Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
Int Clin Psychopharmacol. 2023 Jul 1;38(4):201-208. doi: 10.1097/YIC.0000000000000461. Epub 2023 Feb 27.
Suicidal ideation (SI) is a risk factor for suicidal behaviour. To ascertain the clinical correlates and prognostic impact of severe SI, we analysed 249 outpatients with major depressive disorder (MDD) and suicidal thoughts included in the COmbining Medications to Enhance Depression outcome (CO-MED) trial. Patients with severe SI (36%) were younger at disease onset ( P = 0.0033), more severely depressed ( P = 0.0029), had more lifetime suicidal behaviour ( P < 0.0001) and psychiatric comorbidities (panic disorder: P = 0.0025; post-traumatic stress disorder: P = 0.0216), and a history of childhood maltreatment (neglect: P = 0.0054; emotional abuse: P = 0.0230; physical abuse: P = 0.0076; sexual abuse: P = 0.0016) than those experiencing low-moderate SI. After controlling for depression score, severe SI was positively correlated with lifetime suicidal behaviour (OR [95% CI]: 1.26 [1.12-1.41]), panic disorder (1.05 [1.00-1.12]), and childhood maltreatment (neglect: 1.93 [1.13-3.30]; physical abuse: 2.00 [1.11-3.69]; sexual abuse: 2.13 [1.17-3.88]), and inversely correlated with age of onset (0.97 [0.95-0.99]) and sleep-onset insomnia (0.76 [0.61-0.96]). Finally, the occurrence of serious lifetime suicidal behaviour was predicted by SI severity (2.18 [1.11-4.27]), bipolar score (1.36 [1.02-1.81]), and childhood sexual abuse (2.35 [1.09-5.05]). These results emphasise the importance of assessing childhood maltreatment and bipolar liability in MDD to estimate suicidal behaviour risk.
自杀意念（SI）是自杀行为的一个风险因素。为了确定严重 SI 的临床相关性和预后影响，我们分析了 COmbining Medications to Enhance Depression outcome（CO-MED）试验中纳入的 249 名有自杀想法的重性抑郁障碍（MDD）门诊患者。严重 SI（36%）患者的疾病发病年龄更小（P=0.0033），抑郁程度更严重（P=0.0029），一生中自杀行为更多（P<0.0001），精神共病更多（惊恐障碍：P=0.0025；创伤后应激障碍：P=0.0216），童年期虐待史更多（忽视：P=0.0054；情感虐待：P=0.0230；躯体虐待：P=0.0076；性虐待：P=0.0016）。与经历轻中度 SI 的患者相比。在控制抑郁评分后，严重 SI 与一生中的自杀行为（OR[95%CI]：1.26[1.12-1.41]）、惊恐障碍（1.05[1.00-1.12]）和童年期虐待（忽视：1.93[1.13-3.30]；躯体虐待：2.00[1.11-3.69]；性虐待：2.13[1.17-3.88]）呈正相关，与发病年龄（0.97[0.95-0.99]）和睡眠起始失眠（0.76[0.61-0.96]）呈负相关。最后，严重的一生中自杀行为的发生可由 SI 严重程度（2.18[1.11-4.27]）、双相评分（1.36[1.02-1.81]）和童年期性虐待（2.35[1.09-5.05]）预测。这些结果强调了评估 MDD 中童年期虐待和双相易感性以估计自杀行为风险的重要性。
