重性抑郁障碍患者自杀意念及其影响因素分析

目的探讨重性抑郁障碍患者中自杀意念的发生率及其影响因素。方法使用贝克自杀意念量表(Beck scale for suicidal ideation,SSI)对155例重性抑郁障碍患者评估有无自杀意念,并使用自制的一般资料调查问卷收集人口学资料,使用17项汉密尔顿抑郁量表(Hamilton depression scale,HAMD-17)和汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)对患者进行自杀意念影响因素的评估。结果 重性抑郁障碍患者自杀意念的发生率为49.7%(77/155),有自杀未遂史的患者为17.4%(27/155)。相对于非汉族患者,汉族患者自杀意念更强(P0.05);相对于无自杀未遂史患者,有自杀未遂史患者自杀意念更强(P0.05);与无自杀意念组比较,有自杀意念患者的HAMD总分、焦虑/躯体化因子分、认知障碍因子分、阻滞因子分更高(P0.05)。路径分析结果表明,抑郁(β=0.22,P0.01)、自杀未遂史(β=0.41,P0.01)和疑病(β=-0.21,P0.01)对自杀意念具有直接预测作用,焦虑(β=0.08,P0.01)和疑病(β=0.07,P0.01)皆通过抑郁对自杀意念起间接作用。Bootstrap BC中介效应检验显示,抑郁在焦虑对自杀意念的影响中起完全中介作用,在疑病对自杀意念的影响中起部分中介作用。结论 重性抑郁障碍患者自杀意念的发生率较高,有自杀未遂史和抑郁情绪严重程度是自杀意念主要的危险因素,在自杀预防工作中要多关注有自杀未遂史和严重抑郁情绪的患者。     

伴混合特征的抑郁障碍患者发生非自杀性自伤的危险因素分析

目的 探讨抑郁障碍伴混合特征（DMX）患者发生非自杀性自伤（NSSI）的危险因素。 方法 选取 2021 年 5 月 4 日至 2022 年 7 月 29 日在首都医科大学附属北京安定医院抑郁症门诊就诊的 100 例 DMX 患者为研究对象，根据自我伤害行为问卷中近 1 年是否发生 NSSI 行为将患者分为 NSSI 组 （n=39）和非 NSSI 组（n=61）。采用 17 项汉密尔顿抑郁量表（HAMD-17）、汉密尔顿焦虑量表（HAMA）、杨 氏躁狂量表（YMRS）和哥伦比亚自杀量表（C-SSRS）4 个他评量表评估患者的抑郁、焦虑、躁狂严重程 度和自杀意念风险等级。采用患者健康问卷抑郁量表（PHQ-9）、广泛性焦虑障碍量表（GAD-7）和斯奈 思 - 汉密尔顿快感量表（SHAPS）3 个自评量表评估患者的抑郁、焦虑和快感缺失严重程度。采用多因 素 Logistic 回归模型分析 DMX 患者发生 NSSI 的危险因素。结果 两组患者年龄、居住方式、起病年龄、 HAMD-17 得分、PHQ-9 得分、SHAPS 得分以及自杀意念风险等级比较，差异有统计学意义（P＜ 0.05）。 多因素 Logistic 回归分析结果显示，年龄小（OR=0.900，95%CI=0.829～0.977，P=0.012）、HAMD-17 得分高 （OR=1.361，95%CI=1.013～1.829，P=0.042）、SHAPS 得分高（OR=1.147，95%CI=1.078～1.215，P＜ 0.001） 是 DMX 患者伴 NSSI 的危险因素。结论 年龄小、抑郁程度重、快感缺失程度重是 DMX 患者 NSSI 发生 的危险因素，在临床中应关注伴有此特征的 DMX 患者，尽早干预，以减少 NSSI 的发生。     

新冠肺炎疫情期间封闭管理精神科医护人员焦虑抑郁症状及相关因素调查

目的探讨新冠肺炎疫情期间封闭管理精神科医护人员焦虑抑郁状况及相关因素,为改善其心理健康状况提供参考。方法采用随机数字表法抽取临沂市精神卫生中心接受封闭管理的精神科医护人员124名,应用一般情况调查表、广泛性焦虑量表(GAD-7)、患者健康问卷抑郁量表(PHQ-9)进行测查。结果封闭管理精神科医护人员轻度、中度、重度焦虑症状检出率分别为49.59%、4.96%、4.13%;轻度、中度、中重度、重度抑郁症状检出率分别为30.58%、7.44%、2.48%、2.48%。不同年龄的精神科医护人员GAD-7评分差异有统计学意义(F=3.207,P=0.044),有无子女及不同行为类型的精神科医护人员PHQ-9评分差异有统计学意义(F=3.993,P=0.048;F=6.523,P=0.002)。逐步回归分析显示,影响封闭管理精神科医护人员焦虑的因素为:年龄和存在A型行为(β=0.225、0.183,P均<0.05);影响其抑郁的因素为:A型行为和年龄(β=0.258、0.187,P<0.05或0.01)。结论新冠肺炎疫情期间,封闭管理精神科医护人员普遍出现不同程度的焦虑、抑郁症状,年龄大和存在A型行为类型者是出现焦虑、抑郁症状的高危人群。     

成年癫痫患者抑郁、焦虑状况及生活质量调查

目的调查成年癫痫患者抑郁、焦虑的患病率及可能的危险因素;评价抑郁及焦虑对癫痫患者生活质量的影响。方法采用Beck抑郁问卷(BDI)、贝克焦虑量表(BAI)及癫痫患者生活质量量表-31(QO-LIE-31中文版),对200例成年癫痫患者的抑郁、焦虑情况及生活质量进行评估。结果在200例癫痫患者中43.5%伴发抑郁,28.5%伴发焦虑,23%伴发抑郁及焦虑。发作频繁、无有薪职业是癫痫患者伴发抑郁的重要危险因素,无有薪职业是癫痫患者伴发焦虑的危险因素。抑郁组及抑郁伴焦虑组的QOLIE-31总分及各项评分均低于非抑郁非焦虑组(P=0.000);焦虑组的QOLIE-31总分(P=0.004)及发作的担忧(P=0.019)、认知功能(P=0.009)方面的得分均低于非抑郁非焦虑组。结论抑郁和焦虑是癫痫患者常见的精神共病,严重影响了癫痫患者的生活质量。积极控制发作、为癫痫患者提供更多的就业机会是改善癫痫患者生活质量的重要因素。     

南京地区帕金森病患者抑郁状态情况调查

目的 调查南京地区帕金森病(PD)患者及50岁以上的对照者抑郁状态的发生率,分析PD合并抑郁状态(PDD)的特点及影响因素.方法 采用抑郁自评量表(SDS)、汉密尔顿抑郁量表(HAMD)对126例PD患者进行抑郁状态调查,统计分析PDD的发生率及其特点和相关影响因素,并进行HAMD因子分析.同时选取50岁以上无明显躯体疾病的体检者124名作为对照组.结果 PDD的发生率为48.4％(61/126),包括轻度抑郁15.1％(19/126),中度抑郁27.8％(35/126),重度抑郁5.6％(7/126);对照组抑郁状态发生率为9.7％ (12/124),包括轻度抑郁5.7％ (7/124),中度抑郁2.4％ (3/124),重度抑郁1.6％ (2/124);两组相比差异有统计学意义(x2 =45.36,P＜0.01).单因素及Logistic回归分析显示病程越长,统一帕金森病评分量表Ⅲ得分越高,H-Y分级越大则PDD的发生率越高.HAMD因子分析的结果显示,PDD患者在认知障碍、迟缓、躯体焦虑、睡眠障碍等方面比对照抑郁组得分明显增高.结论 抑郁状态在南京地区PD患者中较常见,以中度抑郁为主.与PD的病程、运动障碍严重程度及H-Y分级相关.     

首发未治疗抑郁症患者自杀风险与情感气质的关系

目的探讨抑郁症患者自杀风险在情感气质特征方面的危险因素。方法来自我院门诊103例首发未治疗抑郁症患者,根据简明国际神经精神访谈(the mini international neuropsychiatric interview,MINI)5.0中文版自杀模块访谈结果,分为有自杀风险组和无自杀风险组。用情感气质量表(temperament evaluation of the Memphis,Pisa,Paris,and San Diego-auto questionnaire,TEMPS-A)评估情感气质,用汉密尔顿抑郁量表(Hamilton depression rating scale,HAMD)评估抑郁症状的严重程度。结果 45.6%(47/103)的抑郁症患者伴有自杀风险。与无自杀风险组患者相比,有自杀风险组患者女性、无业及未婚者较多,发病年龄较早,HAMD总分以及TEMPSA中循环气质、抑郁气质、焦虑气质评分较高(均P 0.05)。logistic回归分析显示,女性(OR=3.392,95%CI:1.246～9.232)、发病年龄(OR=0.924,95%CI:0.844～0.966)、HAMD总分(OR=1.134,95%CI:1.022～1.258)和循环气质评分(OR=1.204,95%CI:1.015～1.427)与自杀风险相关。结论女性、发病年龄早、抑郁症状严重和循环气质突出可能为首发抑郁症患者自杀风险的危险因素。     

新兵入伍初期焦虑、抑郁情绪的影响因素分析

目的 研究新兵焦虑、抑郁情绪的发生情况及其影响因素,为心理教育提供依据。方法 应用焦虑自评量表(SAS)、抑郁自评量表(SDS)、艾森克个性问卷(EPQ)及自编相关因素调查表,对194名男性新兵进行心理测试。结果 ①194名新兵中无焦虑情绪152人(78.4％),轻度焦虑20人(10.3％),中、重度焦虑22人(11.3％);无抑郁情绪122人(62.9％),轻度抑郁50人(25.8％),中度抑郁16人(8.3％),重度抑郁6人(3.0％)。②SAS、SDS评分与EPQ的精神病质、神经质维度分呈显著正相关,SDS评分与内外向维度分呈显著负相关;SAS、SDS评分还与年龄、受表扬情况、人际适应、兵源、爱情状况、饮食等6项因素显著相关。③经多元逐步回归分析,焦虑情绪的直接因素是EPQ-N、爱情状况、兵源、EPQ-P和受表扬情况,抑郁情绪的直接因素是EPQ-N、EPQ-E、人际适应、EPQ-P和是否独生子女。结论 新兵中焦虑和抑郁者约占13％及38％,个性不稳定及性格内向、人际适应不良等是造成负性情绪的主要因素。     

非自杀性自伤行为与自杀风险关系的纵向随访分析

目的 探讨非自杀性自伤(NISS)行为与自杀风险的关系.方法 对146例符合DSM-5建议诊断标准的NSSI进行为期一年的随访,基线期及随访期采用NSSI行为问卷、儿童焦虑量表、儿童抑郁量表、MINI自杀模块进行评估.结果 一年后随访到123例,NSSI一年内出现自杀风险21例,占17.1％,无自杀风险102例,占82.9％;7例(5.7％)个体NSSI消退.自杀风险组的诊断种类要多于无风险组,基线期及随访期NSSI方式更多,随访期NSSI频率及抑郁情绪更高(P＜0.05).Logistic回归分析显示,基线期NSSI方式种类为NSSI一年内出现自杀风险的影响因素.结论 NSSI出现自杀风险较高,而消退较低,NSSI方式种类是自杀风险出现的影响因素.     

伴焦虑症状抑郁症患者自杀未遂的危险因素

目的分析伴焦虑症状抑郁症患者自杀未遂的人口学资料及临床特征方面的危险因素。方法来自全国13个中心的728例伴有焦虑症状抑郁症患者,根据简明国际神经精神访谈(mini international neuropsychiatric interview,MINI)5.0中文版自杀模块,评估其是否有自杀未遂行为。采用多因素logistic回归,分析伴焦虑症状抑郁症患者在性别、年龄、民族等人口学资料及伴精神病性症状、伴不典型特征等临床特征方面可能与自杀未遂相关的危险因素。结果伴焦虑症状抑郁症患者中,135例(18.5%)有自杀未遂,593例(81.5%)无自杀未遂。有自杀未遂组与无自杀未遂组相比,起病年龄早[(32.3±11.9)vs.(35.3±13.1)],既往抑郁发作次数多(中位数:2 vs.2),既往住院次数多(中位数:1 vs.0),更多患者出现抑郁发作频繁(14.8%vs.7.4%),更常伴不典型症状(25.9%vs.15.0%)和伴自杀意念(78.5%vs.50.3%),应用抗抑郁剂治疗者更多见(81.5%vs.71.2%),差异均具有统计学意义(P0.05)。Logistic回归分析显示,伴焦虑症状抑郁症患者既往住院次数多(OR=1.18,95%CI:1.02~1.37)、抑郁发作频繁(OR=2.05,95%CI:1.14~3.68)、伴自杀意念(OR=3.55,95%CI:2.28~5.54)与自杀未遂相关联(P0.05)。结论既往住院次数多、抑郁发作频繁、伴自杀意念可能是伴焦虑症状抑郁症患者自杀未遂的危险因素。     

潍坊市青春期学生焦虑抑郁现状及其相关因素分析

目的调查潍坊市青春期学生的焦虑抑郁流行现状,探讨其焦虑抑郁等情绪障碍发生的影响因素。方法在2016年5~9月期间抽取潍坊市小学、初中、高中年龄处于10~18岁的青春期不同阶段学生435名,根据《中国精神障碍分类方案与诊断标准第3版》(CCMD-3)进行焦虑抑郁诊断。采用焦虑性情绪障碍筛查表(the screen for child anxiety related emotional disorders,SCARED)、抑郁障碍自评量表(depression self-rating scale for children,DSRSC)评定焦虑抑郁学生的焦虑抑郁情绪,采用自编的青春期焦虑抑郁影响因素调查问卷调查所有学生焦虑抑郁发生的危险因素。结果本次调查的435名青春期学生中,90名存在焦虑抑郁情况,发生比例为20.6%,平均年龄为(12.38±3.58)岁,女生在青春期焦虑抑郁的发生情况多于男生(26.5%vs.15.7%,P=0.026)。多因素logistic回归分析示,个人健康欠佳(OR=0.387,P=0.001)、父母陪伴时间少(OR=0.671,P=0.020)、父亲文化程度低(OR=0.338,P=0.001)、母亲文化程度低(OR=0.262,P=0.001)、父母关系差(OR=1.049,P=0.008)、教育方式不良(OR=0.471,P=0.016)是青春期学生焦虑抑郁发生的危险因素。结论青春期学生存在较多的焦虑抑郁等情绪问题,以青春期早期的女生多见,焦虑抑郁的发生与个人健康欠佳、父母陪伴时间少、父亲文化程度低、母亲文化程度低、父母关系差、教育方式不良等因素密切相关。     

Ulcer, attempted suicide and suicide.

Attempted suicide and suicide have been investigated among 2,619 patients suffering from duodenal ulcer, gastric ulcer and ulcer dyspepsia without ulcer demonstrable by x-ray. There was no difference in the percentage of attempted suicides and suicides among the three ulcer groups or between the sexes. Within well-defined periods, there was a statistically significant greater excess of attempted suicides among patients operated on than among unoperated patients. The distribution according to psychiatric diagnosis was very similar to the one observed among persons in general in Copenhagen attempting suicide. The number of patients committing suicide exceeded the expected number significantly, for men as well as for women, but there was no difference between patients operated on and unoperated patients. The psychiatric diagnoses of those committing suicide were predominantly neuroses and psychopathy.     

大连地区居民自杀意念、自杀计划和自杀未遂的调查分析

目的调查大连地区居民自杀意念、自杀计划、自杀未遂情况,为制定自杀预防和干预策略提供科学依据。方法采取分层整群随机抽样的方法,从大连市11个区县共调查5062人。应用复合性国际诊断交谈量表(CIDI3.0)及美国精神障碍诊断标准(DSM-IV),计算不同人群自杀意念、自杀计划、自杀未遂的检出率。结果1自杀意念、自杀计划和自杀未遂的检出率分别为3.93%、1.10%和0.50%。2共病者自杀意念和自杀计划的检出率分别为42.42%和21.21%,单一疾病患者检出率分别为24.32%和13.51%,精神分裂症患者自杀未遂检出率为10.61%。不同精神疾病自杀意念和自杀未遂检出率差异有统计学意义(P0.05)。结论大连地区自杀问题检出率相对较高,其中患两种以上精神疾病者和单一精神分裂症患者更容易出现自杀意念。     

Association of suicide rates, gun ownership, conservatism and individual suicide risk

Objectives

The purpose of the study was to examine the association of suicide rates, firearm ownership, political conservatism, religious integration at the state level, and individual suicide risk. Social structural and social learning and social integration theories were theoretical frameworks employed. It was hypothesized that higher suicide rates, higher state firearm availability, and state conservatism elevate individual suicide risk.

Method

Data were pooled from the Multiple Cause of Death Files. Multilevel logistic regression models were fitted to all deaths occurring in 2000 through 2004 by suicide.

Results

The state suicide rate significantly elevated individual suicide risk (AOR = 1.042, CI = 1.037, 1.046). Firearm availability at the state level was associated with significantly higher odds of individual suicide (AOR = 1.004, CI = 1.003, 1.006). State political conservatism elevated the odds of individual suicides (AOR = 1.005, CI = 1.003, 1.007), while church membership at the state level reduced individual odds of suicide (AOR = 0.995, CI = 0.993, 0.996). The results held even after controlling for socioeconomic and demographic variables at the individual level.

Conclusion

It was concluded that the observed association between individual suicide odds and national suicide rates, and firearm ownership cannot be discounted. Future research ought to focus on integrating individual level data and contextual variables when testing for the impact of firearm ownership. Support was found for social learning and social integration theories.     

Adolescent self-injurers: Comparing non-ideators,suicide ideators,and suicide attempters

Adolescent non-suicidal self-injury (NSSI) and suicidality are serious health concerns; however, factors that contribute to the transition from NSSI to suicide ideation and suicide attempts are unclear. To address this gap, we investigated whether demographic characteristics, child maltreatment, and psychiatric factors are associated with the level suicidality among adolescents with a history of self-injury. Participants were three groups of adolescent inpatient self-injurers (n = 397, 317 female), aged 13–18 years (M = 15.44, SD = 1.36): (a) non-ideators (n = 96; no current suicide ideation and no lifetime suicide attempts), (b) suicide ideators (n = 149; current ideation and no lifetime attempts), and (c) suicide attempters (n = 152; current ideation and at least one lifetime attempt). Participants completed interviews assessing psychiatric diagnoses, suicidality, and NSSI characteristics, as well as questionnaires on childhood trauma, psychiatric symptoms, and risky behavior engagement. Depression severity was associated with greater odds being a suicide ideator (p < 0.001, OR = 1.04) and an attempter (p < 0.001, OR = 1.05) compared to a non-ideator. Suicide attempters used more NSSI methods and reported greater risky behavior engagement than non-ideators (p = 0.03, OR = 1.29 and p = 0.03, OR = 1.06, respectively) and ideators (p = 0.015, OR = 1.25 and p = 0.04, OR = 1.05, respectively); attempters used more severe NSSI methods (e.g., burning). Our results identify a wide range of risk markers for increasing lethality in a sample at high risk for suicide mortality; future research is needed to refine risk assessments for adolescent self-injurers and determine the clinical utility of using risk markers for screening and intervention.     

Depression, attempted suicide, and suicide in patients with chronic schizophrenia

Depression and suicidal behavior are commonly found among schizophrenic patients and schizophrenia is associated with an increased risk of suicide; the reasons for this are reviewed.     

Dementia,suicide attempts and suicide. A case study

The prevalence of suicide or attempts to suicide in patients with any sort of dementia has not been sharply established. The only figures found through a bibliographic search on Medline belong to a paper by Larson (13) dated 1963, who points out that only 0,8 per cent of men and 0,3 per cent of women suffering dementia commit suicide. Although persons over 65 years old are less than the 13 per cent of the world total population, they actually commit between the 17 per cent and the 25 per cent of all the suicides. Usually it was claimed that people with dementia do not commit suicide, on one hand, because of the failure in the executive abilities and in the capability to carry it on, and due to the lost of insight, on the other, both of them acting as protective factors. The aim of this article is to analyse the five clinical cases of patients with dementia that were hospitalized in a psychiatric service of a general hospital after trying to commit suicide, and then compare these cases with other four cases of patients with dementia that commit suicide reported in the international literature.     

The acquired capability for suicide: A comparison of suicide attempters,suicide ideators,and non‐suicidal controls

Background: The Interpersonal Theory of Suicide states that to make a serious or lethal suicide attempt, a person must experience reductions in fear and pain sensitivity sufficient to overcome self preservation reflexes (i.e., the acquired capability for suicide). The purpose of this study was to examine the fearlessness component of the acquired capability for suicide using self‐report assessment instruments and an objective measure of aversion (the affectively modulated startle reflex task). Methods: Depressed suicide ideators (n=15), depressed suicide attempters (n=15), and a group of control participants (n=14) were compared on their self‐report of acquired capability and painful and provocative life events, and completed the affectively modulated startle reflex task. This task compared electromyography recordings of participants' eye‐blink response to a startle probe while viewing pictures of varying hedonic valence (neutral, positive, negative, and suicide‐related). Results: Suicide attempters reported the highest levels of fearlessness and pain insensitivity and a greater history of painful and provocative life events. Although no group differences were found on the psychophysiology data, participants reacted to suicide‐related images with less aversion compared to neutral images with no differences between suicide‐related and positive images. Conclusions: Self‐reported fearlessness and pain insensitivity can differentiate suicide attempters and suicide ideators. Results suggest that one's self‐perception (i.e., cognitions regarding fear and pain tolerance) are more functionally related to suicide attempts than psychophysiological reactivity to suicide‐related stimuli. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Sleep, depression, and suicide

In a retrospective study of the electroencephalographic (EEG) sleep of major depressives with and without a history of suicide attempts, suicide attempters had longer sleep latency, lower sleep efficiency, and fewer late-night delta wave counts than normal controls. Nonattempters, compared to attempters, had less rapid eye movement (REM) time and activity in period 2, but more delta wave counts in non-REM period 4. Although both attempters and nonattempters were like controls in regard to REM period 2, patients with suicide attempts had altered intranight temporal distribution of phasic REM activity, with increased REM activity (by both visual and automated scoring) in REM sleep period 2 (significant group x period interaction). These findings, which may be more traitlike or persistent than state-related, are discussed in the context of current theories on the role of serotonin in the regulation of sleep and in suicidal behavior.