抑郁发作患者认知功能对自杀行为的影响

Impact of cognitive function on suicidal behavior in patients with depressive episodes

目的本研究旨在分析抑郁发作患者自杀意念和自杀行为的认知功能差异性,探索认知功能对自杀行为的影响。方法选取来自首都医科大学附属北京安定医院就诊的抑郁发作患者133例,依据两周内是否存在自杀行为和意念分为以下3组:无自杀症状的抑郁对照组(depression control,DC组)、伴自杀意念组(suicidal ideation,SI组)和伴自杀行为组(suicide attempt,SA组)。采用汉密尔顿抑郁量表17项(Hamilton Depression Scale-17 item,HAMD-17)、自杀意念量表(the Scale for Suicide Ideation,SSI)和精神分裂认知功能成套测验共识版(MATRICS Consensus Cognitive Battery,MCCB)分别评估患者的临床症状和认知功能。采用Logistic回归对各相关因素进行分析。结果3组HAMD-17总分比较差异有统计学意义(F=59.661,P<0.001),事后比较发现SA组和SI组HAMD-17总分显著高于DC组。MCCB结果显示,DC组言语学习和记忆分数显著高于SI组(P<0.05),DC组和SA组推理和问题解决分数显著高于SI组(P<0.05)。Logistic回归结果显示,推理和问题解决能力(P=0.022,OR=1.067,95%CI:1.009~1.127)、认知障碍因子(P=0.001,OR=1.739,95%CI:1.238~2.443)是抑郁发作患者发生自杀行为的独立危险因素,复发(P=0.003,OR=0.100,95%CI:0.022~0.458)和社会认知(P=0.033,OR=0.953,95%CI:0.912~0.996)是抑郁发作患者发生自杀行为的保护性因素。结论认知功能缺陷是影响抑郁发作患者产生自杀行为的重要因素。

Objective To analyze the cognitive functional differences in patients with depressive episodes regarding suicidal ideation and suicidal behavior,and further to explore the impact of cognitive functioning on suicidal behavior.Methods A total of 133 patients with depressive episodes who sought treatment at Beijing Anding Hospital,Capital Medical University,were selected and divided into three groups based on the presence of suicidal behavior and ideation within the past two weeks:depression control(DC)group,suicidal ideation(SI)group,and suicide attempt(SA)group.The Hamilton Depression Scale-17 item(HAMD-17),the Scale for Suicide Ideation(SSI),and the MATRICS Consensus Cognitive Battery(MCCB)were used to assess the patients clinical symptoms and cognitive functioning.Logistic regression analysis was applied to analyze various factors.Results The total HAMD-17 scores of the three groups(F=59.661,P<0.001)showed statistically significant differences,with post hoc comparisons revealing significantly higher scores in the SA and SI groups compared to the DC group.MCCB results indicated that the DC group had significantly higher scores in verbal learning and memory compared to the SI group(P<0.01),and both the DC and SA groups had significantly higher scores in reasoning and problem-solving compared to the SI group(P<0.05).Logistic regression results revealed that reasoning and problem-solving(P=0.022,OR=1.067,95%CI:1.009-1.127)and cognitive impairment factors(P<0.001,OR=1.739,95%CI:1.128-2.2443)were independent risk factors for suicidal behavior in patients with depressive episodes,and recurrent(P=0.003,OR=0.100,95%CI:0.022-0.458)and social cognition(P=0.033,OR=0.953,95%CI:0.912-0.996)were protective factors for suicidal behavior in patients with depressive episodes.Conclusion Cognitive impairment is a crucial factor influencing the occurrence of suicidal behavior in patients with depressive episodes.