心理痛苦、核心症状在精神疾病自杀未遂网络中的作用

Contributions of Psychological Pain and Core Symptoms to Suicide Attempt Networks among Patients with Mental Illness

目的:本文基于心理痛苦三因素模型,在抑郁症、双相障碍和精神分裂症混合样本中探索各疾病核心症状、心理痛苦对自杀未遂的贡献强弱及其可能的作用路径。方法:对101名抑郁症、156名双相障碍和61名精神分裂症患者进行临床量表评估,其中107名患者有自杀未遂史,211名患者无自杀未遂史。采用受试者操作特征曲线探究各变量对自杀未遂的分类效能,使用网络分析方法建立单个以及混合疾病样本的自杀未遂网络。结果:在疾病单样本和混合样本中,痛苦逃避对有、无自杀未遂史者区分效能最优;在所有精神疾病的自杀未遂网络中,痛苦逃避与自杀未遂均具有最强的直接正向联系,核心症状与自杀未遂的联系较弱且不稳定。结论:一般心理病理因素(心理痛苦),而非疾病核心症状是不同精神疾病人群自杀未遂的共享心理机制。

Objective:This study aims to explore whether general psychopathological factors are superior to core symptoms as possible triggers of suicide acts in patients with major depressive disorder(MDD),bipolar disorder(BD)and schizophrenia(SCZ)based on three-dimensional psychological pain model.Methods:101 patients diagnosed with MDD,156with BD,and 61 with SCZ were recruited.All participants were required to complete the interested measures.Receiver operating characteristic curve analysis was used to evaluate the predictive ability of the variables.Network analysis was employed to investigate the relationships between psychological pain,core symptoms,and suicide attempt within the clinical samples.Results:(1)The predictive performance of pain avoidance was superior to all core symptoms and other psychopathological factors in distinguishing suicide attempters from non-attempters in MDD,BD and SCZ samples,as well as in a mixed clinical sample.(2)Within the suicide attempt networks across all clinical samples,pain avoidance emerged as the variable most strongly and positively associated with the number of suicide attempts.Conclusion:Psychological pain,particularly pain avoidance,may serve as a shared trigger for suicide acts in patients with different mental illnesses.