一项关于双相情感障碍中自杀倾向和非自杀性自伤行为的全国性调查：来自网络分析的见解。
A national survey of suicidality and non-suicidal self-injury in bipolar disorder: insights from network analysis.
作者信息
Cui Lvchun, Zhu Yuncheng, Li Yang, Zhou Jia, Xu Guiyun, Pan Miao, Chen Zhiyu, Li Wenfei, Jiao Zhian, Li Mingli, Zhang Yong, Chen Jingxu, Chen Xiuzhe, Li Na, Sun Jing, Zhang Jian, Hu Shaohua, Wu Haishan, Gan Zhaoyu, Qin Yan, Wang Yumei, Ma Yantao, Wang Xiaoping, Li Xiaohong, Wu Chuangxin, Cai Yiyun, Chen Jiaye, Wu Baichuan, Wang Zuowei, Peng Daihui, Fang Yiru
机构信息
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, No. 600 Wanping South Road, Shanghai, 200030, China.
Clinical Research Center for Mental Health, Mental Health Center Affiliated to School of Medicine, Shanghai University, Shanghai, China.
出版信息
BMC Psychiatry. 2025 Mar 28;25(1):297. doi: 10.1186/s12888-025-06750-2.
BACKGROUND
There is a high prevalence of suicidal ideation (SI), suicide attempts (SA), and non-suicidal self-injury (NSSI) in bipolar disorder (BD). Understanding the nature of suicidality and NSSI in BD is an important way to inform optimal intervention for reducing suicide risk. We aimed to investigate the prevalence and correlates of SI, SA, and NSSI in patients with BD using data from a national survey. We used network analysis to explore the associations among suicidality, NSSI, addictive features of NSSI, and symptoms of BD.
METHODS
Participants with BD were recruited from 20 research centers in China. Suicidality, NSSI, addictive features, and symptoms of BD were measured via a standardized electronic case report form. We used logistic regression and network analysis for data analysis.
RESULTS
Of the 1,055 participants recruited, over 50% with depressive or mixed episodes had SI, more than 20% engaged in SA, and over 40% reported NSSI. The polarity of mood episodes was independently associated with SI ([hypo]mania vs. mixed episodes: odds ratio [OR] = 0.22, 95% confidence interval [CI] 0.14-0.33, p < 0.001) and NSSI ([hypo]mania vs. mixed episodes: OR = 0.33, 95% CI 0.19-0.58, p < 0.001; depressive episodes vs. mixed episodes: OR = 0.59, 95% CI 0.35-0.98, p = 0.040). Participants with mixed episodes reported the most severe addictive features of NSSI. SI was the most influential symptom within the network model of the total sample; NSSI, SI, and depressive symptoms were identified as key "bridge symptoms".
CONCLUSIONS
Suicidality and NSSI in BD were closely associated with depressive and mixed episodes, with mixed episodes showing the highest prevalence of NSSI and the most pronounced addictive features. SI was identified as the central symptom within the self-harm network, emphasizing its importance as an intervention target. These findings could offer potential insights regarding suicidality and NSSI in BD that can inform intervention strategies.
背景
双相情感障碍（BD）患者中自杀观念（SI）、自杀未遂（SA）和非自杀性自伤（NSSI）的发生率很高。了解BD中自杀行为和NSSI的本质是为降低自杀风险提供最佳干预措施的重要途径。我们旨在利用一项全国性调查的数据，调查BD患者中SI、SA和NSSI的发生率及其相关因素。我们使用网络分析来探索自杀行为、NSSI、NSSI的成瘾特征与BD症状之间的关联。
方法
从中国的20个研究中心招募BD患者。通过标准化的电子病例报告表测量自杀行为、NSSI、成瘾特征和BD症状。我们使用逻辑回归和网络分析进行数据分析。
结果
在招募的1055名参与者中，超过50%的抑郁或混合发作患者有自杀观念，超过20%的患者有自杀未遂行为，超过40%的患者报告有NSSI。情绪发作的极性与自杀观念（轻躁狂发作与混合发作：比值比[OR]=0.22，95%置信区间[CI]0.14-0.33，p<0.001）和NSSI（轻躁狂发作与混合发作：OR=0.33，95%CI 0.19-0.58，p<0.001；抑郁发作与混合发作：OR=0.59，95%CI 0.35-0.98，p=0.040）独立相关。混合发作的参与者报告NSSI的成瘾特征最严重。在总样本的网络模型中，自杀观念是最具影响力的症状；NSSI、自杀观念和抑郁症状被确定为关键的“桥梁症状”。
结论
BD中的自杀行为和NSSI与抑郁和混合发作密切相关，混合发作的NSSI发生率最高，成瘾特征最明显。自杀观念被确定为自我伤害网络中的核心症状，强调了其作为干预靶点的重要性。这些发现可以为BD中的自杀行为和NSSI提供潜在的见解，为干预策略提供参考。
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