Heterogeneity in the Course of Suicidal Ideation and its Relation to Suicide Attempts in First-Episode Psychosis: A 5-Year Prospective Study.

IF 3.3 3区 医学 Q2 PSYCHIATRY
Roxanne Sicotte, Srividya N Iyer, Éric Lacourse, Jean R Séguin, Amal Abdel-Baki
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引用次数: 1

Abstract

Objectives: Although the risk of suicide is high in first-episode psychosis (FEP), little is known about the course of suicidal ideation and its relation to suicide attempts. Therefore, we aimed to identify 5-year trajectories of suicidal ideation and associated factors in FEP and compare how suicide attempts were distributed across these identified trajectories.

Method: This 5-year prospective study assessed suicidal ideation, suicide attempts and potentially associated factors through research interviews, chart review and coroners' reports in 382 FEP patients [mean age = 23.53 (SD = 3.61)] admitted to 2 5-year early psychosis services in Montreal, Canada. Trajectories were identified using a semiparametric mixture model, and associated factors with multinomial logistic regression.

Results: Three suicidal ideation trajectories were identified: low and decreasing (n = 325, 85.08%); early decline, then increasing (n = 30, 7.85%), and persistent suicidal ideation (n = 27, 7.07%). Suicidal ideation prior to admission (OR = 2.85, 95% CI, 1.23 to 6.63, P < 0.05) and cocaine use disorder (OR = 6.78, 95% CI, 1.08 to 42.75, P < 0.05) were associated with the early decline, then increasing suicidal ideation trajectory. Persons with prior suicide ideation (OR = 4.33, 95% CI, 1.66 to 11.29, P < 0.05) and attempts (OR = 8.18, 95% CI, 2.39 to 27.97, P < 0.001) and alcohol use disorder (OR = 3.63, 95% CI, 1.4 to 9.42, P < 0.05) were more likely to belong to the persistent suicidal ideation trajectory, and to attempt suicide during follow-up.

Conclusions: Our study highlights heterogeneity in the course of suicidal ideation over 5 years and the importance of ongoing assessment of suicidal risk in FEP patients, particularly for patients who persistently report suicidal ideation, as they are likelier to engage in suicide attempts. Patients with factors associated with increasing or persistent suicidal ideation trajectories should be targeted for suicide prevention interventions from the early phase of follow-up. Given the small number of persons in these trajectories and the wide CIs for some factors, larger studies are however needed to further characterize who belongs in each group.

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首次发作精神病患者自杀意念过程的异质性及其与自杀企图的关系:一项为期5年的前瞻性研究。
目的:尽管首发精神病(FEP)的自杀风险很高,但对自杀意念的过程及其与自杀企图的关系知之甚少。因此,我们旨在确定FEP中自杀意念的5年轨迹和相关因素,并比较自杀企图在这些确定的轨迹中的分布情况。方法:这项为期5年的前瞻性研究通过研究访谈、图表回顾和验尸报告评估了382名FEP患者的自杀意念、自杀企图和潜在相关因素[平均年龄 = 23.53(标准差 = 3.61)]在加拿大蒙特利尔接受2项为期5年的早期精神病服务。使用半参数混合模型识别轨迹,并使用多项式逻辑回归确定相关因素。结果:确定了三种自杀意念轨迹:低和下降(n = 325,85.08%);早期下降,然后增加(n = 30,7.85%),以及持续的自杀意念(n = 27.7.07%)。入院前有自杀意念(OR = 2.85,95%置信区间,1.23至6.63,P P 早期下降,然后自杀意念轨迹增加。有自杀意念的人(或 = 4.33,95%置信区间,1.66至11.29,P P P 持续的自杀意念轨迹,以及在随访期间尝试自杀。结论:我们的研究强调了5年来自杀意念过程的异质性,以及持续评估FEP患者自杀风险的重要性,特别是对于持续报告自杀意念的患者,因为他们更有可能进行自杀尝试。具有与自杀意念轨迹增加或持续相关因素的患者应从随访的早期阶段就应成为自杀预防干预的目标。考虑到这些轨迹中的人数较少,并且某些因素的CI较宽,因此需要进行更大规模的研究来进一步确定每组中的成员。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.00
自引率
2.50%
发文量
69
审稿时长
6-12 weeks
期刊介绍: Established in 1956, The Canadian Journal of Psychiatry (The CJP) has been keeping psychiatrists up-to-date on the latest research for nearly 60 years. The CJP provides a forum for psychiatry and mental health professionals to share their findings with researchers and clinicians. The CJP includes peer-reviewed scientific articles analyzing ongoing developments in Canadian and international psychiatry.
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