Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Vagelos College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY, USA.
Mol Psychiatry. 2024 Nov;29(11):3356-3363. doi: 10.1038/s41380-024-02560-2. Epub 2024 May 10.
Decedents with no known mental disorder comprise 5-40% of suicides, suggesting that suicide ideation (SI) and behavior may occur in the psychiatrically healthy with important implications for suicide risk screening. Healthy Volunteers (HV) and patients with Major Depressive Disorder (MDD) provided 7 days of Ecological Momentary Assessment (EMA) data about SI and stressors. Longitudinal mixed effects logistic regression models compared HV and patient SI and stressors. Mixed effects linear regression models compared HVs' and patients' SI score change from the previous epoch's SI score when each stressor occurred. HVs (n = 42) reported less frequent (p < 0.001) and less intense SI (p < 0.003) than patients (n = 80), yet did endorse SI and/or SI-related items in 44% of EMA epochs, endorsing SI items in 25% of epochs with non-zero SI scores. For 7 of 8 stressors, patients reported stressors more often than HVs (all p < 0.001) responding to them with increased SI (0.0001 < p < 0.0472). HVs were relatively resilient to stressors, reporting SI increases only in response to neglect (p < 0.0147). Although SI and SAs are documented among psychiatrically healthy individuals, scientific attention to these observations has been scant. Real-time SI measurement showed that HVs' SI was less pronounced than MDD patients', but was endorsed, nonetheless. Patients were more likely to report stressors than HVs, perhaps due to greater sensitivity to the environment, and reported SI in response to stressors, which was less common in HVs. Both MDD patients and HVs most often manifested passive SI (viz, "decreased wish to live"). However, passive SI (viz, "desire for death"), may predict suicide, even absent SI per se (thinking about killing yourself). This study validates the utility of real-time SI assessment, showing that HVs endorse SI items in 11% of epochs, which implies that suicide risk screening focused on those with mental disorders may be too narrow an approach.
无已知精神障碍的死者占自杀者的 5-40%，这表明自杀意念 (SI) 和行为可能发生在精神健康者中，这对自杀风险筛查具有重要意义。健康志愿者 (HV) 和重度抑郁症 (MDD) 患者提供了 7 天的生态瞬时评估 (EMA) 数据，内容涉及 SI 和应激源。纵向混合效应逻辑回归模型比较了 HV 和患者的 SI 和应激源。混合效应线性回归模型比较了每个应激源发生时 HV 和患者前一个时段 SI 评分的 SI 评分变化。HV (n=42) 报告的 SI 出现频率较低 (p<0.001) 且强度较低 (p<0.003) ，而患者 (n=80) 报告的 SI 出现频率更高 (p<0.001) ，且强度更高 (p<0.003) 。然而，HV 在 44%的 EMA 时段中报告了 SI 和/或与 SI 相关的项目，在 25%的非零 SI 评分时段中报告了 SI 项目。对于 8 个应激源中的 7 个，患者报告的应激源比 HV 更频繁 (p<0.001) ，他们对这些应激源的反应是 SI 增加 (0.0001<p<0.0472) 。HV 对应激源相对具有弹性，仅在被忽视时才会报告 SI 增加 (p<0.0147) 。尽管在精神健康个体中已经记录到 SI 和 SAs，但对这些观察结果的科学关注很少。实时 SI 测量表明，HV 的 SI 不如 MDD 患者明显，但仍被报告。患者比 HV 更有可能报告应激源，这可能是由于他们对环境的敏感性更高，并且对应激源的反应是 SI 增加，而 HV 则不太常见。MDD 患者和 HV 最常见的表现是被动 SI(即，“生活意愿降低”)。然而，被动 SI(即，“想死的愿望”)，即使没有 SI 本身，也可能预示着自杀。这项研究验证了实时 SI 评估的效用，表明 HV 在 11%的时段中报告了 SI 项目，这意味着专注于精神障碍患者的自杀风险筛查可能过于狭隘。
