抑郁和其他心境障碍患者与健康对照者的反刍、自杀意念和自杀企图之间的关联：系统评价和荟萃分析。
Association between rumination, suicidal ideation and suicide attempts in persons with depressive and other mood disorders and healthy controls: A systematic review and meta-analysis.
机构信息
Mood Disorder and Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada.
Mood Disorder and Psychopharmacology Unit, University Health Network, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Canada.
出版信息
J Affect Disord. 2025 Jan 1;368:513-527. doi: 10.1016/j.jad.2024.09.118. Epub 2024 Sep 18.
INTRODUCTION
Suicidal ideation and behaviors are a leading cause of disability worldwide. Approximately 90 % of suicide completers have a diagnosable mood disorder. Extant literature reports rumination mediates functional impairment across mood disorders. Herein, we report the association between rumination and suicidality amongst persons with psychiatric disorders and healthy controls.
METHODS
Our systematic review and meta-analysis included relevant articles retrieved from Web of Science, OVID and PubMed from inception to March 20, 2024. Random effects model was used to calculate the correlation between rumination, suicidal ideation and attempt.
RESULTS
A total of 27 eligible studies were included in our systematic review and meta-analysis. Rumination (r = 0.25 [95 % CI: -0.03, 0.49]), reflection (r = 0.15 [-0.71, 0.83]) and brooding (r = 0.13 [-0.58, 0.73]) were nonsignificantly correlated with suicidal ideation in mood disorders. Suicide attempt history was significantly associated with greater odds of rumination in persons with depressive disorders (OR = 1.13 [0.42, 3.02]). In healthy controls, rumination (r = 0.30 [0.21, 0.38]), reflection (r = 0.23 [0.13, 0.32]) and brooding (r = 0.24 [0.12, 0.36]) were significantly correlated with suicidal ideation. Rumination also predicted lifetime history of suicide attempts in healthy controls (OR = 1.70 [1.16, 2.49]).
LIMITATIONS
There were inadequate sample sizes of persons with different mood and psychiatric disorders which may have underpowered our ability to detect clinically meaningful associations.
DISCUSSION
Our study reports a transdiagnostic association between measures of rumination and suicidality. Future research vistas should parse the neurobiological substrates subserving rumination and identify targeted therapies and their association with general cognition and treatment response.
简介
自杀意念和行为是全球导致残疾的主要原因之一。大约 90%的自杀者患有可诊断的心境障碍。现有文献报告称，反刍与各种心境障碍的功能障碍有关。在此，我们报告了在精神障碍患者和健康对照组中，反刍与自杀意念和自杀企图之间的关联。
方法
我们的系统综述和荟萃分析纳入了从 Web of Science、OVID 和 PubMed 自成立至 2024 年 3 月 20 日检索到的相关文章。采用随机效应模型计算反刍与自杀意念和自杀企图之间的相关性。
结果
本系统综述和荟萃分析共纳入 27 项符合条件的研究。反刍（r=0.25 [95%置信区间：-0.03，0.49]）、反思（r=0.15 [-0.71，0.83]）和沉思（r=0.13 [-0.58，0.73]）与心境障碍患者的自杀意念无显著相关性。有自杀企图史的患者更有可能出现反刍（OR=1.13 [0.42，3.02]）。在健康对照组中，反刍（r=0.30 [0.21，0.38]）、反思（r=0.23 [0.13，0.32]）和沉思（r=0.24 [0.12，0.36]）与自杀意念显著相关。反刍也预测了健康对照组的自杀企图终身史（OR=1.70 [1.16，2.49]）。
局限性
不同心境和精神障碍患者的样本量不足，可能使我们检测有临床意义关联的能力减弱。
讨论
本研究报告了反刍与自杀意念之间的跨诊断关联。未来的研究应解析反刍的神经生物学基础，并确定靶向治疗及其与一般认知和治疗反应的关系。
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