International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, United States of America; Department of Neuroscience, University of Padova, Padua, Italy.
International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Lucio Bini Mood Disorder Centers, Cagliari & Rome, Italy.
J Affect Disord. 2023 Oct 1;338:189-198. doi: 10.1016/j.jad.2023.06.018. Epub 2023 Jun 8.
Suicidal behavior is strongly associated with major affective disorders, but there is a need to quantify and compare specific risk and protective factors in bipolar disorder (BD) and major depressive disorder (MDD).
In 4307 extensively evaluated major affective-disorder participants with BD (n = 1425) or MDD (n = 2882) diagnosed by current international criteria, we compared characteristics among those with versus without suicidal acts from illness-onset through 8.24 years of follow-up.
Suicidal acts were identified in 11.4 % of participants; 25.9 % were violent and 6.92 % (0.79 % of all participants) were fatal. Associated risk factors included: diagnosis (BD > MDD), manic/psychotic features in first-episodes, family history of suicide or BD, separation/divorce, early abuse, young at illness-onset, female sex with BD, substance abuse, higher irritable, cyclothymic or dysthymic temperament ratings, greater long-term morbidity, and lower intake functional ratings. Protective factors included marriage, co-occurring anxiety disorder, higher ratings of hyperthymic temperament and depressive first episodes. Based on multivariable logistic regression, five factors remained significantly and independently associated with suicidal acts: BD diagnosis, more time depressed during prospective follow-up, younger at onset, lower functional status at intake, and women > men with BD.
Reported findings may or may not apply consistently in other cultures and locations.
Suicidal acts including violent acts and suicides were more prevalent with BD than MDD. Of identified risk (n = 31) and protective factors (n = 4), several differed with diagnosis. Their clinical recognition should contribute to improved prediction and prevention of suicide in major affective disorders.
自杀行为与主要情感障碍密切相关，但需要量化和比较双相情感障碍（BD）和重性抑郁障碍（MDD）中特定的风险和保护因素。
在经过广泛评估的 4307 名患有 BD（n=1425）或 MDD（n=2882）的主要情感障碍患者中，这些患者的诊断符合当前的国际标准，我们比较了从疾病发病到 8.24 年随访期间有自杀行为和无自杀行为患者的特征。
在参与者中发现了 11.4%的自杀行为；25.9%是暴力自杀，6.92%（占所有参与者的 0.79%）是致命的。相关的风险因素包括：诊断（BD>MDD）、首发躁狂/精神病特征、自杀或 BD 家族史、分居/离婚、早年受虐待、发病年龄较早、女性（BD）、物质滥用、更高的易激惹、环性或恶劣心境评分、长期发病率更高，以及功能摄入量评分较低。保护因素包括婚姻、同时存在焦虑障碍、更高的兴奋性气质评分和抑郁首发发作。基于多变量逻辑回归，有五个因素与自杀行为显著相关：BD 诊断、前瞻性随访期间抑郁时间更长、发病年龄更早、发病时功能状态较低，以及 BD 女性多于男性。
报告的发现可能在其他文化和地区不一定一致适用。
与 MDD 相比，BD 患者自杀行为（包括暴力自杀和自杀）更为常见。在已识别的风险因素（n=31）和保护因素（n=4）中，有几个因素与诊断不同。对它们的临床认识应有助于提高对主要情感障碍中自杀的预测和预防。
