快感缺失对于MDD自杀意念与自杀行为的影响机制研究

The Influence Mechanism of Anhedonia on Suicidal Ideation and Suicidal Behavior in MDD

目的:考察在MDD患者的自杀意念形成阶段以及自杀“意念-行为转换”阶段,快感缺失各维度的作用及其机制。方法:通过访谈法以及Beck自杀意念量表、Beck抑郁量表、时间性愉快体验量表等评估277例重性抑郁障碍患者的一般人口学和临床资料,并采用分层回归分析、logistics回归分析、中介模型构建等方法对数据进行分析。结果:伴动机成分的消费性快感缺失可预测当前的自杀意念(β=-0.13,P<0.05),而伴动机成分的期待性快感缺失可预测最严重时的自杀意念(β=-0.17,P<0.05),并分别在抑郁程度到当前自杀意念和抑郁到最严重自杀意念间起部分中介作用。快感缺失各维度均无法预测自杀行为,但自杀能力在自杀意念向行为转换中起部分中介作用。结论:自杀意念形成和自杀意念向行为演变过程涉及不同的心理机制,伴动机的快感缺失是MDD自杀意念形成的关键因素,但不是自杀意念向行为转化的关键因素。自杀能力是介导自杀“意念-行为转换”的重要因素。

Objective:To explore the effects and mechanisms of each dimension of anhedonia between the formation stage of suicidal ideation and the“ideation-behavior transition”stage in major depressive disorder patients.Methods:The demographic and clinical characteristics of 277 patients with major depressive disorder were evaluated by interview,Beck Suicidal Ideation Scale,Beck Depression Scale and The Temporal Experience of Pleasure Scale.Results:Consummatory and anticipatory anhedonia with motivational component predicted the current and the worst suicidal ideation,respectively(β=-0.13,P<0.05;β=-0.17,P<0.05).Consummatory anhedonia with motivational component had a partial mediating effect on the association between depression and current suicidal ideation,and anticipatory anhedonia with motivational component had a partial mediating effect on the association between depression and the worst suicidal ideation.All dimensions of anhedonia could not predict suicidal behavior,but capability for suicide played a partial mediating role in the transition from suicidal ideation to behavior.Conclusion:The development of suicidal ideation and the progression from suicidal ideation to behavior are distinct processes with distinct psychological mechanism.The motivational anhedonia is a key factor in the formation of suicidal ideation,but not in the transition of suicidal ideation into behavior.Capability for suicide is an important factor mediating ideation-behavior transition.