自杀未遂干预,治疗中的几个相关问题

自杀未遂是自杀的高危因素已被人们所公识,据随访研究,４—１２％的自杀未遂者日后会再次自杀,对自杀死亡者的回顾性调查也发现,４２％的男性自杀者,６３％的女性自杀者,以及近半数的精神病自杀者,在既往史中有过自杀行为［１］。因此,对自杀未遂者进行有效的干预...     

为什么女性自杀未遂率显著高于男性

目的 :通过对男女自杀未遂者特征的比较 ,了解女性自杀未遂率显著高于男性的原因。方法 :由经过严格培训的调查员用自制调查表对综合医院诊治的病情较重的 3 2 6例自杀未遂病人进行调查 ,并做出精神科诊断 (根据DSM -IV诊断标准 ) ,然后比较男女自杀未遂者 (女 2 48例 ,男 78例 )的特征。结果 :男女自杀未遂者在平均年龄、家庭经济与环境状况、既往自杀未遂次数、自杀方式、自杀意图强度、负性生活事件数目及其对心理的影响程度、精神障碍总的患病率等方面差异无统计学意义。而且男女自杀未遂者前三位常见的负性生活事件相同 :夫妻吵架或不和、生活规律的重大变化和经济困难。但与男性相比 ,女性接受正规教育的年限短 ,现婚的比例高 ,自杀前一直在工作的比例高 ,同住家人的平均年龄较小 ,自杀前一个月内与不同成年家属的接触天数之和较少 ,酒精依赖的患病率低 (P均 <0 0 5 )。结论 :农村地区病情较重的男女自杀未遂者多数与自杀有关的关键特征相似 ,因此需要进一步寻找导致女性自杀未遂率显著高于男性的关键因素。     

服农药与其他方式自杀未遂者的特征

目的:比较服农药与其他方式自杀未遂留院观察者的特征。方法:本研究是横断面研究,以我国6省市9所市县级综合医院为研究现场,由经培训的调查员用自制调查表对留院观察的617例自杀未遂者及家属等知情者进行调查,主要了解自杀意图强度、生活事件、生命质量等,并由精神科医师做精神科诊断。诊断依据美国精神障碍分类与诊断标准第4版(the Diagnostic and Statistical Manual of Mental Disorders-IV DSM-IV)进行。用非条件logistic回归模型分析自杀的危险因素。结果:617例被试以女性为主,占74%,平均年龄(33±13)岁,平均受教育年限(5.5±3.4)年。将被试分为服农药组468例,其他方式组149例,服农药组居住农村比例高(OR=4.7,95%CI=3.1~7.1)。控制居住地、性别和年龄后,服农药组受教育年限低(OR=2.6,95%CI1.6~4.1),家庭人均月收入低(OR=1.8,95%CI=1.2~2.8),生命质量高(OR=1.9,95%CI=1.2~2.8),前2天有急性严重生活事件影响(OR=2.6,95%CI=1.7~3.8),客观自杀意图强度低(OR=3.4,95%CI=2.2~5.1),诊断为精神障碍比例低(OR=0.4,95%CI=0.3~0.6),既往有自杀未遂史者所占比例低(OR=0.4,95%CI=0.2~0.6),但亲友或熟人自杀者所占比例高(OR=1.9,95%CI=1.3~2.9)。结论:服农药自杀者客观自杀意图强度低,且自杀前多存在急性严重生活事件。     

农村地区综合医院诊治的自杀未遂病人的特征

目的 :我国每年至少有 2 0 0万人自杀未遂 ,但对其特征缺乏了解 ,因此难以建立并实施任何有效的干预及预防措施。为此 ,本研究着重了解主要服务于农村地区的综合医院自杀未遂病人的特征。方法 :由经过严格培训的调查员用自制调查表对 4所市县级综合医院留院观察的 3 2 6例自杀未遂病人及其家属进行调查 ,并由精神科主治医师做出精神科诊断 (以DSM -IV为诊断标准 ) ;每个案例需 2～ 3小时。结果 :被调查的自杀未遂者的特征如下 :平均年龄 3 2岁 (标准差 =13 ) ,76%为女性 ,75 %已婚 ,78%住在乡村 ,家庭经济状况与当地人经济状况相近 ;65 %自杀前发生夫妻吵架或不和 ;83 %服农药 ;77%的服毒者服用家里存放的物品 ;5 4%属于冲动性自杀 (自杀前考虑自杀的时间≤ 2小时 ) ;自杀当时 40 %患精神障碍 (以心境障碍为主 ) ,其中仅 3 0 %寻求过帮助、 16%看过精神科。结论 :与西方发达国家相比 ,国内农村地区自杀未遂者精神障碍的患病率显著低 ,自杀方式以服农药为主。因此 ,我国的自杀预防及干预措施不能从国外照搬 ,为了解决我国这一巨大的公共卫生问题 ,需要尽快开展高质量的全国性项目以评价不同干预措施的效果     

自杀死亡与自杀未遂病人自杀原因及自杀方式比较

自杀死亡与自杀未遂病人自杀原因及自杀方式比较谢巧明四川绵阳精神卫生中心自杀是比较文化精神病学的重点研究课题之一，有报告自杀是人类十大死因之一［１］，自杀行为包括自杀死亡和自杀未遂。本文收集我院记载完整的自杀住院病例１１６例，按是否救治成功分为自杀死亡...     

保定市2004-2008年自杀行为流行病学分析

目的 了解急诊科自杀未遂者流行病学情况,为预防自杀和危机干预提供护理对策.方法 收集了保定市4家医院急诊科近5年内收治的2121例自杀行为者的资料,并进行了流行病学分析.结果 自杀比例女性高于男性(女性所占比例为77.56%),乡村高于城市(农村占55.68%;城市占44.32%.);自杀方式以服毒居多;91.87%自...     

自杀未遂者社会心理因素和临床特点对照研究

目的：了解自杀未遂者的社会心理因素及临床特点。方法：本研究对７６名自杀未遂者进行了调查,对其中部分自杀未遂者进行了心理量表评定,并作出了精神病学诊断,以３１名正常人为对照。结果：１自杀未遂者中年轻女性多见;自杀方式绝大多数为服药或服毒;自杀未遂者中一半患精神障碍。２自杀未遂者早年与父母分离比例较高,自杀未遂者早年得到父母情感温暖与理解明显少于正常对照。３自杀未遂者具有焦虑、病态人格和疑心等性格特点。４自杀未遂者的个体素质因素是自杀未遂发生的主要原因。     

抑郁症与精神分裂症自杀未遂的临床分析

对４２例抑郁症与４７例精神分裂症自杀未遂患者进行临床分析，结果显示，抑郁症病人起病多较急，常有明显的精神刺激因素，绝望，早醒和精神运动性抑郁等症状较多而幻听较少，未遂自杀率为２８．６％，较精神分裂症组（２２．９％）高。     

农村女性自杀未遂者的相关因素研究

目的：研究农村女性自杀未遂者自杀行为的相关因素,方法：应用自编的自杀未遂者自杀原因与方式调查表,家庭环境量表,心理健康测查表,对128名自杀未遂者进行测查,评定,并进行1：1的对照研究。结果：自杀未遂者的自杀原因主要为婚恋家庭矛盾（43．8％）,邻里关系矛盾（25．8％）;自杀方式主要为服毒服药（49．2％）,自溺（25．8％）、自缢（16．4％）,研究组与对照组在家庭亲密度、文化性、娱乐性,组织性的不满意程度上及家庭矛盾性方面有显著性差异（P＜0．01）。自杀未遂者具有焦虑、疑心、抑郁、脱离现实等人格特征。自杀组中22例能出精神病学诊断,结论：农村女性产生自杀未遂行为与其人格特征,不良家庭环境及精神障碍有关,应积极进行干预。     

广州市精神病医院50年住院病人自杀危险因素的病例对照研究

目的:识别精神分裂症住院病人自杀的潜在危险因素,为探讨如何进一步预防住院精神病人的自杀提供依据。方法:对广州市精神病医院1956-2005年住院精神病人自杀进行回顾性分析,并对其中的精神分裂症病人按同性别、同诊断、相同或相近年龄、住院进行1:1匹配的病例对照研究。结果:共有77例住院精神病人发生自杀,自杀发生率为133.1/10万(95%CI103.4-162.85/10万)。多数自杀者为精神分裂症病人(64例,占83.1%),多数自杀者采取自缢的方式(59例,占76.6%),多数病人的自杀行为发生在病房内(52例,占67.5%);自杀组的住院次数明显高于对照组(2.13±1.89/1.23±0.75,P=0.001);自杀组本次住院前1月及住院期间的自杀未遂次数明显高于对照组(0.39±0.85/0.09±0.39,0.59±1.52/0.00±0.00,P=0.017,0.003)。自杀组有罪恶观念、心境抑郁者多于对照组(18.8%/3.1%,28.1%/6.3%,P=0.006,0.004);住院精神分裂症病人的罪恶观念、心境抑郁、本次住院前1月有自杀意念和自杀未遂是其自杀行为发生的危险因素(β=2.407、1.566、1.201、1.643)。结论:该院50年住院病人的自杀发生率与国外近似,精神分裂症病人自杀的危险因素是罪恶观念、心境抑郁、住院前1月自杀意念和自杀未遂。     

Suicide in adolescents: using life charts to understand the suicidal process

BACKGROUND: A greater understanding of the pathways which lead young people to take their lives is important in ensuring that prevention strategies and health service delivery are as effective as possible. In this study we examined the duration, development and characteristics of the suicidal process in young people who ultimately died by suicide. METHODS: Life charts of psychological autopsy information from multiple informants were used to identify the suicidal process among 27 young people who died by suicide. RESULTS: Life charts were generated for 27 young people who died by suicide, of whom 93% (n=25) were male, with an average age at death of 20.9 years (SD=2.4). Three types of suicidal process were identified: Group I characterised by longstanding difficulties which spanned the developmental domains of home, school and peers. The suicidal process was longstanding, and included deliberate self-harm prior to their death and direct communication to friends and family about suicidal ideas and plans. The second group was characterised by evidence of an established psychiatric disorder. Two subgroups were identified, namely those individuals with a protracted suicidal process which lasted approximately 5-9 years, and those with a brief suicidal process lasting approximately one year. The third and smallest group was characterised by the emergence of the suicidal process as an acute response to life events among young people who appeared to have previously been functioning well, without apparent mental illness or known self-harm. However, two out of five in this group communicated specific suicidal intent in the weeks before their death. CONCLUSIONS: The suicidal process may emerge and disappear in the lives of young people. Repeated episodes of self-cutting by young men, against a backdrop of substance abuse, relationship difficulties, and mental health problems require further clinical attention.     

The role of alcohol in suicide: a case-control psychological autopsy study

BACKGROUND: The purpose of the study was to estimate the proportion of alcohol abuse and dependence (AAD) among suicides and controls, and to compare the incidence of AAD documented by clinicians with diagnoses derived from a research protocol. METHOD: AAD according to DSM-IV was diagnosed on the basis of interviews with relatives of people who committed suicide and with controls. A total of 427 people who committed suicide during one year were paired by region, gender, age and nationality with controls randomly selected from general practitioners' lists. RESULTS: Alcohol abuse was found in 10% and alcohol dependence in 51% of suicide cases. The corresponding figures for controls were 7% and 14% respectively. AAD was a statistically significant predictor of completed suicides, while abstinence was a significant predictor for female suicides and former use a significant predictor for older male suicides. AAD was diagnosed in 68% of male and 29% of female suicides. Middle-aged (35-59 years) males who committed suicide had the highest risk of alcohol dependence. Among suicide cases only 29% had received a lifetime diagnosis of AAD, against 23% of controls. CONCLUSIONS: AAD was significantly more prevalent among suicides than controls. Overall, the proportion of male suicides affected by alcohol was the same in the present psychological autopsy study as in our previous findings for Estonia on the aggregate level, while the share of female suicides with an AAD diagnosis was dramatically higher on the individual level. AAD is markedly underdiagnosed by general practitioners and clinicians.     

溺网学生的心理健康状况及社会原因分析

目的 初步探讨互联网对大学生心理健康状况的影响及引起溺网的社会原因.方法 利用SCL-90量表,一般情况表,16PF量表对某大学3409名大一学生进行心理调查.结果 以每周上网不低于10小时作为划分是否溺网的标准,溺网的检出率为4.9%;认为上网对自己的生活和学习产生了不好以至于严重影响的学生为16.13%;男生溺网的情况比女生要严重得多;除了抑郁症状和敌对情绪外,溺网学生与其它学生相比,心理健康状况并无明显差异;溺网与某些性格特征有关;男性,大学与想象中不一致,对专业不喜欢,经济状况不困难,情绪低落时有过自杀意念是容易被网络所吸引的危险因子.结论 溺网与性别、人格特征及对大学的适应情况密切相关.     

Suicide in young people aged 15-24: a psychological autopsy study

BACKGROUND: The suicide rate in young people in the United Kingdom has increased over the last decade. As there is a paucity of information about the characteristics of young suicides we have undertaken a detailed investigation of suicides in people aged 15-24 years by means of the psychological autopsy approach. METHODS: The sample consisted of 27 subjects (25 males, two females) whose deaths received a verdict of suicide (N=24) or undetermined cause (N=3). Information was collected from informant interviews, coroners' inquest notes, medical records and psychiatric case notes. A sub-sample of 22 male subjects was compared with an age-matched sample of male deliberate self-harm (DSH) patients. RESULTS: Psychiatric disorders were diagnosed in 19 (70.4%) subjects. These were most commonly depressive disorders (55.5%). Very few individuals were receiving treatment for their disorders. Substance abuse disorders were uncommon but a substantial proportion of individuals had problems with alcohol or drug misuse. Personality disorders were present in 29.6% of subjects and disorders or personality trait accentuation in 55.6%. Comorbidity of psychiatric disorders was found in a third of subjects. The suicides were often the end-point of long-term difficulties extending back to childhood or early adolescence. In addition to mental disorders, relationship and legal difficulties were identified as relatively common contributory factors to the suicides. In comparison to deliberate self-harm patients, male suicides were more likely to use dangerous methods and live alone. LIMITATIONS: Several potential informants could not be interviewed and there was no general population control sample. CONCLUSIONS: The process leading to suicide in young people is often long term, with untreated depression in the context of personality and/or relationship difficulties being a common picture at the time of death. The prevention of suicide in the young clearly requires multiple strategies.     

湖南省城乡部分老年人口自杀流行学研究

目的 :描述湖南省城乡 1990 -1998年部分老年人口自杀流行学特征 ,为老年人口自杀预防以及降低老年自杀率提供科学依据。方法 :根据湖南省卫生厅生命统计资料 ( 1990 -1998年 ) ,对部分老年人口自杀状况进行统计分析 ,并以湖南省城区 (长沙市天心区 )、农村 (浏阳县 )两地为代表 ,着重描述两地流行学特征。结果 :自 1990 -1998年九年来 ,湖南省老年人口自杀率均有上升趋势 (天心区Y =8 76± 2 88X ,p<0 0 0 1;浏阳县Y =77 45 0± 1 697X ,p =0 0 5 )。老年人口平均自杀率城区为 2 4 4/10万 (天心区 2 2 1/10万 ) ,农村为 88 9/10万 (浏阳县 88 3 /10万 )。城区、农村两地男女自杀率比例分别为 1∶1和 1 4∶1。两地自杀方式城区多以服毒服药、自缢、跳楼为主 ,农村则多以服毒服药、自缢、自溺为主。城区、农村两地自杀原因城区多以久病厌世、家庭纠纷以及精神疾病为主 ,农村则多以家庭纠纷、久病厌世、生活困难为主。结论 :社会、经济环境可能是老年人自杀的最重要的诱发因素 ,尤其在农村地区老年人有更突出的心理问题 ,他们需要更多的医学关怀和社会的关注。     

183例在急诊室就诊的自杀患者特征

目的：分析综合医院就诊的自杀患者，为自杀的预防和干预提供依据。方法：对我院急诊科2004年1月1日-2004年12月31日收治的183例自杀患者进行调查。结果：自杀患者20-29岁8l例（占44．3％），女性（147例）明显多于男性（36例），男女比例为1：4．1；口服药物是最常见的自杀方式（170例，92、8％），其中口服安眠药和农药119例，占口服药物70％，总死亡率3．3％；男性自杀死亡率（3／36）高于女性（3／147）；自杀发生于18～24时7l例（38．8％），与其他时间段相比有显著性差异（P〈0．005）。结论：急诊自杀病例以年轻人、女性居多，采用安眠药、农药为主要手段。经抢救大部分生命得以挽救，但男性死亡率高于女性。，     

The effect of macroeconomic variables on suicide

BACKGROUND: There are a large number of factors mediating suicide. Many studies have searched for a direct causal relationship between economic hardship and suicide, however, findings have been varied. METHOD: Suicide data was obtained from the Australian Bureau of Statistics for the period between January 1968 and August 2002. These were correlated with a suite of macroeconomic data including housing loan interest rates, unemployment rates, days lost to industrial disputes, Consumer Price Index, gross domestic product, and the Consumer Sentiment Index. RESULTS: A total of 51845 males and 16327 females committed suicide between these dates. There were significant associations between suicide rates and eleven macroeconomic indicators for both genders in at least one age range. Data was divided into male and female and five age ranges and pooled ages. Analyses were conducted on these 132 datasets resulting in 80 significant findings. The data was generally stronger for indices measuring economic performance than indices measuring consumers' perceptions of the state of the economy. A striking difference between male and female trends was seen. Generally, male suicide rates increased with markers of economic adversity, while the opposite pattern was seen in females. There were significantly different patterns in age-stratified data, with for example higher housing loan interest rates having a positive association with suicide in younger people and a negative association in older age groups. CONCLUSION: Macroeconomic trends are significantly associated with suicide. The patterns in males and females are very different, and there are further substantial age-related differences.     

Mortality of patients with mood disorders: follow-up over 34-38 years

BACKGROUND: All follow-up studies of causes of death in affective disordered patients have found they have markedly elevated suicide rates and a less reproducible increased mortality from other causes. The reported rates by gender, disorder type and treatment are more variable. METHODS: Hospitalised affective disordered patients (n=406) were followed prospectively for 22 years or more. Later, mortality was assessed for 99% of them at which time 76% had died. RESULTS: Standardised Mortality Rates (observed deaths/expected deaths) for patients were elevated especially for suicide and circulatory disorders in both men and women. Women actually had higher suicide rates but that did not take into account the twofold increase in general population rates for men. Unipolar patients had significantly higher rates of suicide than bipolar Is or IIs. In all groups long term medication treatment with antidepressants alone or with a neuroleptic, or with lithium in combination with antidepressants and/or neuroleptics significantly lowered suicide rates even though the treated were more severely ill. Although at the age of onset the suicide rates were most elevated, from ages 30 to 70 the rates were remarkably constant despite the different courses of illness. LIMITATIONS: The patients were identified as inpatients and followed prospectively. The treatments were uncontrolled and are not quantifiable but were documented during the follow-up. CONCLUSIONS: Men and women hospitalised for affective disorders have elevated mortality rates from suicide and circulatory disorders. Unipolars have higher suicide rates than bipolar Is or IIs. Long term medication treatment lowers the suicide rates, despite the fact that it was the more severely ill who were treated.     

Life problems and physical illness as risk factors for suicide in older people: a descriptive and case-control study

BACKGROUND: The role of physical illness and life problems in contributing to suicide in older people is potentially important with regard to suicide prevention. METHOD: The aim of the study was to determine the life problems other than psychiatric illness contributing to suicide in older people. Semi-structured psychological autopsy interviews, covering life problems and physical illness prior to death, were conducted with informants for 100 people aged 60 years old and over who died through suicide in five English counties. Interviews were completed with informants for 54 age- and sex-matched control subjects who died through natural causes. RESULTS: The three most frequent life problems associated with suicide were physical illness, interpersonal problems, and bereavement. Physical health problems were present in 82% and felt to be contributory to death in 62%. Pain, breathlessness and functional limitation were the most frequent symptoms. Interpersonal problems were present in 55% of the sample and contributory in 31%. The corresponding figures for bereavement-related problems were 47% and 25%. In the case-control analysis, the problems found to be risk factors for suicide were problems related to a bereavement over 1 year before death (OR 3.5, 95% CI 1.2-10.6), and problems with accommodation (OR 5.0, 95% CI 1.1-22.8), finances (p=0.01), and retirement (p=0.02). CONCLUSION: Physical illness, interpersonal problems and bereavement are commonly associated with suicide in older people, but financial, accommodation, retirement and long- term bereavement-related problems may be more specific risk factors.