Суицидальное поведение в контексте посттравматического стрессового расстройства — психиатрические и психосоциальные аспекты

   Обоснование: стресс и травма играют важную роль в патогенезе ПТСР и суицида, однако суицидальное поведение при ПТСР охарактеризовано недостаточно.

   Цель описательного обзора — представить новейшие и наиболее доказательные данные о связи суицидального поведения (под которым понимается широкий спектр проявлений — от суицидальных мыслей и попыток до завершенного суицида) с психиатрическим диагнозом ПТСР, либо с отдельными симптомами этого расстройства у разных контингентов.

   Материал и методы: поиск информации осуществлялся в базах данных PubMed и eLibrary, а также в монографических изданиях, с учетом степени доказательности.

   Результаты: имеющиеся данные убедительно свидетельствуют о том, что ПТСР является не приоритетным, но существенным фактором повышенного риска суицида, особенно в сочетании с депрессией и аддикциями. Чем в большей степени тот или иной контингент подвержен травматическому стрессу, тем сильнее проявляется связь между симптомами ПТСР и суицидальным поведением. Влияние ПТСР на суицидальность в значительной степени опосредовано коморбидностью и выраженностью психосоциальной дезадаптации, которая часто сопутствует ПТСР. Зависимость от травмирующего события и стресс-уязвимость выступают общими звеньями патогенеза ПТСР, депрессии и суицида.

   Заключение: в клинической практике наличие диагноза или признаков ПТСР является основанием для более пристального внимания к суицидальным тенденциям пациента и адресного использования мер превенции. На популяционном уровне необходимо стремиться к укреплению общей жизнестойкости и стрессоустойчивости населения.

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