中青年慢性病住院患者自杀意念的危险因素分析

目的 探讨中青年慢性病住院患者自杀意念的危险因素。方法 采用横断面研究设计和方便抽样法选取2019年8月1~31日安徽医科大学第一附属医院收治的住院号末尾数为偶数的中青年慢性病住院患者270例为研究对象。通过问题"最近一周内，你是否曾有过自杀的念头"来测定患者自杀意念发生情况，回答"是"则判定为有自杀意念，反之则无。根据有无自杀意念，将患者分成有自杀信念组（23例）和无自杀信念组（247例）。通过logistic回归分析导致患者有自杀意念的危险因素。结果 logistic回归分析结果显示，婚姻状况（OR=0.182，95% CI：0.065~0.504，P=0.001）、主观支持（OR=0.703，95% CI：0.588~0.841，P=0.000）和家庭功能（OR=0.793，95% CI：0.658~0.956，P=0.015）是中青年慢性病住院患者自杀意念的危险因素。结论 单身、获得社会支持少和家庭功能欠佳是中青年慢性病住院患者产生自杀意念的危险因素，临床对此类患者在治疗过程中应予密切关注并及时干预。     

抑郁症 185例自杀意念、行为的危险因素分析

目的 分析抑郁症病人自杀意念、行为的危险因素。方法 选取商丘市第二人民医院2020年1月至2021年8月185例抑郁症初诊病人（研究组）,采用倾向值匹配法另选取185例健康志愿者（对照组）。采用聚合酶链式反应-限制性片段长度多态性（PCR-RFLP）检测两组脑源性神经营养因子（BDNF）基因多态性并比较;分别采用自杀意念自评量表（SIOSS）和专家访谈方式调查研究组的自杀意念、行为,采用logistic多元回归法分析自杀意念、行为的影响因素。结果 两组BDNF第66个氨基酸处的缬氨酸突变为蛋氨酸（Val66Met）基因型分布与等位基因频率比较差异无统计学意义（P>0.05）,且均符合遗传平衡规律（P>0.05）;研究组离婚/丧偶病人SIOSS评分高于未婚、已婚[（12.86±3.05）分比（8.73±1.98）分、（10.02±2.01）分]（P<0.05）,无业病人SIOSS评分高于在编人员、普通职员/个体户[（13.63±3.04）分比（8.04±1.95）分、（9.78±2.04）分]（P<0.05）,收入水平<3 000元/月SIOSS评分高于3 ...     

新入伍士兵自杀意念与自杀行为影响因素调查

目的调查分析影响新入伍士兵自杀意念与自杀行为的主要因素,为自杀预防干预提供依据。方法采取随机整群抽样的方式对5345名官兵使用SCL-90问卷筛查,对筛查阳性者再实施半结构式访谈定性,确认自杀意念形成的主要相关因素。结果存在不同程度自杀意念者共171人,占调查人数的3.1%,其中13人有过对有关实施方式的计划。自杀意念和行为形成的因素中,家庭因素影响较多,主要是家庭关系、家族史、家庭经济等。结论新入伍士兵自杀意念和自杀行为形成过程中,家庭是重要的因素,进行预防性自杀干预时,应对其家庭因素给予充分的关注。     

强制戒毒者的成瘾程度与抑郁状况和自杀意念的相关分析

目的：探讨抑郁情绪与吸毒人群自杀意念和成瘾程度之间的关系,并为进一步认识该人群的自杀行为提供依据。方法：对甘肃省兰州市榆中县强制戒毒所中的强制戒毒人员,采用随机抽样,使用阿片成瘾严重程度量表及自杀意念自评量表和抑郁量表,采取各大队各班抽测方式进行调查。结果：共157名调查对象的问卷有效,抑郁状况为成瘾程度和自杀意念产生的中介变量。结论：强制戒毒者的抑郁程度、自杀意念的发生率都远高于一般人群。成瘾和抑郁情绪的严重程度都可作为强制戒毒者自杀意念出现的重要评定因子。     

Poor response to antidepressants predicts new suicidal ideas and behavior in depressed outpatients

BackgroundOnly a few studies have investigated the factors associated with suicidal behavior after antidepressant treatment onset in adults. We examined the specific predictors of de novo suicidal ideas or attempts among depressed patients in the community, including subjects potentially at risk of suicidal behaviors, who initiated a new antidepressant treatment.MethodsA large set of GPs and psychiatrists throughout France followed-up, for 6 weeks, 4357 outpatients for whom an antidepressant drug was prescribed. Dimensions related with antidepressant-induced suicidal events, such as depression, anxiety or hopelessness, were assessed longitudinally using univariate and multivariate approaches among subjects with treatment-emergent suicide ideation or attempts.ResultsNew suicidal ideas were observed in 9% of patients with no suicidal ideation at baseline (n=81), while suicidal attempts were reported for 1.7% of the sample during the 6-week observation period (n=75). The onset of suicidal ideas and attempts was associated with the initial features of the patients (baseline level of anxiety, past history of suicide attempts and alcohol misuse) and the non-improvement of depression. Worsening of depressive symptoms during the follow-up increased the onset of new suicidal ideas (OR=5.67, p<0.001) and attempts (OR=2.60, p=0.002), corresponding to 67.5% and 56.5% of attributable risk respectively.ConclusionsWhen the analyses are restricted to the occurrence of suicidal ideas or attempts, the link between antidepressants and suicide risk might be more adequately explained by a poor response to antidepressant treatment rather than by a direct trigger-effect. This naturalistic study is limited by the use of non-structured diagnoses and self-report outcomes.     

North Carolina community pharmacists’ attitudes about suicide and willingness to conduct suicidal ideation assessment: A cross-sectional survey study

BackgroundSuicide is a major and growing public health problem. Pharmacists are one of the most accessible members of the health care team. Due to their unique place in the health care system, pharmacists may be an ideal resource for monitoring patients at risk of suicide. The objectives of this study were to: (1) investigate community pharmacists’ attitudes toward suicide; (2) identify pharmacist-reported barriers to suicidal ideation assessment; and (3) evaluate facilitators and barriers to pharmacists conducting suicidal ideation assessment.MethodsAn anonymous questionnaire was distributed to North Carolina (NC) community pharmacists. Measures included contact with suicide, perceived role in suicidal ideation assessment, Attitudes Towards Suicide (ATTS), and barriers in suicidal ideation assessment. Multivariable logistic regression was used to analyze the data.ResultsThere were usable and complete data for 225 participants (3.52% response rate). The median ATTS score was 70 (IQR = 7). Community pharmacists were significantly more likely to perform a suicidal ideation assessment at least sometimes when (s)he reported a lower number of barriers (OR = 0.70, 99.5% CI = 0.51–0.98) and when (s)he agreed or strongly agreed that they knew how to help someone who was suicidal (OR = 6.63, 99.5% CI = 1.74, 25.23). The most common barrier to suicidal ideation assessment was lack of education in mental health screening (n = 176).ConclusionsSuicide prevention education programs for pharmacists may need to address reducing barriers, increasing knowledge about suicide, and improving self-efficacy. Targeting these areas may lead more pharmacists conducting these assessments.     

大学生自杀意念及行为因素的相关分析

目的 分析在校大学生自杀意念的发生状况,探讨自杀意念及自杀行为的影响因素.方法 采用自制的调查表,以随机整群抽样的方法对520名在校大学生进行调查,并进行单因素和多因素Logistic回归分析.结果 大学生自杀意念的发生率为21.5%,进行过自杀的有15.8%.多因素的Logistic回归模型分析显示:自杀意念发生有关的主要危险因素是:家庭成员的支持、家庭和睦程度、与他人的关系等.结论 自杀意念及自杀行为与其影响因素联系密切,应根据其影响因素予以积极干预,从而减少自杀行为的发生.     

Solitary and social heavy drinking,suicidal ideation,and drinking motives in underage college drinkers

In college students, solitary heavy drinking (i.e., while alone) is associated with depression and with higher rates of drinking problems than heavy drinking in social contexts. This study explored the relationship among heavy episodic drinking context, suicidal ideation, and drinking motives among underage college drinkers (n = 91) with a history of passive suicidal ideation. Participants completed measures of depression, suicidal ideation, alcohol consumption and problems, and drinking motives. Multiple regression analyses revealed that suicidal ideation, but not depression, was significantly related to solitary heavy drinking. Neither was related to social heavy drinking. Enhancement motives for drinking, but not other drinking motives (i.e., social, conformity, drinking to cope), were significantly associated with social heavy drinking. In contrast, only drinking to cope was associated with solitary heavy drinking. These findings suggest that greater suicidal ideation is associated with greater frequency of becoming intoxicated while alone, and that this drinking is motivated by attempts to cope. Solitary heavy drinking is a potentially dangerous coping strategy for an individual experiencing suicidal ideation.     

国防生有自杀意念者心身健康状况及其危险因素的研究

目的探讨国防生有自杀意念者心身健康状况及其影响因素,以便有针对性的采取心理干预,提高其心身健康水平。方法随机整群抽取某高校国防生519名,采用《中国军人心身健康量表》测试心身健康水平,将第63条目＂有想死的念头＂得分等于1分定义为有自杀意念。同时采用《军人心理疾病预测量表》探讨其危险因素。结果国防生自杀意念的发生率为10.3%,除呼吸系、消化系和皮肤因子外,有自杀意念组心身健康量表总分、心理健康因子、躯体健康因子以及其余各因子分均显著高于无自杀意念组（P〈0.05或0.01）;相关分析的结果显示,有自杀意念者的焦虑、抑郁与其成长经历、个性内向、心理防御不良、社会支持缺乏呈显著正相关（r=0.277～0.666,P〈0.05或0.01）,个性内向、心理防御不良、社会支持缺乏、应激源与心身健康总分、心理健康因子分及躯体健康因子分亦呈显著正相关（r=0.292～0.691,P〈0.05或0.01）;经多元逐步回归分析发现,心理防御不良分别进入以有自杀意念者的心身健康总分、心理健康因子、躯体健康因子、焦虑及抑郁因子分为因变量的多元回归方程（P〈0.01）。结论国防生有自杀意念者心身健康状况较差,心理防御不良是自杀意念者心身健康状况的重要影响因素。     

Suicidal ideation and drinking to cope among college binge drinkers

Suicidality among college students is associated with binge drinking and alcohol-related problems. Consistent with motivational models of alcohol use, drinking to cope (DTC) is a significant intervening variable in the association between suicidal ideation and alcohol use and problems among students. This study examined whether several factors shown to be associated with both suicidal ideation and DTC (i.e., impulsivity, mood regulation expectancies, and coping skills) account for the relationship between these variables, as well as the associations of depression and hopelessness with DTC. Participants were 109 emerging adult (18- to 25-year-old) college students who reported at least one episode of binge drinking during a typical month in the past year. Hierarchical regression analyses revealed that while greater negative urgency and low negative mood regulation expectancies were significantly associated with DTC, suicidal ideation remained significantly associated with DTC, even when controlling for depression. Suicidal ideation showed a stronger association with DTC than either depression or hopelessness both before and after accounting for other variables. These findings suggest that suicidal ideation has a direct association with DTC, and that negative urgency and mood regulation expectancies may be useful treatments targets for reducing alcohol misuse among emerging adult students who experience suicidal ideation.     

The role of inflammatory cytokines in suicidal behavior: A systematic review

There is growing evidence that inflammatory mediators play a critical role in the pathophysiology of both major depression and suicidal behavior. Immunological differences have been reported in both major affective disorders and suicidal behavior. Specifically, increased levels of pro-inflammatory cytokines have been shown to correlate with the severity of depression and various cytokines have been identified as potentially important in understanding the pathophysiology of major affective disorders/suicidality. We aimed to conduct a systematic review of the current literature to investigate the association between inflammatory cytokines and suicidal behavior. Only articles from peer-reviewed journals were selected for inclusion in the present review. Most studies documented the association between suicidality and IL2, IL-6, IL-8, TNF-α and VEGF levels that have been found altered in suicidal behavior. The presence of major depressive disorder (MDD) with suicidal ideation/attempts was associated with differences in inflammatory cytokine profile when compared to that without suicidal ideation/attempts. Most suicide attempters or subjects with suicidal ideation showed an imbalance of the immune system but this does not imply the existence of a causal link. Also, not all studies demonstrated a positive correlation between inflammatory cytokines and suicidal behavior. Further additional studies should elucidate the molecular mechanisms of the immune activation pathways underlying suicidality.     

Study on risk factors of suicidal ideation in people with drug abuse

In Japan, the target mental disorders of preventive strategies for suicide had been limited to be mood disorder, but recently drug abuse are known to be significant as a cause of suicide because some researches has found the association between substance use disorder and suicidal behavior in Japan. However, the preventive plans for suicide of drug abusers has not been developed yet. In this study we would like to examine the risk factors of suicide ideation in Japanese drug abusers. We analyzed the data of 445 drug addicts from the Nationwide Research of Drug Addiction Rehabilitation Centers by Tokyo DARC and compared many variables including demographic factors, drug use status, family history, psychopathologies, treatment and daily life satisfactions between people with suicide ideations and without ideations. It was found that 182 cases (43.8%) had suicide ideations in a recent month, and that addicts who had suicide ideations had significantly shorter abstinence time, higher prevalence of victimized experiences before 15 years age, and more mental symptoms such as insomnia, depression, and psychotic symptoms, and more tendencies to use prescribed psychotropic drug than those without suicide ideation. These results suggested that to prevent suicide of drug abusers, we should pay attention to family histories, insomnia and abstinence periods, and help them recovery from psychological damages caused by childhood trauma without inappropriate medications.     

The dynamic relationship between insight and suicidal behavior in first episode psychosis patients over 3-year follow-up

Studies have established the high risk of suicide in first episode psychosis (FEP). Between 15% and 26% of FEP patients attempt suicide at least once before their first contact with psychiatric services and 2–5% die from suicide. Also, many patients with schizophrenia spectrum disorders lack insight into having a mental disorder. However, the relationship between insight changes and suicidal behavior in FEP remains poorly understood. In the present study information about suicidal behavior over a 3 years period was available on a cohort of 397 FEP patients, of whom 270 were assessed in the three dimensions of insight (into mental illness, the need for treatment, and the social consequences) at baseline, 1 and 3 years after treatment initiation. Survival analyses examined time to suicidal behavior in relation to (i) insight at baseline, (ii) the closest insight measure to the suicide attempt, and (iii) changes in insight during the follow-up. No associations were found between baseline insight dimensions and time to suicidal behavior. However, poor insight at the evaluation closest to the suicide attempt was associated with an increased risk of suicide. Stability of insight did not affect the risk of suicidal behavior, while changes in either direction were linked with an increased risk of suicidal behavior, particularly worsening insight. Insight in psychosis is a dynamic concept and we demonstrated the relationship between insight and suicide risk to be equally dynamic. Poor insight seems to increase the risk, especially when insight levels change. Repeated insight assessment to detect change from early psychosis may play a role in suicide prevention.     

New and incremental FDA black box warnings from 2008 to 2015

Background: The boxed warning (also known as ‘black box warning [BBW]’) is one of the strongest drug safety actions that the U.S. Food & Drug Administration (FDA) can implement, and often warns of serious risks. The objective of this study was to comprehensively characterize BBWs issued for drugs after FDA approval.

Methods: We identified all post-marketing BBWs from January 2008 through June 2015 listed on FDA’s MedWatch and Drug Safety Communications websites. We used each drug’s prescribing information to classify its BBW as new, major update to a preexisting BBW, or minor update. We then characterized these BBWs with respect to pre-specified BBW-specific and drug-specific features.

Results: There were 111 BBWs issued to drugs on the US market, of which 29% (n = 32) were new BBWs, 32% (n = 35) were major updates, and 40% (n = 44) were minor updates. New BBWs and major updates were most commonly issued for death (51%) and cardiovascular risk (27%). The new BBWs and major updates impacted 200 drug formulations over the study period, of which 64% were expected to be used chronically and 58% had available alternatives without a BBW.

Conclusions: New BBWs and incremental updates to existing BBWs are frequently added to drug labels after regulatory approval.     

Serotonin transporter gene expression predicts the worsening of suicidal ideation and suicide attempts along a long-term follow-up of a Major Depressive Episode

The quest for biomarkers in suicidal behaviors has been elusive so far, despite their potential utility in clinical practice. One of the most robust biological findings in suicidal behaviors is the alteration of the serotonin transporter function in suicidal individuals. Our main objective was to investigate the predictive value of the serotonin transporter gene expression (SLC6A4) for suicidal ideation and as secondary, for suicide attempts in individuals with a major depressive episode (MDE). A 30-week prospective study was conducted on 148 patients with a MDE and 100 healthy controls including 4 evaluation times (0, 2, 8 and 30 weeks). Blood samples and clinical data were collected and SLC6A4 mRNA levels were measured from peripheral blood mononuclear cells using RT-qPCR. We first demonstrated the stability and reproducibility of SLC6A4 mRNA expression measures over time in healthy controls (F=0.658; p=0.579; η²=0.008; ICC=0.91, 95% CI [0.87–0.94]). Baseline SLC6A4 expression level (OR=0.563 [0.340–0.932], p=0.026) as well as early changes in SLC6A4 expression between baseline and the 2^nd week (β=0.200, p=0.042) predicted the worsening of suicidal ideation (WSI) in the following 8 weeks. Moreover, changes in SLC6A4 expression between the 2^nd and 8^th weeks predicted the occurrence of a suicide attempt within 30 weeks (OR=10.976 [1.438–83.768], p=0.021). Altogether, the baseline level and the changes in SLC6A4 mRNA expression during a MDE might predict the WSI and the occurrence of suicidal attempts and could be a useful biomarker in clinical practice.     

护理干预对妄想性抑郁症自杀行为的影响

目的降低妄想性抑郁症患者的自杀行为发生率。方法选取本院从2011年1月～2013年1月所收治的130例抑郁症患者作为临床研究对象,将患者根据有无出现妄想症状分为妄想性抑郁症组和非妄想性抑郁症组两组,对患者有无自杀遗传史和有无发出自杀信号进行调查,同时提出针对性的护理措施。结果妄想性抑郁症患者中,有58.5%（38/65）的患者出现自杀行为;而非妄想性抑郁症患者中,有27.7%（18/65）的患者出现自杀行为。但由于发现及时,均无1例死亡。两组比较,差异有统计学意义（P〈0.05）。而两组患者的自杀方式差异无统计学意义（P〉0.05）。两组患者比较,自杀遗传史的差异无统计学意义（P〉0.05）。而自杀前发出语言信号与行为信号的差异则有统计学意义（P〈0.05）,非妄想性抑郁症患者多于妄想性抑郁症患者。结论妄想性抑郁症患者的自杀行为发生率较高,自杀信号较少,护理难度较大。因此我们辅以心理护理等多种护理方法,力求达到更好效果,为患者的恢复和生命健康贡献最大的力量。     

综合干预对降低精神病患者危险行为因素的作用探析

目的探讨综合干预对降低精神病患者危险行为因素的作用。方法选择本院2012年1月～2013年1月收治的100例精神病患者,分析其危险行为因素,并采取综合干预措施。结果综合干预后患者的危险行为级别与综合干预前比较明显降低,差异有统计学意义（P〈0．01）。与综合干预前比较,综合干预后肇事肇祸危险事件发生率明显降低,差异有统计学意义（P〈0．05）。结论综合干预可显著降低不良事件发生率,提高患者的遵医依从性,维护社会稳定,具有积极的意义。     

Unintentional overdose and suicide among substance users: A review of overlap and risk factors

Substance use is a risk factor for suicide, suicide attempts, and fatal and non-fatal overdose, but to date, little has been done to integrate the research on suicidal behavior and overdose among substance users. This study reviews the literature on suicide and overdose among substance users with the goal of illuminating the similarities and differences between these two events. A structured review resulted in 15 articles (describing 14 unique studies) published between 1990 and 2010 that examined both overdose and suicide in samples of substance users. There is some evidence that substance users who attempt suicide are more likely to report an overdose and vice versa. This relationship may be partially explained by the fact that overdose is a common method of suicide. The results of the literature review also indicate that substance users with a history of both events may represent a group with particularly poor psychological and social functioning and severe drug-related problems. Further research is needed to understand the overlap of, and differences between, suicide and accidental overdose among individuals who misuse substances, particularly individuals who primarily use substances other than heroin. An improved understanding of the interrelationships between suicide and unintentional overdose among individuals who use alcohol or drugs is necessary to guide the development of effective prevention and intervention approaches.     

Early initiation of substance use and subsequent risk factors related to suicide among urban high school students

OBJECTIVE: To examine the association between onset of substance use and risk factors related to suicide. METHOD: 1252 adolescents in two urban school districts completed surveys as part of a large, randomized controlled prevention effectiveness trial. Risk factors measured included depressive symptoms, suicide ideation, suicide ideation specifically with alcohol and/or drug use, endorsement of suicide as a personal option, and suicide attempt. RESULTS: In our final multivariate models that controlled for current substance use and demographic characteristics, we found that earlier onset of hard drug use among boys was associated with all five suicide risk factors. In comparison, among girls, earlier onset of regular cigarette smoking, getting drunk, and hard drug use was associated with some of suicide risk factors. CONCLUSIONS: The findings confirm the importance of screening for substance use in early adolescence. The association between early substance use and suicide risk factors differed by gender; both research and intervention efforts need to incorporate gender differences.