青少年心境障碍伴自杀未遂患者的决策特征  

Decision characteristics in adolescents with mood disorders and suicide attempts

作　　者：倪婷珺陶 李孟哲 李婉容 赵汗青 曹庆久[4] 安莉 NI Tingjuntao;LI Mengzhe;LI Wanrong;ZHAO Hanqing;CAO Qingjiu;AN Li(School of Education,Tianjin University,Tianjin 300354,China;Tianjin University,Institute of Applied Psychology,Tianjin 300354,China;Laboratory of Suicidology,Tianjin Municipal Education Commission,Tianjin 300354,China;Peking University Sixth Hospital,Peking University Institute of Mental Health,NHC Key Laboratory of Mental Health(Peking University),National Clinical Research Center for mental Disorders(Peking University Sixth Hospital),Beijing 100083,China)

机构地区：[1]天津大学教育学院,天津300354 [2]天津大学应用心理研究所,天津300354 [3]天津市自杀心理与行为研究实验室,天津300354 [4]北京大学第六医院,北京大学精神卫生研究所,国家卫生健康委员会精神卫生学重点实验室(北京大学),国家精神心理疾病临床医学研究中心(北京大学第六医院),北京100083

出　　处：《中国心理卫生杂志》2024年第3期247-253,共7页Chinese Mental Health Journal

基　　金：国家精神心理疾病临床医学研究中心(北京大学第六医院)自主探索课题(20210121);天津大学自主创新基金(2021XSC-0003)。

摘　　要：目的:通过计算模型来分析青少年自杀未遂者不同维度的决策特征。方法:总共纳入符合疾病和有关健康问题的国际统计分类第十次修订本(ICD-10)心境障碍诊断标准的伴自杀未遂的青少年心境障碍患者70例,非自杀未遂的青少年心境障碍患者40例,以及正常青少年对照49例。使用金钱选择问卷(MCQ)、爱荷华博弈任务(IGT),并采用计算模型分析,考察青少年自杀未遂者的冲动性决策和基于价值和学习的决策表现和潜在认知成分。结果:自杀未遂组、非自杀未遂组和正常对照组在MCQ中的总体延迟折扣率差异无统计学意义(均P>0.05);自杀未遂组和非自杀未遂组的总体延迟折扣率高于正常对照组(P<0.05);3组被试在IGT中的净分数得分差异无统计学意义(P>0.05)。计算模型分析显示,相比于非自杀未遂组和正常对照组,自杀未遂组表现出对结果的敏感性降低以及探索性降低(参数估计80%HDI不重叠)。结论:青少年自杀未遂者可能无法通过对决策的结果进行学习,无法探索更多可能的方案来解决危机,而冲动性决策损害可能与抑郁状态而非自杀未遂有关。Objectives:To analyze the performance and characteristics of adolescent suicide attempters in different dimensions of decision making,a computational model was used in this study.Methods:A total of 70 adolescent suicide attempters with mood disorders meeting the International Statistical Classification of Diseases and Related Health Problems,Tenth Revision(ICD-10)diagnosis,40 non-suicide attempters with mood disorder,and 49 normal controls were included.By using the MCQ and IGT and through computational model analysis,the adolescent suicide attempters′performance and underlying cognitive components in impulsive decision making and value-and learning-based decision making were analyzed.Results:The overall delay discounting rates showed no significant differences(P>0.05)among the group of suicide attempters,patient controls,and normal controls in the MCQ.This rate was significantly higher in suicide attempters and non-suicide attempters than in normal controls(P<0.05);there was no significant difference between the three groups of subjects′decision making performance in the IGT(P>0.05).Computational model analysis revealed that compared to non-suicide attempters and normal controls,suicide attempters showed reduced sensitivity to the outcome as well as reduced exploratory behavior(Parameter estimate with non-overlapping 80%HDI).Conclusion:Adolescent suicide attempters may not be able to learn from the outcome of the decision and explore more possible options to resolve the crisis,as well as impulsive decision-making impairment may be associated with depressed states rather than suicide attempts.

关 键 词：青少年 自杀未遂 决策特征 计算模型 

分 类 号：C913.9[经济管理] R749.94[社会学]