心理学
精神病理学
自杀意念
烦躁
重性抑郁障碍
萧条(经济学)
焦虑
傍晚
双相情感障碍
临床心理学
昼夜节律
精神科
毒物控制
伤害预防
医学
心情
神经科学
物理
环境卫生
天文
经济
宏观经济学
作者
Paola Salvatore,Premananda Indic,Hari-Mandir K. Khalsa,Mauricio Tohen,Ross J. Baldessarini,Carlo Maggini
摘要
<b><i>Background:</i></b> Identifying suicidal risk based on clinical assessment is challenging. Suicidal ideation fluctuates, can be downplayed or denied, and seems stigmatizing if divulged. In contrast, <i>vitality</i> is foundational to subjectivity in being immediately conscious before reflection. Including its assessment may improve detection of suicidal risk compared to relying on suicidal ideation alone. We hypothesized that objective motility measures would be associated with vitality and enhance assessment of suicidal risk. <b><i>Methods:</i></b> We evaluated 83 adult-psychiatric outpatients with a DSM-5 bipolar (BD) or major depressive disorder (MDD): BD-I (<i>n</i> = 48), BD-II (20), and MDD (15) during a major depressive episode. They were actigraphically monitored continuously over 3 weekdays and self-rated their subjective states at regular intervals. We applied cosinor analysis to actigraphic data and analyzed associations of subjective psychopathology measures with circadian activity parameters. <b><i>Results:</i></b> Actigraphic circadian mesor, amplitude, day- and nighttime activity were lower with BD versus MDD. Self-rated vitality (wish-to-live) was significantly lower, self-rated suicidality (wish-to-die) was higher, and their difference was lower, with BD versus MDD. There were no other significant diagnostic differences in actigraphic sleep parameters or in self-rated depression, dysphoria, or anxiety. By linear regression, the difference between vitality and passive suicidal ideation was strongly positively correlated with mesor (<i>p</i> < 0.0001), daytime activity (<i>p</i> < 0.0001), and amplitude (<i>p</i> = 0.001). <b><i>Conclusions:</i></b> Higher circadian activity measures reflected enhanced levels of subjective vitality and were associated with lesser suicidal ideation. Current suicidal-risk assessment might usefully include monitoring of motility and vitality in addition to examining negative affects and suicidal thinking.
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