上海地区自杀死亡与未遂者冲动攻击人格特征、急性生活事件等危险因素重要性及其脑电生理特征的病例对照研究

Findings from our previous studies suggest that one important reason for China's high rate and unique pattern of suicides is that many impulsive self-destructive acts in persons who do not intend to die and have no pre-existing mental illness-who would be classified as suicide attempts in other countries-result in death due to the lethality of the method employed (primarily pesticides) and the lack of effective resuscitation services, particularly in rural areas. If this hypothesis about the substantial overlap of so-called 'failed attempts' and completed suicides in China is true, it would have major implications for the development and promulgation of suicide prevention activities in the country. We have developed reliable Chinese versions of the Barratt Impulsiveness Scale and the Buss and Perry Aggression Questionnaire; so we are now able to directly asses the relative importance of impulsive and aggressive personality traits, acute life events, mental illness and other risk factors in both attempted and completed suicides and, thus, estimate the degree of 'psychological overlap' between attempted and completed suicides. We have just completed a related study in four rural parts of North China; the goal of the current study is to assess the role of these factors in suicide in urban China. These findings will help direct the subsequent development of a comprehensive suicide prevention plan for the Shanghai Municipality. Hypotheses 1. Acute life events and high levels of impulsiveness and aggressiveness are independent predictors of attempted and completed suicide after controlling for other risk factors (such as mental illness, prior attempts, etc.). 2. The level of impulsiveness and aggressiveness reported by proxy informants of persons who attempt suicide is not statistically different than that reported by proxy informants of persons who complete suicide. The psychological impact of acute precipitating life events prior to completed suicides and attempted suicides is similar. The objectively measured level of suicidal intent (based on information provided by proxy informants) in at least 30% of completed suicides is relatively low-lower than the median level of assessed suicidal intent in attempted suicides. 3. There are significant differences in the central serotonergic functioning of persons who make suicide attempter compared to that in control subjects as assessed using the Loudness Dependent Auditory Evoked Potential (LDAEP) methodology. This study aims to systematically assess the relative importance of impulsive and aggressive personality traits and triggering life events in both attempted and completed suicides in Shanghai China.

我国部分冲动性自杀死亡者实际的死亡意图较低但自杀方式致死性高，对其中诱发事件、冲动攻击性等任何环节的干预都可能逆转死亡结局。本项目拟以伤病死亡和社区人群作为对照，开展上海市自杀死亡与自杀未遂的危险因素调查，希望评估可以逆转冲动性自杀行为死亡结局的因素，并结合既往农村研究的结果，全面分析自杀人群的危险因素和城乡差异。同时探索自杀者脑电生理特征，寻找自杀行为的生物学指标。项目假设为：1.急性生活事件、冲动和攻击性较高（控制其他危险因素如精神疾病或既往自杀未遂史等）是自杀未遂与自杀死亡重要的预测因子；2.自杀未遂与自杀死亡两者比较：知情人所报告的冲动性和攻击性程度无明显差异；促发自杀行为的急性生活事件所导致心理变化相似。根据知情人提供的相关信息客观评估自杀意图，至少有30%自杀死亡者的自杀意图低于自杀未遂者的平均水平。3.强度依赖的听觉诱发电位可反映自杀者中枢五羟色胺能功能下调而作为生物学指标。

背景：在西方国家，超过90%的自杀未遂者伴有某种精神疾病的诊断，但是，国内的多个研究发现国内自杀未遂者伴有精神障碍的概率不足一半。为了探索导致这个重要区别的原因，本研究旨在在控制精神疾病患病情况和其它危险因素的条件下评估冲动和攻击人格对导致自杀行为的重要性，以及自杀行为与冲动行为的关键生物标记物LDAEP之间的关系。.研究方案：在银川市第一人民医院就诊的自杀未遂者会先接受自杀相关行为的筛查。150例符合入组标准且签署知情同意书的自杀未遂者及其一名家属独立进行以下评估：a）一组在既往研究中已经验证过信效度的关于冲动、攻击和其它危险因素的量表；b）由经过培训的精神科医师进行规范的SCID精神科诊断；c) 20分钟的LDAEP事件相关电位测试。同时，对150名社区健康对照进行同样的全套评估。.课题启动延迟说明：在上海的综合医院进行了近两年的原始项目计划预试验后，我们得出结论，我们无法在上海的综合医院收集到足够的自杀未遂案例完成本项目。我们当时考虑将研究方案调整为在国家伤害监测系统的基础上发展额外的自杀未遂登记系统，与国家疾控中心和其选择的9家医院进行了多次筹备会议。上海精神卫生中心伦理委员会认为该方案与原始方案出入太大，所以我们最终在这9家国家CDC推荐的医院中选择了报告自杀未遂数最多的且院内有精神科的银川市第一人民医院执行课题的原始方案。同时，课题也获批一个大型的中加合作国自然项目，在目前与银川市第一人民医院执行的方案基础上，对自杀未遂患者进行干预，减少其再次自杀的可能性。.当前进展：我们已经获得了在银川市第一人民医院进行该项目的伦理审批件、与该医院签订了科研合作协议、制定并完善了项目量表、与相关部门召开了合作会议并开始项目相关培训。第一批案例会在2018年4月入组，所有案例会在2019年内完成案例收集工作。.结论：本研究会对在国内制定如何预防未患精神疾病的人员出现自杀行为提供重要的信息。

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