Murphy Nicholas, Kypriotakis George, Lijffijt Marijn, Iqbal Sidra, Iqbal Tabish, Amarneh Dania, O'Brien Brittany, Tamman Amanda, Thomas Ynhi, Moukaddam Nidal, Kosten Thomas R, Averill Lynnette A, Mathew Sanjay, Swann Alan C
Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
MD Anderson Cancer Center, Houston, TX, USA.
J Mood Anxiety Disord. 2025 Mar 14;10:100118. doi: 10.1016/j.xjmad.2025.100118. eCollection 2025 Jun.
Suicide is a prominent cause of death across the lifespan, especially between 10 and 34 years old. Most suicides are first attempts, during crises with unpredictably fluctuating risk, arising insidiously from mechanisms related to long-term exposure to psycho-bio-social risk factors. Identifying susceptibility from interacting immediate and long-term mechanisms of action regulation could prevent suicidal crises.
We investigated interacting immediate and long-term regulation of action in risk for suicide. Immediate processes were assessed through affective and behavioral symptoms and a computer measure of impaired action-regulation, the Immediate Memory Task (IMT). Long-term processes included history of trauma, stress, and addictive behaviors. We used Beck Suicidal Ideation at its Worst (SSI-W) to measure global suicidal behavior. Participants were 28 survivors of medically severe suicide attempt (MSSA) within the previous 9 months compared to 23 age, sex, and diagnosis-similar psychiatric controls with previous suicidal ideation but without attempt (NA).
MSSA was related, independent of SSI-W, to IMT impulsive responses, Internal State Scale (ISS) activation, and Lifetime Cumulative Adversity (LCA). MSSA was indirectly related, through SSI-W, to depression, aggression, alcohol-use severity and IMT stimulus discrimination. Minimization-denial of childhood trauma directly increased MSSA,but indirectly reduced apparent MSSA through reduced SSI-W reporting.
MSSA combines characteristics independent of and dependent on SSI-W, reinforced by minimization/denial of childhood trauma. Stress-related hyperarousal and denial of early trauma facilitate MSSA through ISS activation, LHA, and impulsive IMT responses. These characteristics can identify individuals who, without previous suicide attempt or conventional psychiatric diagnosis, need preventive treatment of suicide risk.
自杀是全生命周期中一个突出的死亡原因，尤其是在10至34岁之间。大多数自杀行为都是首次尝试，发生在风险不可预测地波动的危机期间，其根源在于长期暴露于心理-生物-社会风险因素相关的机制。从即时和长期行动调节机制的相互作用中识别易感性可以预防自杀危机。
我们研究了自杀风险中即时和长期行动调节的相互作用。通过情感和行为症状以及一项行动调节受损的计算机测量任务——即时记忆任务（IMT）来评估即时过程。长期过程包括创伤、压力和成瘾行为史。我们使用最严重时的贝克自杀意念量表（SSI-W）来测量总体自杀行为。与23名年龄、性别和诊断相似但有自杀意念但未尝试自杀的精神科对照者（NA）相比，参与者为过去9个月内医学上严重自杀未遂（MSSA）的28名幸存者。
独立于SSI-W，MSSA与IMT冲动反应、内部状态量表（ISS）激活和终身累积逆境（LCA）相关。通过SSI-W，MSSA与抑郁、攻击性、酒精使用严重程度和IMT刺激辨别间接相关。对童年创伤的最小化否认直接增加了MSSA，但通过减少SSI-W报告间接降低了明显的MSSA。
MSSA结合了独立于和依赖于SSI-W的特征，并因对童年创伤的最小化/否认而得到强化。与压力相关的过度唤醒和对早期创伤的否认通过ISS激活、LHA和IMT冲动反应促进了MSSA。这些特征可以识别出那些没有既往自杀未遂或传统精神科诊断但需要进行自杀风险预防性治疗的个体。
