JAMA Psychiatry：美国青少年自杀行为的发生率、相关因素与治疗

　　日前，发表在《美国医学会杂志·精神病学》（JAMA Psychiatry）上的一篇文章报告了美国共病再调查青少年附录的结果，主要涉及青少年终生自杀行为的发生率、相关因素与治疗情况。

　　尽管自杀是美国青少年的第三大死因，但青少年自杀行为的发生率、相关因素或前兆的治疗几乎尚不为人知。该调查旨在评价美国青少年自杀行为的终生发生率和前瞻性报道的暂时性原发性DSM-IV障碍与随后自杀行为的联系。

　　该调查选取了共计6483名13岁到18岁的青少年和他们的父母，通过面对面家访青少年并对青少年的父母进行问卷调查来收集青少年终生自杀意念、自杀计划和自杀企图方面的数据。

　　结果显示，在被调查者中，估计的自杀意念、自杀计划和自杀企图终生发生率分别为12.1%, 4.0% 和4.1%。在该项调查中，大多数有这些行为的青少年符合至少一项DSM-IV精神障碍的终生标准。大多数暂时的原发性恐惧/愤怒，痛苦，分裂行为和物质相关障碍明显地预测了二元变量模型中随后自杀行为的比值比升高。尽管许多障碍也是自杀计划和有计划的与无计划的自杀企图的预测因素，但与这些障碍最一贯的显著联系是与自杀意念的联系。大多数自杀的青少年接受过某些形式的心理治疗。大多数病例中，治疗先于自杀行为，但未能阻止这些自杀行为的发生。

　　在美国青少年中，自杀行为很常见，其发生率与成年人接近。大多数有自杀行为的青年之前就存在精神障碍。尽管这些障碍最有力地预测了自杀意念，但不同于那些最有力地预测从自杀意念到自杀计划和自杀企图的条件性转变。这些不同之处表明，对于自杀意念、自杀计划、有计划的自杀企图和无计划的自杀企图都需要特殊的预测和预防策略。

Prevalence, Correlates, and Treatment of Lifetime Suicidal Behavior Among Adolescents

Results From the National Comorbidity Survey Replication Adolescent Supplement

Context  

Although suicide is the third leading cause of death among US adolescents, little is known about the prevalence, correlates, or treatment of its immediate precursors, adolescent suicidal behaviors (ie, suicide ideation, plans, and attempts).

Objectives  

To estimate the lifetime prevalence of suicidal behaviors among US adolescents and the associations of retrospectively reported, temporally primary DSM-IV disorders with the subsequent onset of suicidal behaviors.

Design  

Dual-frame national sample of adolescents from the National Comorbidity Survey Replication Adolescent Supplement.

Setting  

Face-to-face household interviews with adolescents and questionnaires for parents.

Participants 

A total of 6483 adolescents 13 to 18 years of age and their parents.

Main Outcome Measures  

Lifetime suicide ideation, plans, and attempts.

Results  

The estimated lifetime prevalences of suicide ideation, plans, and attempts among the respondents are 12.1%, 4.0%, and 4.1%, respectively. The vast majority of adolescents with these behaviors meet lifetime criteria for at least one DSM-IV mental disorder assessed in the survey. Most temporally primary (based on retrospective age-of-onset reports) fear/anger, distress, disruptive behavior, and substance disorders significantly predict elevated odds of subsequent suicidal behaviors in bivariate models. The most consistently significant associations of these disorders are with suicide ideation, although a number of disorders are also predictors of plans and both planned and unplanned attempts among ideators. Most suicidal adolescents (>80%) receive some form of mental health treatment. In most cases (>55%), treatment starts prior to onset of suicidal behaviors but fails to prevent these behaviors from occurring.

Conclusions  

Suicidal behaviors are common among US adolescents, with rates that approach those of adults. The vast majority of youth with suicidal behaviors have preexisting mental disorders. The disorders most powerfully predicting ideation, though, are different from those most powerfully predicting conditional transitions from ideation to plans and attempts. These differences suggest that distinct prediction and prevention strategies are needed for ideation, plans among ideators, planned attempts, and unplanned attempts.