Résumés
Résumé
Objectif Le taux de mortalité par suicide parmi les personnes souffrant d’un trouble de la personnalité du groupe B (TPB) se situe autour de 20 %. La haute prévalence de comorbidités anxiodépressives ainsi que l’abus de substances majorent ce risque. Selon des études récentes, l’insomnie persistante serait aussi un facteur de risque suicidaire dans ce groupe clinique. Les mécanismes expliquant cette association sont peu connus. Il a été proposé que des facteurs psychopathologiques comme la dysrégulation émotionnelle ou l’impulsivité pourraient agir comme médiateurs dans ce lien entre l’insomnie et le suicide. Afin de bien comprendre la relation insomnie-suicide dans le TPB, il est important d’identifier le rôle des comorbidités.
L’étude comporte deux objectifs. Le premier vise à comparer la sévérité des symptômes d’insomnie et le niveau d’impulsivité d’un groupe avec TPB à ceux d’un groupe contrôle, le deuxième tente d’établir les relations entre l’insomnie, l’impulsivité, les comorbidités anxiodépressives, l’abus de substance et le risque suicidaire.
Méthode Étude transversale portant sur 138 patients (âge moyen = 33,74 ; 58,7 % femmes) ayant un TPB. Les données de ce groupe, obtenues à partir d’une base de données d’un institut en santé mentale québécois (banque Signature : www.banquesignature.ca) ont été comparées à celles d’un groupe de 125 sujets sains appariés sur l’âge et le sexe et sans historique de trouble mental. C’est à l’admission aux urgences psychiatriques que le diagnostic de TPB a été déterminé à l’aide d’une entrevue diagnostique et que des questionnaires autorapportés mesurant l’anxiété, la dépression, l’impulsivité et l’abus de substances ont été remplis par les participants. Les participants du groupe contrôle se sont rendus au centre Signature afin de compléter ces mêmes questionnaires. Une matrice corrélationnelle et une régression linéaire multiple ont été utilisées pour explorer les relations entre les variables.
Résultats Le groupe avec TPB présentait des symptômes d’insomnie plus élevés et des niveaux d’impulsivité supérieurs par rapport au groupe contrôle, à l’exception du temps total de sommeil. Dans le modèle de régression, la satisfaction envers le sommeil, le manque de préméditation, l’urgence positive, la dépression et l’utilisation de substances étaient significativement associés aux scores au Suicidal Behavior Questionnaire-Revised (SBQ-R). Ce modèle expliquait 46,7 % de la variance des scores au SBQ-R.
Conclusion Les résultats ont permis de mettre en évidence, pour la première fois, les éléments d’insomnie et d’impulsivité qui distinguent un groupe avec TPB par rapport à un groupe contrôle sain. Cette étude indique que l’insomnie et l’impulsivité pourraient être des facteurs de risque suicidaire dans le TPB, indépendamment des comorbidités et de l’utilisation de substances. De futures études permettront de vérifier la pertinence clinique potentielle de ces éléments de risque pour cette patientèle.
Mots-clés :
- trouble de la personnalité du groupe B,
- insomnie,
- suicide,
- anxiété,
- dépression,
- abus de substances,
- abus d’alcool,
- impulsivité,
- comorbidités psychiatriques
Abstract
Objective The suicide mortality rate among people suffering from cluster B personality disorders is estimated at approximately 20%. High occurrence of comorbid depression and anxiety, as well as substance abuse, are known contributors to this risk. Not only have recent studies indicated that insomnia may be a suicide risk factor, but it is also thought to be highly prevalent in this clinical group. However, the mechanisms explaining this association are still unknown. It has been suggested that emotion dysregulation and impulsivity may mediate the link between insomnia and suicide. In order to better understand the association between insomnia and suicide in cluster B personality disorders, it is important to consider the influence of comorbidities.
The aims of this study were first to compare the levels of insomnia symptoms and impulsivity between a group of patients with cluster B personality disorder and a healthy control group and second, to measure the relationships between insomnia, impulsivity, anxiety, depression, substance abuse and suicide risk within the cluster B personality disorder sample.
Methods Cross-sectional study including 138 patients (mean age = 33.74; 58.7% women) with cluster B personality disorder. Data from this group were extracted from a Quebec-based mental health institution database (Signature bank: www.banquesignature.ca) and were compared to that of 125 healthy subjects matched for age and sex, with no history of personality disorder. Patient diagnosis was determined by diagnostic interview upon admission to a psychiatric emergency service. Anxiety, depression, impulsivity and substance abuse were also assessed at that time point via self-administered questionnaires. Participants from the control group visited the Signature center to complete the questionnaires. A correlation matrix and multiple linear regression models were used to explore relations between variables.
Results In general, more severe insomnia symptoms and higher levels of impulsivity distinguished the group of patients with cluster B personality from the sample of healthy subjects, although groups did not differ on total sleep time. When all variables were included as predictors in a linear regression model to estimate suicide risk, subjective sleep quality, lack of premeditation, positive urgency, depression level and substance use were significantly associated with higher scores on the Suicidal Questionnaire-Revised (SBQ-R). The model explained 46.7% of the variance of scores at the SBQ-R.
Conclusion This study yields preliminary evidence indicating the possible implication of insomnia and impulsivity in suicide risk for individuals with cluster B personality disorder. It is proposed that this association seems to be independent of comorbidity and substance use levels. Future studies may shed light on the possible clinical relevance of addressing insomnia and impulsivity in this clinical population.
Keywords:
- cluster B personality disorder,
- insomnia,
- suicide,
- anxiety,
- depression,
- substance abuse,
- alcohol abuse,
- impulsivity,
- psychiatric comorbidity
Parties annexes
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