自杀研究中生活事件量表不同信息来源的一致性

目的比较生活事件量表在自杀研究中不同信息来源下的一致性。方法纳入104例自杀未遂和147例自杀死亡案例。每个案例都分别由1名家属和1名亲友报告案例对象在自杀行为前经历过的生活事件,自杀未遂者本人也报告自己在自杀行为前经历过的生活事件,用生活事件量表进行评估。采用Kappa值、组内相关系数(intraclass correlation coefficient,ICC)等指标评估生活事件量表的不同信息来源之间的一致性。结果自杀未遂者本人和2名知情人报告的夫妻关系、自身患病、家庭关系、家人去世等类型生活事件的一致性接近中等及以上水平(Kappa≥0.39),而本人与知情人之间慢性压力总分及急性应激强度得分的一致性较低(ICC为0.11~0.24)。自杀者的2名知情人在配偶去世、工作学习、自身患病类生活事件上的一致性达到中等及以上水平(Kappa≥0.49),慢性压力总分一致性一般(ICC=0.47)。结论在自杀研究中运用结构化的生活事件量表从知情人处获得自杀者或未遂者的生活事件信息比较可靠。     

负性生活事件与自杀行为研究

目的 评估自杀研究用生活事件量表的效度并了解负性生活事件在自杀行为发生中的影响机制.方法 制定了一个由调查员询问填写的自杀研究用生活事件量表,以有自杀行为者为研究对象,调查[1]926例自杀死亡和756例其他伤害死亡案例(对照组)的家属和周围知情人;[2]570例自杀未遂者本人及其知情亲友,并对其中212例按年龄(±5岁)、性别配对从急诊非自杀病人的家属中选择对照进行调查.结果 两种信息来源(死者家属与周围知情人;或自杀未遂者与陪伴亲友)的同一生活事件评估指标之间的相关性较强(自杀死亡调查中急性应激强度的秩和相关系数为0.67,慢性心理压力为0.69;自杀未遂调查中分别为0.75和0.68).多因素Logistic回归分析显示,自杀当时的急性应激强度和自杀前1年内的慢性心理压力均是自杀行为发生的独立危险因素.结论 自制"自杀研究用生活事件量表"的效度良好.负性生活事件导致的急性应激和慢性心理压力对自杀行为的影响机制相对独立.     

15～24岁人群自杀特征及危险因素的病例对照研究

目的了解全国15～24岁自杀死亡者的特征,并通过与其他伤害死亡案例的比较了解青年自杀的危险因素。方法由精神科医师运用心理解剖方法对全国有地理代表性的23个疾病监测点上报的15～24岁的88例自杀案例(自杀组)和76例其他伤害死亡案例(对照组)的家属和周围知情人进行深入调查。结果(1)自杀组的平均受教育年限为(6.2±3.2)年,59%为女性,88%居住在乡村,82%服毒或服药自杀,26%为现婚,76%自杀前一直在工作或学习,26%有自杀未遂既往史,14%有血缘关系的人曾有自杀行为,31%朋友或熟人有过自杀行为,50%自杀当时有精神疾病,18%曾因心理问题寻求过帮助。(2)有既往自杀未遂史(经单因素分析)、自杀前2周有抑郁症状、自杀当时急性应激强度大和自杀前1个月生命质量低(后3项经多因素logistic回归分析)是自杀的危险因素。结论15～24岁自杀死亡者中50%有精神疾病,仅极少数自杀死亡者曾因心理问题寻求帮助。自杀未遂既往史、近2周有抑郁症状、经历急性负性生活事件和近1个月生命质量低为青年自杀死亡的主要危险因素。     

农村未遂自杀者的再自杀意念及相关因素研究

目的探讨农村未遂自杀者再自杀意念的发生率及其相关因素。方法以乡镇卫生院近2年的抢救记录为调查线索,共完成74例自杀未遂者的调查,对其再自杀意念进行评定,并用SDS和FES对其抑郁症状和家庭环境进行评估,收集其一般资料。结果74例自杀未遂者中有48例(64.86%)有不同程度的再自杀意念,48例有再自杀意念者的SDS得分(42.42±7.64)明显高于26例无再自杀意念者(33.58±9.52)(t=4.35,P<0.001),有再自杀意念组的家庭亲密度、成功性、文化性、娱乐性和组织性均较无再自杀意念组差,家庭矛盾性较对照组突出。多元逐步回归分析显示,影响自杀未遂者再自杀意念的主要危险因素为:家庭成功性、SDS总分和家庭矛盾性。结论64.86%的自杀未遂者在其后的一段时期内仍存在不同程度的再自杀意念,而且再自杀意念主要与患者的家庭环境和患者的抑郁症状有关。     

有严重躯体疾病老年自杀死亡者的特征及其有无精神障碍者间的比较

目的了解有严重躯体疾病的老年自杀死亡者的特征并比较有无精神障碍者特征的异同。方法由精神科医师运用心理解剖方法对全国23个疾病监测点上报的≥55岁的304例自杀案例的家属和周围知情人进行调查,分析其中178例(58.6%)报告自杀死亡前1年内有严重躯体疾病者的自杀特征。结果178例自杀死亡者中,女性占41.6%;79.2%居住在乡村;58.4%从未上过学;38.8%丧偶;25.8%有自杀未遂既往史;10.7%一级血缘亲属有自杀行为;43.3%服农药或鼠药自杀,32.6%上吊;68.0%自杀当时有精神障碍,主要是重性抑郁障碍;仅5.1%自杀当时有人在场。有、无精神障碍者在社会人口经济学特征、有无自杀未遂史和自杀行为家族史、负性生活事件导致的慢性心理压力和急性应激强度以及自杀前一个月的生命质量等方面的差异无统计学意义(P均大于0.05)。结论有严重躯体疾病老年人自杀死亡最常见的两种方式是服毒和上吊,2/3有精神障碍,但有无精神障碍者的自杀相关特征无明显不同。     

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。     

分裂症未遂自杀和抑郁

经病人和普通人口自杀的流行病学研究证实,精神分裂症患者常发生未遂自杀。大多数研究发现,伴有抑郁症状是识别精神分裂症有无未遂自杀的最通常的精神病理学因素。本研究目的在于详尽探讨疾病复发时和6个月后病情缓解时,未遂自杀和抑郁之间的关系,更确切地说,阐明疾病急性期过后,未遂自杀与抑郁症是否相关。方法:受试者为连续住院的50例精神分裂症患者,根据修订的精神现状检查表(PSE)检查病人和与病人亲属交谈所收集的资料,符合DSM-Ⅲ精神分裂症诊断标准,受试者均接受抗精神病药物治疗。有中枢神     

中国农村严重自杀未遂危险因素的配对病例对照研究(英文)

背景中国农村的自杀率是城市自杀率的2~3倍,但造成城乡自杀率之巨大差异的原因并不清楚。目的评估国内农村严重自杀未遂者的特征及危险因素。方法精神科医生采用结构式问卷对山东郓城县人民医院急诊室收治的297例严重自杀未遂者(至少在医院6小时者)及其陪伴的家属分别进行访谈。该问卷内容详尽,完成问卷需要2~3h。对照组选取同一居住地中年龄、性别与自杀未遂组相匹配的、既往无自杀未遂史的居民及其同住家庭成员,分别进行同样的结构式访谈。使用Cox回归模型来识别自杀未遂的危险因素。结果 297例自杀未遂者中,74%为女性,78%是农民,平均(标准差)年龄为33.2(14.6),平均受教育年限为4.8(3.1)年,80%为口服农药自杀,57%的自杀未遂者报告在采取自杀行动之前考虑自杀只有或不足5分钟,76%的自杀意图量表中计划分量表得分不足50分(0~100分),11%有过自杀未遂史,只有38%存在符合DSM-IV诊断标准的精神障碍。在控制性别、年龄、居住地以及之前的自杀未遂史(在配对分析中控制该变量)后,通过多因素分析,自杀未遂的危险因素包括:受教育水平低、与有过自杀行为的人交往、之前1年中至少有4次负性生活事件、之前1个月中生活质量低且家庭不够和睦、之前2周内的抑郁症状得分高以及冲动性和攻击性高(最后一项仅在小样本中进行评估)。结论我国农村严重自杀未遂者多数不符合精神障碍的诊断标准,冲动性和攻击性高、自杀意图并不强烈,多采用口服农药的方式。这些特点与高收入发达国家的特点不同,因而需要采取不同的方法来预防自杀行为。这些方法应更多的关注如何降低获取农药的便利性,并教育冲动性个体如何自我调整情绪和行为,而不是过度地关注精神障碍的识别和治疗。     

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。     

综合医院自杀未遂者精神障碍和自杀意念强度特征

目的探讨自杀未遂者精神障碍和自杀意念强度特征,为自杀未遂的心理危机干预策略提供参考。方法在沈阳市4所三级综合医院急诊室同一时段内收集到资料完整的239例自杀未遂者,以贝克自杀意念量表(BSS)评估自杀意念及其强度,以汉密尔顿抑郁量表(HAMD)评定自杀前1周的抑郁程度。精神障碍诊断标准按照美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)。结果①自杀未遂者总的精神障碍发生率为69.46%(166/239),前3位依次为:心境障碍47.70%(114/239),焦虑障碍38.91%(93/239),精神病性障碍8.37%(20/239);②有自杀意念的自杀未遂组总的精神障碍发生率为84.34%(140/166),其中心境障碍和焦虑障碍的发生率分别为61.45%(102/166)和48.19%(80/166),均明显高于从无自杀意念组(P0.01);HAMD总分以及其中焦虑/躯体化、体重减轻、认知障碍、日夜变化、迟缓、睡眠障碍、绝望感等因子中的项目得分明显高于从无自杀意念组(P0.01);③在有自杀意念的自杀未遂患者中,有精神障碍组BSS中13个条目的自杀意念强度较无精神障碍组高(经秩和检验,P0.05)。结论自杀未遂者中以精神障碍患者居多,且有自杀意念并伴精神障碍的自杀未遂者其自杀意念严重程度更重。     

Validity and reliability of surrogate information for controls in a case-control study on Alzheimer's disease

This study is aimed to investigate proxy respondent's information usefulness in retrospective studies by comparing information obtained with a questionnaire (with a total of 171 items) from controls and their proxy respondents in a case-control study on Alzheimer's disease. Kappa indices and intraclass correlation coefficients were calculated to assess reliability, and bias factor and mean differences were calculated to assess validity. Proxy respondent's personal features (gender, age and relationship with the index subject) were also studied. Kappa indices and intraclass correlation coefficients were in general good or very good (>0.6), specially regarding control's personal and family data (ranges 0.45-1 for Kappa and 0.86-0.99 for intraclass correlation coefficient) and occupational exposures (range for Kappa 0.48-1). No systematic biases were found (range for bias factor 0.65-4.12 and range for mean differences -1.81-1.30, none of them statistically significant). Proxy respondent's individual features were not found to systematically affect reliability. The use of surrogate information for controls in etiologic case-control studies of Alzheimer's disease may be useful without unacceptable loss of information or systematic biases.     

Parsing the clinical phenotype of depression: the need to integrate brief depressive episodes

OBJECTIVE: To expand the concept of recurrent brief depression (RBD) to brief depression (BD) and to test its clinical relevance. METHOD: Subjects (N = 591) were studied prospectively six times from ages 20/21 to 40/41 years. RBD was defined according to DSM-IV as episodes under 2 weeks with about monthly recurrence and work impairment. BD embraces RBD and brief depressive episodes with a frequency of 1-11 per year. RESULTS: Pure BD and pure major depressive episodes (MDE) did not differ in treatment rates, family history of mood and anxiety disorders or comorbidity with bipolar spectrum and anxiety disorders but they differed in work impairment, suicide attempt rates and distress self-ratings. The combination of BD + MDE identified a very severe group of MDE, comparable with combined depression (MDE + RBD) and double depression (MDE + dysthymia). CONCLUSION: Our data argue for the use of BD as a diagnostic specifier for severe MDE. RBD remains an important independent subgroup.     

Prevalence,demographic and clinical correlates of suicide attempts in Chinese medicated chronic inpatients with schizophrenia

The high prevalence of suicide in schizophrenia may be related to its demographic and clinical characteristics. Because suicide prevalence and its associations with clinical variables are less well characterized in Chinese than European patients with schizophrenia, we assessed the suicide attempts in 520 Chinese inpatients with schizophrenia. The suicide attempt data were collected from medical case notes and interviews with the patients and their family members. Patients were rated on the Positive and Negative Syndrome Scale (PANSS), the Simpson and Angus Extrapyramidal Symptom Rating Scale (SAES), and the Abnormal Involuntary Movement Scale (AIMS). Smoking severity was evaluated using clinician-administered questionnaires and the Fagerstrom Test for Nicotine Dependence (FTND). We found a suicide attempt rate of 9.2% in these schizophrenic inpatients. The attempters were single, had a significantly younger age but more hospitalizations, had higher depressive symptoms, and began smoking at an earlier age, smoked more cigarettes each day and had higher FTND total scores than patients without suicide attempts. The logistic regression analysis also indicated that suicide attempts were associated with the number of hospitalizations, depressive symptoms and FTND total scores. These results suggest that Chinese inpatients with schizophrenia attempt suicide more often than the general population. Further, some demographic and clinical variables are risk factors for suicide attempts in schizophrenia.     

住院重性抑郁发作患者自杀未遂保护性因素的研究

目的：探讨住院重性抑郁发作（MDE）患者自杀未遂的保护性因素。方法收集当前符合DSM －IV MDE标准的住院患者，进行人口学调查问卷、自杀意念及自杀未遂调查表、汉密尔顿抑郁量表（HAMD）、贝克绝望量表（BHS）、生存理由量表中文版（RFL －C）评定。根据RFL －C来确定在抑郁发作期间可以用来预防或抑制自杀未遂的因素。结果筛查的214例住院情感障碍患者中，101例符合MDE标准。96例纳入最终分析，63例（65．6％）无自杀未遂史。和有自杀未遂史者比，无自杀未遂的患者更多为男性、BHS得分低，而RFL －C总分、生存和应对信念、家庭责任、对自杀的恐惧、对社会排斥的恐惧因子分均高。RFL －C总分及各因子分均与BHS得分呈负相关。结论生存和应对信念、家庭责任、对自杀的恐惧、对社会排斥的恐惧可能是重性抑郁发作患者自杀未遂的保护性因素，较高的RFL －C得分可能抑制绝望观念。     

A 2–4 year follow up of depressive symptoms, suicidal ideation, and suicide attempts among adolescent psychiatric inpatients

One hundred eleven (58%) of 191 adolescent inpatients previously admitted to the emergency wards at the Child and Adolescent Psychiatric Clinics in the cities of Uppsala and Göteborg participated in a 2–4 year follow-up evaluation. The prevalence, incidence, and stability of depressive symptoms, suicidal ideation, and suicide attempts among the adolescents, and predictors of follow-up functioning were examined. Although a majority of the patients substantially reduced their depressive symptoms over the 2–4 year period, a smaller group (13%), mainly girls (94%), continued reporting high symptom levels at follow-up, and one out of five adolescents had moderate-severe levels of suicidal ideation. The accumulated frequency of suicide attempts among the patients shortly prior to hospitalization and during the follow-up was 59% including two patients who committed suicide. Significant predictors of depressive symptom severity at follow-up were depressive symptom scores and V-diagnoses at inpatient assessment. Previous suicide attempts before hospitalization, high levels of self-reported depressive symptoms and nonintact family status at inpatient assessment predicted suicide attempts during the follow-up period. The high prevalence of attempted and completed suicide in this clinical group underscores the importance of developing effective treatments for suicidal adolescents.     

The validity of proxy-based data in suicide research: a study of patients 50 years of age and older who attempted suicide. II. Life events, social support and suicidal behavior.

OBJECTIVE: To investigate the validity of proxy respondent reports of stressful life events, social support and suicidal behavior among individuals who attempted suicide. METHOD: Subjects were 80 psychiatric in-patients admitted following a suicide attempt. Data based on structured interviews with proxy respondents were compared with data based on interviews with subjects (gold standard). RESULTS: Specificity was higher than sensitivity across life event categories, and agreement was substantial for public and observable events (e.g. parent's death) but lower for more ambiguous events. Proxies were good judges of subject reports of frequency of social interaction but not perceived emotional support. Proxies were good judges of past history of suicide attempts and level of suicidal intent. CONCLUSION: Results support proxy-based data on suicidal behavior and certain aspects of social support and stressful life events in research of suicidal behavior in this age group, with potential implications for interpreting postmortem research of completed suicide.     

The prevalence, clinical relevance, and public health significance of subthreshold depressions.

Scientific evidence has accumulated during the last 15 years establishing that SD symptoms have a high prevalence in the general population and in clinically depressed patient cohorts studied cross-sectionally or followed longitudinally. The clinical relevance and public health importance of SD symptoms were confirmed when various investigators, including the authors' group at University of California, San Diego, found that SD symptoms are associated with a significant and pervasive impairment of psychosocial function when compared to no depressive symptoms. There is strong evidence that all levels of depressive symptom severity of unipolar MDD are associated with significant psychosocial impairment, which increases significantly and linearly with each increment in level of symptom severity. It is only when MDD patients are completely symptom free that psychosocial function returns to good or very good levels. The disability associated with depression is state dependent, and disability returns to good or normal levels only when all of the depressed patients' symptoms abate, because disability is present when even a few symptoms (i.e., SD symptoms) are detected. There is strong evidence during the long-term course of illness that major, minor, dysthymic, and subsyndromal symptoms wax and wane within the same patient and that these symptomatic periods are interspersed in the overall course with times when patients are remitted and symptom free. The modal longitudinal symptom status of MDD patients involves primarily subthreshold depressive symptoms, which are much more common than symptoms at the syndromal MDE level. The longitudinal systematic examination of the clinical relevance and high prevalence of SD symptoms helped establish the fact that the long-term symptomatic expression of MDD is dimensional, not categorical, in nature. Abatement of SD symptoms is of fundamental importance in defining full remission or recovery of MDEs. Ongoing residual SD symptoms during the recovery periods after an MDE are associated with psychosocial disability, more rapid MDE relapse, and a more severe chronic future course of illness, all of which indicate that when residual SD symptoms are present the MDE has not fully remitted and the disease is still active. When all depressive symptoms of an MDE abate for a minimum of 8 weeks, then full remission has been achieved. MDE remission defined in this way is associated with significant delay or even prevention of future episode relapse and a less severe, relapsing, and chronic future course. The authors submit that the research reviewed in this article heralds a new paradigm in understanding the progression of clinical depression through various overlapping stages of severity, which begin at the seemingly "subclinical" level of depressive symptoms. This conceptualization in turn dictates a public health approach, which emphasizes that treatment of MDD even at the deceptively mild levels of symptoms should be initiated or maintained.     

Suicide attempt and suicidal ideation and their associations with demographic and clinical correlates and quality of life in Chinese schizophrenia patients

Objectives

This study aimed to examine the prevalence and correlates of lifetime suicide attempts and current suicidal ideation in community-dwelling schizophrenia patients in China.

Method

A sample of 540 schizophrenia patients was randomly selected in Beijing, China. All subjects were interviewed using standardized assessment instruments and their basic socio-demographic and clinical data including history of suicide attempts were collected.

Results

The prevalence of lifetime suicide attempts and the point prevalence of suicidal ideation were 12.0 %, and 21.1 %, respectively. In multiple logistic regression analyses, the presence of lifetime suicide attempt was independently associated with rural residence, having major medical conditions and better social functioning, while higher likelihood of current suicidal ideation was associated with past suicide attempt, the severity of overall psychopathology and depressive symptoms and lower psychological quality of life (QOL).

Conclusion

Among Chinese outpatients with schizophrenia, increased current symptoms and poorer QOL were correlated with current suicidal ideation, while demographic factors and indicators of greater social support were mostly correlated with lifetime suicide attempts. This study may help to identify important subgroups of patients with schizophrenia at particularly high risk of suicidal behavior.     

Depressive symptoms and depressive episodes in recently widowed older men

Older widowers have high rates of completed suicide but have rarely been the subject of systematic inquiry. We investigated the prevalence of depressive symptoms and major depressive episodes (MDEs) in recently widowed older men over the first 13 months after bereavement. We employed a matched-pair longitudinal design and recruited subjects from a suburban community population. Fifty-seven recently widowed older men were identified from official death records and 57 matched married men were identified from the electoral roll. Subjects were assessed for the presence of current DSM-III-R MDEs using the Composite International Diagnostic Interview (CIDI), a fully structured psychiatric interview. Widowers were assessed at 6 weeks after bereavement (T1) and 13 months after bereavement (T2). Married men were assessed at similar intervals. At T1, seven widowers (12.3%) and no married men were found to have CIDI cases of current MDE. At T2, one widower (1.9%) and no married men were found to have CIDI cases of current MDE. Current MDE was not predicted by a past history of dysphoria. At T1, 14.0% (8/57) of widowers reported specific suicidal thoughts or actions. At T2, 15.4% (8/52) of widowers reported suicidal thoughts or actions. We conclude that health workers should monitor closely the clinical course of MDEs in recently widowed older men. Routine inquiry about suicidal ideation should be an essential component of the clinical assessment of recently widowed older men.