年的人口统计学特征和精神障碍的患病率。
从2016 - 2018年全国住院患者样本数据集（NISD）中确定因杀人意念诊断而入院的青少年（12 - 17岁）人群。没有HI的患者被定义为对照组。通过应用Rao - Scott校正卡方检验比较两组之间精神共病的患病率。我们使用多变量逻辑回归生成作为结果的杀人意念的比值比（OR）；我们对年龄、性别、种族、社会经济地位、物质使用障碍、酒精使用障碍和精神共病进行了调整。
本研究共确定了18935例诊断为HI的患者（平均年龄：14.5岁）。与对照组相比，HI组中的大多数患者为男性（58.7%对41.2%，P < 0.001）。在种族方面，与西班牙裔种族相比，HI在白人种族（56.0%对52.6%，P < 0.001）和黑人种族（22.3%对17.8%，P < 0.001）中更为普遍（14.9%对21.3%，P < 0.001）。重度抑郁症（比值比[OR]：2.66，P < 0.001）、双相情感障碍（OR：3.52，P < 0.001）、焦虑症（OR：1.85，P < 0.001）、注意力缺陷多动障碍和其他行为障碍（OR：4.01，P < 0.001）、精神分裂症（OR：4.35，P < 0.001）是HI的强有力预测因素。66.9%的HI患者有自杀倾向。
我们发现在住院环境中有杀人意念的青少年中，抑郁症、焦虑症和双相情感障碍等精神疾病的患病率较高。白人种族和黑人种族在有杀人意念的患者中更为普遍。有必要进行进一步的大规模纵向研究，以确定青少年精神障碍与杀人意念之间的相关性。
