Division of Injury Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia.
Palantir Technologies, Cambridge, Massachusetts.
JAMA Netw Open. 2023 Mar 1;6(3):e231190. doi: 10.1001/jamanetworkopen.2023.1190.
Suicide prevention is an important component of depression management. Knowledge about depressed adolescents with increased risk for suicide can inform suicide prevention efforts.
To describe the risk of documented suicidal ideation within a year following a diagnosis of depression and to examine how the risk of documented suicidal ideation differed by recent violence encounter status among adolescents with new depression diagnoses.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study in clinical settings including outpatient facilities, emergency departments, and hospitals. Using IBM's Explorys database containing electronic health records from 26 US health care networks, this study observed a cohort of adolescents with new depression diagnoses from 2017 to 2018 for up to 1 year. Data were analyzed from July 2020 to July 2021.
Recent violence encounter was defined by a diagnosis of child maltreatment (physical, sexual, or psychological abuse or neglect) or physical assault within 1 year before depression diagnosis.
The main outcome was diagnosis of suicidal ideation within 1 year following depression diagnosis. Multivariable adjusted risk ratios of suicidal ideation were calculated for overall recent violence encounters and for individual forms of violence.
Among a total of 24 047 adolescents with depression, 16 106 (67.0%) were female and 13 437 (55.9%) were White. A total of 378 had experienceda violence (hereafter, encounter group) and 23 669 had not (hereafter, nonencounter group). Following the diagnosis of depression, 104 adolescents with any past-year violence encounter (27.5%) documented suicidal ideation within 1 year. In contrast, 3185 adolescents in the nonencounter group (13.5%) experienced thoughts of suicide following the diagnosis of depression. In multivariable analyses, those with any violence encounter had 1.7 times (95% CI 1.4-2.0) higher risk of documented suicidal ideation compared with those in the nonencounter group (P < .001). Among different forms of violence, sexual abuse (risk ratio, 2.1; 95% CI, 1.6-2.8) and physical assault (risk ratio, 1.7; 95% CI, 1.3-2.2) were associated with significantly increased risk of suicidal ideation.
Among adolescents with depression, persons who experienced past-year violence encounters showed a higher rate of suicidal ideation than those who had not. These findings highlight the importance of identifying and accounting for past violence encounters when treating adolescents with depression to reduce risk of suicide. Public health approaches to prevent violence may help to avert morbidity associated with depression and suicidal ideation.
自杀预防是抑郁症管理的一个重要组成部分。了解有自杀风险的抑郁青少年的相关知识，可以为自杀预防工作提供信息。
描述青少年在新诊断为抑郁症后的一年内有记录的自杀意念的风险，并研究在新诊断为抑郁症的青少年中，近期暴力遭遇状况对有记录的自杀意念风险的影响。
设计、地点和参与者：这是一项回顾性队列研究，在包括门诊、急诊和医院在内的临床环境中进行。本研究使用 IBM 的 Explorys 数据库，该数据库包含来自 26 个美国医疗保健网络的电子健康记录，对 2017 年至 2018 年间新诊断为抑郁症的青少年队列进行了为期 1 年的观察。数据于 2020 年 7 月至 2021 年 7 月进行分析。
近期暴力遭遇的定义为在抑郁症诊断前 1 年内诊断出儿童虐待（身体、性或心理虐待或忽视）或身体攻击。
主要结局是在抑郁症诊断后 1 年内诊断出自杀意念。对总体近期暴力遭遇和个体形式的暴力分别计算了自杀意念的多变量调整风险比。
在总共 24047 名患有抑郁症的青少年中，有 16106 名（67.0%）为女性，13437 名（55.9%）为白人。共有 378 人经历过暴力（以下简称遭遇组），23669 人没有经历过暴力（以下简称非遭遇组）。在抑郁症诊断后，有 104 名有过任何过去一年暴力遭遇的青少年（27.5%）在 1 年内有记录的自杀意念。相比之下，在非遭遇组中，有 3185 名青少年（13.5%）在抑郁症诊断后有自杀念头。在多变量分析中，与非遭遇组相比，有任何暴力遭遇的青少年自杀意念的风险高 1.7 倍（95% CI 1.4-2.0）（P<0.001）。在不同形式的暴力中，性虐待（风险比，2.1；95% CI，1.6-2.8）和身体攻击（风险比，1.7；95% CI，1.3-2.2）与自杀意念风险显著增加相关。
在患有抑郁症的青少年中，经历过过去一年暴力遭遇的人比没有经历过的人自杀意念的发生率更高。这些发现强调了在治疗患有抑郁症的青少年时，识别和考虑过去的暴力遭遇的重要性，以降低自杀风险。预防暴力的公共卫生措施可能有助于避免与抑郁症和自杀意念相关的发病。
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