Zuidersma Marij, de Vries Ymkje Anna, Bogers Ista C H M, Rhebergen Didi, Oude Voshaar Richard C
University of Groningen, University Medical Centre Groningen, Department of Psychiatry, Interdisciplinary Centre Psychopathology and Emotion regulation (ICPE), 9700 RB Groningen, the Netherlands.
Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands.
J Affect Disord. 2025 Feb 1;370:90-99. doi: 10.1016/j.jad.2024.10.097. Epub 2024 Oct 29.
It is important to know predictors of long-term course over time of suicidal thoughts and ideation in depressed older persons.
In this study, 378 depressed older persons were interviewed at baseline, and after 2 and 6 years to evaluate the presence of depressive disorder. The Inventory of Depressive Symptomatology (IDS) was administered every 6 months for 6 years. Latent Class Growth Analysis was performed on the IDS item on suicidal ideation to identify subgroups with different trajectories.
Five subgroups with suicidal ideation trajectories were identified: 1) severe, transient (10.9 %), 2) severe, persisting (8.0 %), 3) mild, but increasing (14.9 %), 4) moderate, persisting (35.6 %), and 5) no thoughts (30.6 %). Mixed model analysis showed that trajectories were related to 6-year course of depressive symptoms. Yet, suicidal ideation or thoughts of loss of meaning of life were still present in 22.7 % and 17.4 % of those who remitted after 2 and 6 years. Independent of baseline depressive symptom severity, loneliness, childhood trauma, history of suicidal ideation or attempt, openness to experience, earlier age of depression onset, anxiety symptom severity and worse mastery predicted worse trajectories.
47 % dropped out at 6-years follow-up, we did not distinguish between thoughts of death and suicide, we did not assess death by suicide.
Although trajectories of suicidal ideation and thoughts of loss of meaning of life were strongly related to the course of depression severity, they also appear after remission. Clinicians should be vigilant for suicidal ideation or death wish, even after remission of depression.
了解老年抑郁症患者自杀念头和想法的长期发展预测因素很重要。
在本研究中，378名老年抑郁症患者在基线时接受了访谈，并在2年和6年后进行随访，以评估抑郁症的存在情况。在6年时间里，每6个月进行一次抑郁症状量表（IDS）评估。对IDS中关于自杀念头的项目进行潜在类别增长分析，以识别具有不同轨迹的亚组。
确定了五个具有自杀念头轨迹的亚组：1）严重、短暂（10.9%），2）严重、持续（8.0%），3）轻度但逐渐增加（14.9%），4）中度、持续（35.6%），5）无念头（30.6%）。混合模型分析表明，轨迹与抑郁症状的6年病程相关。然而，在2年和6年后缓解的患者中，仍有22.7%和17.4%存在自杀念头或生命无意义感。独立于基线抑郁症状严重程度、孤独感、童年创伤、自杀念头或企图史、经验开放性、抑郁发病年龄较早、焦虑症状严重程度和较差的掌控感可预测更差的轨迹。
6年随访时有47%的患者失访，我们未区分死亡念头和自杀念头，未评估自杀死亡情况。
虽然自杀念头轨迹和生命无意义感与抑郁严重程度病程密切相关，但在缓解后也会出现。即使在抑郁症缓解后，临床医生也应警惕自杀念头或死亡意愿。
