急诊科患者自杀风险的心理危险因素网络结果分析

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】不同的自杀理论提出了导致自杀想法和行为的心理因素，但略有不同。例如，贝克的自杀理论强调无望感，而人际心理学自杀理论则强调负担、缺乏归属感以及对死亡的无畏。令人惊讶的是，很少有研究检验过哪些理论上提出的心理因素最能预测自杀想法和行为。我们使用网络结果分析来梳理这些概念在预测自杀意念、自杀计划和自杀未遂方面的影响。研究对象为1412名因精神疾病到急诊科就诊的患者，并在一个月和六个月后进行了随访评估（n=938）。结果表明，不同的心理因素可以预测自杀想法和行为的不同阶段。缺乏归属感最能预测自杀意念（偏相关（pcor）=0.14），获得死亡能力（即无惧死亡）最能预测自杀计划（pcor=0.08），而绝望最能预测自杀未遂（pcor=0.12）。个体与死亡的外显关联（即死亡=我）前瞻性地预测了所有这三种结果（pcor=0.13-0.23）。使用来自几种不同自杀理论的构造可以最好地预测自杀意念和行为的发生。未来的理论和实证研究应整合现有理论的组成部分。

[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.

论文原文：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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