自杀意念及其风险因素的短时波动探索

Short-time Fluctuation Exploration of Suicidal Ideation and Its Risk Factors

目的:在有自杀史的精神科住院病人中,探索自杀意念及其风险因素在短时间内如何变化以及三种风险因素对短期自杀意念的预测效力。方法:采用方便取样对天津市某精神病院27名有自杀史的住院病人进行自然住院周期内(1-28天)每日随机4次的自杀意念生态瞬时评估(实时纸笔作答,累计评估538天,共计完成1883次评估,整体遵从率90.9%)。结果:几乎所有被试的自杀意念及其风险因素在研究期内经历了相当大的变化,自杀意念及其风险因素的时间序列均遵循锯齿形的变化模式。多层线性模型显示,同一时刻的绝望、归属受挫、累赘感知与自杀意念显著相关,但在控制前一时刻的自杀意念后,三种风险因素均与数小时后的自杀意念不相关。此外,自杀意念在一天之内遵循显著的线性增长模式。结论:在有自杀史的精神科住院病人中,自杀意念及其三种风险因素均具有短时波动性,自杀意念从早到晚呈逐渐加重的趋势;绝望、归属受挫以及累赘感知均不能显著预测短期自杀意念。

Objective:To explore how suicidal ideation and its risk factors change in a short time and the predictive effectiveness of three risk factors on short-time suicidal ideation in Chinese psychiatric inpatients with a history of suicide.Methods:Selected by convenient sampling method,27 inpatients with a history of suicide in one psychiatric hospital in Tianjin were arranged to participate in one ecological momentary assessment of suicidal ideation,which was randomly assessed four times a day during natural hospitalization(ranging from 1 to 28 days,using real-time paper-pen answering method,total assessment days=538,total completed assessment times=1883,overall compliance rate=90.9%).Results:For nearly all participants,suicidal ideation and its risk factors varied dramatically during the study period.The time series of suicidal ideation and its risk factors all followed a sawtooth pattern.According to the multilevel linear model,hopelessness,thwarted belongingness,perceived burdensomeness and suicidal ideation at the same time were significantly correlated.However,when previous suicidal ideation was controlled,none of the three risk factors were associated with suicidal ideation a few hours later.In addition,suicidal ideation within one day followed one significant linear growth pattern.Conclusion:Among Chinese psychiatric inpatients with a history of suicide,suicidal ideation and its three risk factors have fluctuations in a short time and the intensity of suicidal ideation gradually increases from morning to night;but none of hopelessness,thwarted belongingness,perceived burdensomeness can effectively predict short-time suicidal ideation.