Department of Psychiatry & Behavioral Health, The Ohio State University College of Medicine, Columbus, Ohio, USA.
Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Suicide Life Threat Behav. 2023 Jun;53(3):352-361. doi: 10.1111/sltb.12948. Epub 2023 Mar 13.
Approximately half of those who attempt suicide report experiencing suicidal ideation and suicidal planning in advance; others deny these experiences. Some researchers have hypothesized that rapid intensification is due to past suicidal ideation and/or behaviors that are "mentally shelved" but remain available for rapid access later.
To evaluate this hypothesis, we examined (a) temporal sequencing of suicidal ideation, suicidal planning, and suicidal behavior, and (b) speed of emergence of suicidal behavior in a prospective cohort study of 2744 primary care patients.
Of 52 patients reporting suicidal behavior during follow-up, 20 (38.5%) reported suicidal ideation and planning prior to their suicidal behavior, 23 (44.2%) reported suicidal ideation but not planning, and nine (17.3%) denied both suicidal ideation and planning. Over half (n = 30, 57.7%) reported the onset of suicidal ideation and/or planning on the same day as or after their suicidal behavior (i.e., rapid intensification). Rapid intensification was not associated with increased likelihood of reporting recent or past suicidal ideation, planning, or behaviors, suggesting rapid intensification does not depend on prior experience with suicidal ideation and/or behaviors.
Detecting primary care patients at risk for this form of suicidal behavior may be limited even with universal suicide risk screening.
大约有一半试图自杀的人报告称，他们在自杀前有过自杀意念和自杀计划；其他人则否认有过这些经历。一些研究人员假设，快速强化是由于过去的自杀意念和/或“被搁置”但仍然可以快速获取的行为。
为了验证这一假设，我们在一项对 2744 名初级保健患者的前瞻性队列研究中，考察了（a）自杀意念、自杀计划和自杀行为的时间顺序，以及（b）自杀行为的出现速度。
在随访期间报告自杀行为的 52 名患者中，有 20 名（38.5%）在自杀行为前报告了自杀意念和计划，23 名（44.2%）报告了自杀意念但没有计划，9 名（17.3%）否认有自杀意念和计划。超过一半（n=30，57.7%）报告自杀意念和/或计划在自杀行为发生的当天或之后开始（即快速强化）。快速强化与报告近期或过去自杀意念、计划或行为的可能性增加无关，这表明快速强化不依赖于之前的自杀意念和/或行为经历。
即使进行了普遍的自杀风险筛查，也可能难以发现有这种自杀行为形式风险的初级保健患者。
