急診科患者自殺風險的心理危險因素網絡結果分析

A Network Outcome Analysis of Psychological Risk Factors Driving Suicide Risk in Emergency Department Patients

——《自然/心理健康》2025年，第3卷，第3期——

<Nature /Mental Health> Volume 3, Issue 3, 2025

【摘要】不同的自殺理論提出了導致自殺想法和行為的心理因素，但略有不同。例如，貝克的自殺理論強調無望感，而人際心理學自殺理論則強調負擔、缺乏歸屬感以及對死亡的無畏。令人驚訝的是，很少有研究檢驗過哪些理論上提出的心理因素最能預測自殺想法和行為。我們使用網絡結果分析來梳理這些概念在預測自殺意念、自殺計劃和自殺未遂方面的影響。研究對象為1412名因精神疾病到急診科就診的患者，並在一個月和六個月後進行了隨訪評估（n=938）。結果表明，不同的心理因素可以預測自殺想法和行為的不同階段。缺乏歸屬感最能預測自殺意念（偏相關（pcor）=0.14），獲得死亡能力（即無懼死亡）最能預測自殺計劃（pcor=0.08），而絕望最能預測自殺未遂（pcor=0.12）。個體與死亡的外顯關聯（即死亡=我）前瞻性地預測了所有這三種結果（pcor=0.13-0.23）。使用來自幾種不同自殺理論的構造可以最好地預測自殺意念和行為的發生。未來的理論和實證研究應整合現有理論的組成部分。

[Abstract] Different theories of suicide propose somewhat different psychological factors that lead to suicidal thoughts and behaviors. For example, Beck’s theory highlights hopelessness, while the interpersonal–psychological theory of suicide emphasizes burdensomeness, lack of belonging and fearlessness about death. Surprisingly, few studies have tested which theoretically proposed psychological factors are most predictive of suicidal thoughts and behaviors. We used network outcome analysis to disentangle the effects of these constructs in predicting suicidal ideation, suicide plans and attempts. Participants were 1,412 patients presenting to an emergency department with psychiatric complaints, with follow-up assessments one month and six months (n = 938) later. Here we showed that different psychological factors predicted different parts of the continuum of suicidal thoughts and behaviors. Lack of belongingness was most predictive of suicidal ideation (partial correlation (pcor) = 0.14), acquired capability for death (that is, fearlessness of death) was most predictive of suicide planning (pcor = 0.08), and hopelessness was most predictive of suicide attempts (pcor = 0.12). Individuals’ explicit associations with death (that is, death = me) prospectively predicted all three outcomes (pcor = 0.13–0.23). The occurrence of suicidal thoughts and behaviors is best predicted using constructs from several different theories of suicide. Future theoretical and empirical work should integrate components of existing theories.

論文原文：René Freichel, Matthew K. Nock & Brian A. O’Shea (2025). A network outcome analysis of psychological risk factors driving suicide risk in emergency department patients. Nature /Mental Health, Volume 3, Issue 3, Pages 346–353.

https://doi.org/10.1038/s44220-025-00389-4 

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