AbstractSuicidal ideation (SI) is a significant precursor and risk marker for suicide behaviors in major depressive disorder (MDD). Exploration of SI trajectory from a longitudinal framework are essential for treatment guidelines and clinical management of suicide risk. This study sought to explore SI trajectories and its associated clinical, sociodemographic characteristics, and initial treatment among patients with MDD.

自杀意念（SI）是重性抑郁障碍（MDD）自杀行为的重要前兆和风险标志物。从纵向框架探索SI轨迹对于治疗指南和自杀风险的临床管理至关重要。本研究旨在探讨MDD患者的SI轨迹及其相关的临床，社会人口学特征和初始治疗。

We used data from a non-interventional, national multi-centered prospective cohort study. 1 461 patients with MDD were included in the growth mixture modeling using SI at baseline, 2 weeks, 4 weeks, 8 weeks, 12 weeks, and 6 months, 9 months, and 12 months as the indicator. A multinomial regression was employed with SI trajectory as the outcome and anhedonia, depressive symptoms, atypical depressive symptoms, pharmacological treatments, and other covariates as the predictors.

我们使用了来自非介入性国家多中心前瞻性队列研究的数据。1461名MDD患者被纳入生长混合物模型，使用SI在基线，2周，4周，8周，12周，6个月，9个月和12个月作为指标。采用多项式回归，SI轨迹作为结果，快感缺失，抑郁症状，非典型抑郁症状，药物治疗和其他协变量作为预测因子。

Four distinct SI trajectories were identified: a consistently low SI trajectory(50.7%), a persistently mild SI trajectory(20.6%), a fast declined SI trajectory(8.9%), and a slowly declined trajectory(19.8%). Compared to those with a consistently low SI trajectory, a higher score of anhedonia was associated with an increased risk of experiencing persistently mild (RRR = 1.20, 95%CI: 1.05, 1.38) and slowly declined SI (1.54, 95%CI: 1.32, 1.80).

确定了四个不同的SI轨迹：持续低SI轨迹（50.7%），持续温和的SI轨迹（20.6%），快速下降的SI轨迹（8.9%）和缓慢下降的轨迹（19.8%）。与SI轨迹持续较低的患者相比，快感缺失评分较高与持续轻度（RRR=1.20,95%CI:1.05,1.38）和SI缓慢下降（1.54,95%CI:1.32,1.80）的风险增加有关。

Severity of depressive symptom was also positively associated with the risk of experiencing persistently mild (1.15, 95%CI: 1.13, 1.18) and slowly declined SI (1.17, 95%CI: 1.14, 1.21). And the risk of experiencing slowly declined SI was higher for those use SSRI(1.49, 95%CI: 1.02, 2.31), and for those use antidepressant and antipsychotic/mood stabilizer combined therapy (3.78, 95%CI: 1.48, 9.61).

抑郁症状的严重程度也与持续轻度（1.15，95%CI:1.13，1.18）和SI缓慢下降（1.17，95%CI:1.14，1.21）的风险呈正相关。使用SSRI（1.49,95%CI:1.02,2.31）和使用抗抑郁药和抗精神病药/情绪稳定剂联合治疗（3.78,95%CI:1.48,9.61）的患者SI缓慢下降的风险更高。

The findings of this study are potentially use.

这项研究的结果有潜在的用途。

IntroductionSuicide has long been a devastating public health concern. It is one of the global leading causes of death and injury—the overall global death toll from suicide was about one million per year, which indicating that one suicide death occurred every 40 s [1]. Suicide is frequently paired with mental health problems, of which major depressive disorder (MDD) remains the most commonly reported conditions associated with suicidal ideation (SI) and suicidal behaviors [2].

引言自杀长期以来一直是一个破坏性的公共卫生问题。它是全球主要的死亡和伤害原因之一。全球自杀死亡人数每年约为100万，这表明每40秒发生一次自杀死亡。自杀经常伴随着心理健康问题，其中重度抑郁症（MDD）仍然是与自杀意念（SI）和自杀行为相关的最常报告的病症（2）。

Large epidemiological studies have linked suicidal thinking and non-fatal suicide attempts with the presence of depressive symptoms [3, 4], and psychological autopsy showed that ~60% of people died by suicide have depressive disorders [5].SI appears to precede the decision of suicide acts [6]. More than half of the patients with major depressive disorders experienced SI and 95% of those who attempted suicide had reported SI [7].

大型流行病学研究将自杀念头和非致命自杀未遂与抑郁症状的存在联系起来[3，4]，心理尸检显示，自杀死亡的人中约有60%患有抑郁症[5]。SI似乎先于自杀行为的决定（6）。超过一半的重度抑郁症患者经历了SI，95%的自杀未遂者报告了SI（7）。

A study based on 17 countries showed that 60% of transitions from suicidal ideation to plan or attempts in depression occur within the first year after ideation onset [8, 9]. Though only a minority (<10%) of SI actually progress to suicidal attempts, SI remains a significant precursor and risk marker for suicide behaviors [6].

一项针对17个国家的研究表明，60%的自杀意念转变为抑郁症的计划或尝试发生在意念发作后的第一年内[8，9]。虽然只有少数（10%）的SI实际上进展为自杀未遂，但SI仍然是自杀行为的重要前兆和风险标志〔6〕。

A better understanding of the pattern and the predictors of SI for patients with MDD may help elucidate the link between depressive symptoms, suicidal thinking, and attempts, which is essential for the clinical management of suicide risk [10].However, SI is a heterogeneous phenomenon, and little is known about the relation between depressive symptoms and the emergence, as well as the change of SI, which requires exploration of SI trajectory from a longitudinal framework [11].

更好地了解MDD患者SI的模式和预测因子可能有助于阐明抑郁症状，自杀思维和企图之间的联系，这对于自杀风险的临床管理至关重要。然而，SI是一种异质现象，关于抑郁症状与出现之间的关系以及SI的变化知之甚少，这需要从纵向框架探索SI轨迹。

Recent research indicated that short-term SI trajectories were related to d.

最近的研究表明，短期SI轨迹与d有关。

Data availability

数据可用性

Data may be obtained from a third party and are not publicly available. The data were provided by Beijing Anding Hospital. These are third party data. Authors in this study have the right to use this dataset, but not the right to share and distribute. A deidentified minimal dataset of the quantitative data is available on request to researchers who meet the criteria for confidential information, by sending a request to gangwangdoc@ccmu.edu.cn..

数据可以从第三方获得，并且不公开。数据由北京安定医院提供。这些是第三方数据。本研究的作者有权使用此数据集，但无权共享和分发。符合保密信息标准的研究人员可以根据要求，通过向gangwangdoc@ccmu.edu.cn..

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Download referencesFundingCapital’s Funds for Health Improvement and Research Program (2022-4-2125) (Recipient: XZ). Beijing Municipal Science & Technology Commission (Z221100007422010) (Recipient: GW).Author informationAuthor notesThese authors contributed equally: Ruoxi Ding, Xuequan Zhu.Authors and AffiliationsPeking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, ChinaRuoxi DingBeijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, ChinaXuequan Zhu, Lei Feng, Le Xiao, Ling Zhang & Gang WangChina Center for Health Development Studies, Peking University, Beijing, ChinaPing HeAuthorsRuoxi DingView author publicationsYou can also search for this author in.

下载referencesFundingCapital的健康改善和研究基金计划（2022-4-2125）（收件人：XZ）。北京市科学技术委员会（Z2211007422010）（收件人：GW）。作者信息作者注意到这些作者做出了同样的贡献：丁若西，朱雪泉。作者和附属机构北京大学第六医院，北京大学心理健康研究所，国家卫生委员会心理健康重点实验室（北京大学），国家精神疾病临床研究中心（北京大学第六医院），北京，中国若西丁北京精神疾病重点实验室，国家精神疾病临床研究中心和国家精神疾病中心，首都医科大学北京安定医院，北京，中国朱雪泉，雷锋，乐啸，张玲和王刚北京大学健康发展研究中心，北京，中国平健康作者若西丁观点作者出版物您也可以在中搜索这位作者。

PubMed Google ScholarXuequan ZhuView author publicationsYou can also search for this author in

PubMed Google ScholarXuequan ZhuView作者出版物您也可以在

PubMed Google ScholarLei FengView author publicationsYou can also search for this author in

PubMed Google ScholarLei FengView作者出版物您也可以在

PubMed Google ScholarLe XiaoView author publicationsYou can also search for this author in

PubMed谷歌学术评论作者出版物您也可以在

PubMed Google ScholarLing ZhangView author publicationsYou can also search for this author in

PubMed Google ScholarLing ZhangView作者出版物您也可以在

PubMed Google ScholarPing HeView author publicationsYou can also search for this author in

PubMed Google ScholarPing HeView作者出版物您也可以在

PubMed Google ScholarGang WangView author publicationsYou can also search for this author in

PubMed Google ScholarGang WangView作者出版物您也可以在

PubMed Google ScholarContributionsRD initiated the study, analyzed data, and wrote the original manuscript. XZ provided advices on research design, data analysis, and manuscript writing. LF, LX, and LZ provided advices on manuscript writing. GW and PH originated the study, obtained the funding, supervised all aspects of its implementation, and contributed to writing the article.

PubMed Google ScholarContributionsRD发起了这项研究，分析了数据，并撰写了原始手稿。XZ为研究设计，数据分析和手稿撰写提供了建议。LF，LX和LZ为稿件撰写提供了建议。GW和PH发起了这项研究，获得了资金，监督了其实施的各个方面，并为撰写本文做出了贡献。

All authors contributed to and have approved the final manuscript.Corresponding authorsCorrespondence to.

所有作者都参与并批准了最终稿件。通讯作者通讯。

Ping He or Gang Wang.Ethics declarations

平和或王刚。道德宣言

Competing interests

相互竞争的利益

The authors declared no competing interests.

作者声明没有利益冲突。

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Reprints and permissionsAbout this articleCite this articleDing, R., Zhu, X., Feng, L. et al. Trajectories and predictors of suicidal ideation in clinical characteristics and pharmacological treatments for major depressive disorder: a study based on a national multi-centered prospective cohort.

转载和许可本文引用本文Ding，R.，Zhu，X.，Feng，L。等人。重性抑郁症临床特征和药物治疗中自杀意念的轨迹和预测因素：基于国家多中心前瞻性队列的研究。

Transl Psychiatry 14, 422 (2024). https://doi.org/10.1038/s41398-024-03115-3Download citationReceived: 09 February 2024Revised: 20 September 2024Accepted: 23 September 2024Published: 06 October 2024DOI: https://doi.org/10.1038/s41398-024-03115-3Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

Transl精神病学14422（2024）。https://doi.org/10.1038/s41398-024-03115-3Download引文收到日期：2024年2月9日修订日期：2024年9月20日接受日期：2024年9月23日发布日期：2024年10月6日OI：https://doi.org/10.1038/s41398-024-03115-3Share本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

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