Bellato Alessio, Admani Muskaan Aleeza, Deak Camila, Farhat Luis Carlos, Fontana Antunes de Oliveira Maria Carolina, Vasconcelos Rebeca, Malanchini Margherita, Shephard Elizabeth, Michelini Giorgia
School of Psychology University of Nottingham Semenyih Malaysia.
Department of Biological and Experimental Psychology School of Biological and Behavioural Sciences Queen Mary University of London London UK.
JCPP Adv. 2023 Mar 23;3(3):e12148. doi: 10.1002/jcv2.12148. eCollection 2023 Sep.
Self-injurious thoughts and behaviours (SITBs) have been associated with dysfunction of the Autonomic Nervous System (ANS) in children and young people, suggesting that objective ANS measures may aid assessment of suicide risk, but a systematic synthesis of this literature is currently lacking.
Following a pre-registered protocol (PROSPERO CRD42022327605), we conducted a systematic search of PubMed, Medline, Embase, PsycINFO, and Web of Science, for empirical studies published until 10th May 2022 that compared indices of ANS functioning in individuals aged 0-25 years with versus without SITBs, or reported continuous associations between ANS measures and SITBs. Study quality was assessed with the Newcastle-Ottawa Scales. Pooled effect sizes (Hedge's g) were estimated with random-effects meta-analytic models.
Twenty studies (1979 participants) were included in our systematic review, with 16 included in meta-analyses. Results suggested that SITBs were associated with altered cardiac indices of arousal ( = -0.328, < 0.001), which was driven by lower heart rate variability in individuals with SITBs ( = -0.375, = 0.025). Overall results for electrodermal activity were not significant ( = 0.026, = 0.857), but subgroup analyses showed increased activity in studies of individuals who engaged specifically in non-suicidal self-harm ( = 0.249, = 0.014) but decreased activity in the remaining studies ( = -0.567, = 0.004).
Our systematic review and meta-analysis found evidence of reduced parasympathetic regulation as well as more tentative evidence of altered electrodermal activity in children and young people displaying SITBs. Future longitudinal studies should test the clinical utility of these markers for detecting and monitoring suicide risk.
自我伤害性想法和行为（SITBs）与儿童和青少年的自主神经系统（ANS）功能障碍有关，这表明客观的ANS测量可能有助于评估自杀风险，但目前缺乏对该文献的系统综述。
按照预先注册的方案（PROSPERO CRD42022327605），我们对PubMed、Medline、Embase、PsycINFO和Web of Science进行了系统检索，以查找截至2022年5月10日发表的实证研究，这些研究比较了0至25岁有和没有SITBs的个体的ANS功能指标，或报告了ANS测量与SITBs之间的连续关联。使用纽卡斯尔-渥太华量表评估研究质量。采用随机效应荟萃分析模型估计合并效应量（Hedge's g）。
20项研究（1979名参与者）纳入我们的系统评价，16项纳入荟萃分析。结果表明，SITBs与唤醒的心脏指标改变有关（g = -0.328，p < 0.001），这是由有SITBs的个体较低的心率变异性驱动的（g = -0.375，p = 0.025）。皮肤电活动的总体结果不显著（g = 0.026，p = 0.857），但亚组分析显示，在专门从事非自杀性自我伤害的个体研究中活动增加（g = 0.249，p = 0.014），而在其余研究中活动减少（g = -0.567，p = 0.004）。
我们的系统评价和荟萃分析发现，有证据表明表现出SITBs的儿童和青少年副交感神经调节减少，以及有初步证据表明皮肤电活动改变。未来的纵向研究应测试这些标志物在检测和监测自杀风险方面的临床效用。
