自杀未遂者出院后再次出现自杀行为的6年随访

目的 了解自杀未遂者再自杀情况及其影响因素.方法 对115例住院自杀未遂者出院后18个月、3年、5年、6年进行4次随访.结果 115例自杀未遂者中6年内21例再次出现自杀行为(18.3%),其中自杀死亡5例(4.3%).21例再次自杀者平均年龄(44.2±14.3)岁,13例有精神障碍(61.9%),8例既往(入院前)有自杀未遂史(38.1%),与94例无再次自杀行为者比较,两组在年龄(t=3.42)、精神疾病(χ2=11.20)、既往自杀未遂史(χ2=24.18) 方面的差异有统计学意义(均P<0.05).Logistic回归分析,仅既往自杀未遂史(P＜0.01,OR=10.21,β=2.32)进入回归方程.115例自杀未遂人群总的随访时间为723.55人年,以此推算6年内该组自杀未遂者群体年人均自杀死亡率为0.7%,年人均自杀未遂率为2.2%,年人均自杀行为率为2.9%.结论 部分自杀未遂者会再次出现自杀行为,而既往有自杀未遂史和有精神障碍的自杀未遂者更易再次发生自杀行为.     

有严重躯体疾病老年自杀死亡者的特征及其有无精神障碍者间的比较

目的了解有严重躯体疾病的老年自杀死亡者的特征并比较有无精神障碍者特征的异同。方法由精神科医师运用心理解剖方法对全国23个疾病监测点上报的≥55岁的304例自杀案例的家属和周围知情人进行调查,分析其中178例(58.6%)报告自杀死亡前1年内有严重躯体疾病者的自杀特征。结果178例自杀死亡者中,女性占41.6%;79.2%居住在乡村;58.4%从未上过学;38.8%丧偶;25.8%有自杀未遂既往史;10.7%一级血缘亲属有自杀行为;43.3%服农药或鼠药自杀,32.6%上吊;68.0%自杀当时有精神障碍,主要是重性抑郁障碍;仅5.1%自杀当时有人在场。有、无精神障碍者在社会人口经济学特征、有无自杀未遂史和自杀行为家族史、负性生活事件导致的慢性心理压力和急性应激强度以及自杀前一个月的生命质量等方面的差异无统计学意义(P均大于0.05)。结论有严重躯体疾病老年人自杀死亡最常见的两种方式是服毒和上吊,2/3有精神障碍,但有无精神障碍者的自杀相关特征无明显不同。     

天水市农村女性自杀未遂者危险因素研究

目的:探讨甘肃天水市农村自杀未遂女性的自杀危险因素。方法:对天水市3个县区23个乡镇自杀未遂报告系统2007年6月至2009年1月报告的年龄≥14岁的自杀未遂女性150人(自杀未遂组)及由同一报告者提供的近1年内无自杀行为、年龄、居住地相匹配的正常女性150人(正常对照组)分别采用自编《伤害幸存者研究问卷》和《正常对照者研究问卷》进行自由访谈及问卷调查;分析自杀行为的危险因素。结果:自杀未遂组在文盲、人均年收入低、现患精神障碍、有人格障碍、对自杀接受性高、自杀意念强、既往有自杀未遂史、近1个月有过失眠、近1个月因心理问题难以工作、近1年有生活事件、急/慢性应激高、生命质量低、冲动性及攻击性高、家庭亲密性及家庭适应性低、社会支持差的发生率上明显高于正常对照组(χ~2=5.051~71.082,P0.05或P0.001);自杀行为特征为冲动性、服农药、家庭纠纷或为解脱痛苦。Logistic回归分析显示年龄40岁、文盲、现患精神障碍、对自杀接受性高、近1月因心理问题难以工作、近1年有生活事件、急性应激高、攻击性高、家庭亲密性低进入方程。结论:服药是天水市农村女性最常见的自杀方式;年龄40岁、文盲、现患精神障碍、对自杀接受性高、近1月因心理问题难以工作、近1年有生活事件、急性应激高、攻击性高、家庭亲密性低是天水农村女性自杀行为的危险因素。     

有精神疾病家族史抑郁症患者自杀未遂的危险因素

目的探讨有精神疾病家族史抑郁症患者自杀未遂的危险因素,为临床干预提供依据。方法采用自制调查表对1146例抑郁症患者进行调查,纳入其中有精神疾病家族史的患者150例,根据是否有自杀未遂行为,分为自杀未遂组和对照组,分析有精神疾病家族史的抑郁症患者在性别、年龄等社会人口学资料及既往抑郁发作次数、起病年龄等临床特征方面可能与自杀未遂相关的因素。结果有精神疾病家族史抑郁症患者自杀未遂发生率为24.0%(36/150),无精神病家族史患者自杀未遂发生率为7.1%(71/996),前者自杀未遂发生率更高(P0.01)。150例有精神疾病家族史抑郁症患者中,相较于无自杀未遂组,自杀未遂组患者既往因精神疾病住院次数较多(P0.01),自杀意念及合并有严重或慢性躯体疾病的比例更高(P0.05)。多因素logistic回归分析显示,既往因精神疾病住院次数(OR=3.714,95%CI:1.426～9.673,P=0.007)、自杀意念(OR=8.347,95%CI:2.339～29.790,P=0.001)与有精神病家族史抑郁症患者的自杀未遂相关联。结论有精神疾病家族史抑郁症患者自杀未遂风险较高。既往因精神疾病住院次数多、自杀意念等可能是有精神疾病家族史抑郁症患者自杀未遂的主要危险因素。     

重复自杀行为众多影响因素分析

目的探讨重复自杀行为者的特点及其自杀的危险因素。方法采用WHO健康量表、Beck抑郁自评量表、自杀强度量表等对115例住院的自杀未遂者实施调查,并追踪随访6年,对整个病程中仅有单次自杀行为和重复自杀行为两类人群住院时人文特点及评估资料进行比较。结果115例自杀未遂者中重复自杀行为24例,占20.9%。24例重复自杀行为者就诊治疗时年龄42.6±13.2岁,WHO健康量表得分7.04±5.64,Beck抑郁自评得分26.25±17.36,自杀强度得分10.04±4.94,16例(66.7%)患有精神疾病;91例单次自杀行为者年龄32.6±13.9岁,WHO健康量表得分15.91±5.61,Beck抑郁自评得分6.82±10.51,自杀强度得分7.76±3.97,20例(22.0%)患有精神疾病。重复与单次自杀行为者比较,两组在年龄、WHO健康量表、Beck抑郁自评得分、自杀强度得分、有无精神疾病以及自杀方式、是否真的想死、是否存在困扰1年以上躯体病或残疾、未来没有希望、身体健康状况自评方面存在明显差异(均P<0.05)。回归分析显示,自杀强度得分与是否真的想死得分相加代表的自杀致死倾向(P=0.036,OR=2.85,β=1.047),WHO健康量表与身体健康自评得分相加所代表的健康心理状态(P=0.026,OR=0.320,β=-1.141)进入回归方程。结论重复自杀行为者多患有精神疾病,抑郁心境、无望、自杀强度高等。有效评估这些因素对了解或防范未遂者再次出现自杀风险有重要意义。     

中国农村严重自杀未遂危险因素的配对病例对照研究(英文)

背景中国农村的自杀率是城市自杀率的2~3倍,但造成城乡自杀率之巨大差异的原因并不清楚。目的评估国内农村严重自杀未遂者的特征及危险因素。方法精神科医生采用结构式问卷对山东郓城县人民医院急诊室收治的297例严重自杀未遂者(至少在医院6小时者)及其陪伴的家属分别进行访谈。该问卷内容详尽,完成问卷需要2~3h。对照组选取同一居住地中年龄、性别与自杀未遂组相匹配的、既往无自杀未遂史的居民及其同住家庭成员,分别进行同样的结构式访谈。使用Cox回归模型来识别自杀未遂的危险因素。结果 297例自杀未遂者中,74%为女性,78%是农民,平均(标准差)年龄为33.2(14.6),平均受教育年限为4.8(3.1)年,80%为口服农药自杀,57%的自杀未遂者报告在采取自杀行动之前考虑自杀只有或不足5分钟,76%的自杀意图量表中计划分量表得分不足50分(0~100分),11%有过自杀未遂史,只有38%存在符合DSM-IV诊断标准的精神障碍。在控制性别、年龄、居住地以及之前的自杀未遂史(在配对分析中控制该变量)后,通过多因素分析,自杀未遂的危险因素包括:受教育水平低、与有过自杀行为的人交往、之前1年中至少有4次负性生活事件、之前1个月中生活质量低且家庭不够和睦、之前2周内的抑郁症状得分高以及冲动性和攻击性高(最后一项仅在小样本中进行评估)。结论我国农村严重自杀未遂者多数不符合精神障碍的诊断标准,冲动性和攻击性高、自杀意图并不强烈,多采用口服农药的方式。这些特点与高收入发达国家的特点不同,因而需要采取不同的方法来预防自杀行为。这些方法应更多的关注如何降低获取农药的便利性,并教育冲动性个体如何自我调整情绪和行为,而不是过度地关注精神障碍的识别和治疗。     

负性生活事件与自杀行为研究

目的 评估自杀研究用生活事件量表的效度并了解负性生活事件在自杀行为发生中的影响机制.方法 制定了一个由调查员询问填写的自杀研究用生活事件量表,以有自杀行为者为研究对象,调查[1]926例自杀死亡和756例其他伤害死亡案例(对照组)的家属和周围知情人;[2]570例自杀未遂者本人及其知情亲友,并对其中212例按年龄(±5岁)、性别配对从急诊非自杀病人的家属中选择对照进行调查.结果 两种信息来源(死者家属与周围知情人;或自杀未遂者与陪伴亲友)的同一生活事件评估指标之间的相关性较强(自杀死亡调查中急性应激强度的秩和相关系数为0.67,慢性心理压力为0.69;自杀未遂调查中分别为0.75和0.68).多因素Logistic回归分析显示,自杀当时的急性应激强度和自杀前1年内的慢性心理压力均是自杀行为发生的独立危险因素.结论 自制"自杀研究用生活事件量表"的效度良好.负性生活事件导致的急性应激和慢性心理压力对自杀行为的影响机制相对独立.     

情感性精神障碍患者出院后自杀危险因素探讨

目的 探讨情感性精神障碍患者自杀的危险因素及家庭安全护理要点.方法 对符合中国精神疾病分类方案与诊断标准第3版修订本中情感性精神障碍诊断标准出院的144例患者,进行为期2～6年的护理随访,对自杀危险因素的单因素和非条件Logistic回归分析.结果 36例(25%)患者发生过自杀,其中自杀未遂30例(20.83%),自杀死亡6例(4.17%).自杀危险因素:为双方相混合或快速循环型频繁发生和自杀未遂史,保护因数为多次住院.结论 有潜在自杀危险因素的情感性精神障碍患者应加强自杀的防范,家庭安全护理非常重要,住院治疗为有效的保护因素.     

乡村严重自杀未遂者的特征

目的了解乡村严重自杀未遂者的特征并通过比较乡村与非乡村严重自杀未遂者的特征来深入了解2组人群是否相对独立,为制定自杀预防及干预措施提供依据。方法用自制调查表对1所市级、3所县级综合医院诊治的326例严重自杀未遂者进行包括精神科检查在内的2-3小时的调查。结果278例乡村严重自杀未遂者平均年龄(32±13)岁,平均接受正规学校教育(5±3)年,女性占74%,现婚74%,14%有自杀未遂既往史,88%服用农药或鼠药自杀未遂,39%有精神障碍(主要是重性抑郁障碍),13%自杀前曾因心理问题寻求帮助,家庭纠纷和情绪低落是前两位重要的自杀原因。与48例非乡村自杀未遂者相比,乡村组受教育年限短,家庭经济状况差,男性、自杀前一直在工作或学习者、服农药自杀者所占比例高,经历的负性生活事件少,慢性心理压力小(P均小于0.05)。2组在年龄、婚姻状况、自杀意图强度、急性应激强度、自杀前1个月的生命质量、家庭关系、精神疾病患病率等方面的差异无统计学显著性。结论乡村与非乡村严重自杀未遂者的不同特征提示:即使是同样的自杀预防措施,在农村与城镇实施的模式和侧重点应不同。     

自杀未遂再自杀危险因素及其干预的研究进展

研究发现自杀未遂者可能不止一次出现自杀行为,直至最终导致自杀死亡。本文归纳了自杀未遂再自杀的危险因素及再自杀的干预措施。     

Clinical characteristics of adolescent psychiatric inpatients who have attempted suicide

 The clinical characteristics of 191 adolescent inpatients were examined in relation to frequency of previous suicide attempts, predictors of suicide attempts prior to hospitalization, and lifetime suicide attempts. Overall, more than 50% of the adolescent inpatients had attempted suicide during their lifetime, and of these more than half (58%) had made more than one attempt. Approximately half of the suicide attempters had made a serious attempt prior to hospitalization. Girls reported higher levels of depressive symptoms and suicidal ideation than boys, in addition to having attempted suicide prior to hospitalization (33%) or during lifetime (37%) more often than the boys (13% and 26%, respectively). Although about two thirds of the adolescent inpatients reported that they had received some help after a suicide attempt, approximately half of the repeaters had not received any help. The results of multivariate analyses showed that suicide attempts made prior to hospitalization were predicted by depressive symptom levels and a clinical diagnosis of depressive disorder, whereas frequency of lifetime suicide attempts was predicted by suicidal ideation levels and having a family member or a friend who had attempted (or committed) suicide. The high prevalence of lifetime and repeated suicide attempts among the psychiatric inpatients underscores the importance of identifying risk factors in the clinical evaluation of adolescent suicide attempters. Accepted: 1 April 1998     

Suicide and attempted suicide in general practice, 1979-1986

Using data from the Continuous Morbidity Registration Sentinel Stations over the period 1979-1986, the authors tried to determine the incidence and the characteristics of patients in general practice who attempted or committed suicide. Almost half of the suicide attempts and suicides had contacted their general practitioner (GP) shortly before the suicidal act. A minority of these cases were recognized by the GP as having a high suicide risk. In almost 70% of the suicides and 58% of the suicide attempters the GPs reported the existence, currently or previously, of a depressive episode. About half of both the suicides and the suicide attempters had been treated or seen by mental health professionals or social workers. Given the fact that suicide and suicide attempt are relatively rare events in general practice, and given the fact that for the patients who contact their GP shortly before the suicidal act, it is not at all certain whether they present clearly recognizable signs of suicide risk at that time, the authors conclude that GPs cannot play an important role in the prevention of suicidal behaviour.     

Suicide behaviour among Guyanese orphans: identification of suicide risk and protective factors in a low- to middle-income country

Objective: Suicide is the leading cause of death among youth in Guyana, a low- and middle-income country (LMIC), which globally ranks first in female adolescent suicides over the last decade. Worldwide, Guyana has experienced the largest increase in youth suicide, despite focused public health efforts to reduce suicide. Further, youth in Guyana, who are clients of the orphanage system and have faced early childhood trauma, may have an additive risk for suicide. Guided by an ideation-to-action theoretical framework for suicide prevention, the goal of the proposed research study is to describe and identify risk and protective factor correlates of youth suicidal behaviour among those at highest risk for suicide – orphans who reside in a LMIC institutional setting. Methods: In a preliminary sample of 25 orphan youth, one licensed psychologist and two social workers administered the DSM-5 Level 1 Cross-Cutting Symptom Measure and Behavioural Assessment Schedule for Children, 2nd Edition (BASC-2) during a semi-structured interview. Results: Nine of the 25 (36%) orphans reported a previous suicide attempt. Youth who endorsed suicidal behaviour had clinically elevated interpersonal relations scale scores when compared to youth who did not. Conclusions: Interpersonal skills may be protective for youth at highest risk for suicide.     

Knowledge and attitudes about suicide in 25-year-olds

OBJECTIVE: To examine knowledge and attitudes about suicide in a New Zealand sample of young people aged 25 years. METHOD: The sample was a birth cohort of 1265 young people born in New Zealand in 1977 who have been followed in a longitudinal study for 25 years. At age 25, participants were asked a series of questions designed to assess their knowledge and attitudes about suicide. RESULTS: Young people had poor knowledge about youth suicide. They overestimated the number of youth suicide deaths, with a quarter believing that the number of deaths was at least 10x higher than the actual number. They overestimated the fraction of all suicides accounted for by youth suicides with two-thirds believing that 50% or more of all suicides occurred among young people. The most common source of information about suicide was the media. Young people tended to hold mixed attitudes toward suicide, having both liberal and conservative views. Those with lifetime histories of suicidal ideation or suicide attempt and those with family histories of suicide or suicide attempt tended to hold more liberal attitudes. Attitudes toward suicide were unrelated to gender and to knowledge about suicide. CONCLUSIONS: Young people over-estimate the prevalence of youth suicide and the fraction of suicides accounted for by youth deaths, and hold both conservative and liberal attitudes toward suicide. Their primary source of information about suicide is the media. These findings raise concerns about the potential for media coverage of youth suicide issues to normalize suicide as a common, and thereby acceptable, response among young people, and suggest the need for careful dissemination of accurate information about suicide by knowledgeable, respected and reputable sources.     

Suicidal Behaviour in Mood Disorders—Who,When, and Why?

Objective:

About one-half to two-thirds of all suicides are by people who suffer from mood disorders; preventing suicides among those who suffer from them is thus central for suicide prevention. Understanding factors underlying suicide risk is necessary for rational preventive decisions.

Method:

The literature on risk factors for completed and attempted suicide among subjects with depressive and bipolar disorders (BDs) was reviewed.

Results:

Lifetime risk of completed suicide among psychiatric patients with mood disorders is likely between 5% and 6%, with BDs, and possibly somewhat higher risk than patients with major depressive disorder. Longitudinal and psychological autopsy studies indicate suicidal acts usually take place during major depressive episodes (MDEs) or mixed illness episodes. Incidence of suicide attempts is about 20- to 40-fold, compared with euthymia, during these episodes, and duration of these high-risk states is therefore an important determinant of overall risk. Substance use and cluster B personality disorders also markedly increase risk of suicidal acts during mood episodes. Other major risk factors include hopelessness and presence of impulsive–aggressive traits. Both childhood adversity and recent adverse life events are likely to increase risk of suicide attempts, and suicidal acts are predicted by poor perceived social support. Understanding suicidal thinking and decision making is necessary for advancing treatment and prevention.

Conclusion:

Among subjects with mood disorders, suicidal acts usually occur during MDEs or mixed episodes concurrent with comorbid disorders. Nevertheless, illness factors can only in part explain suicidal behaviour. Illness factors, difficulty controlling impulsive and aggressive responses, plus predisposing early exposures and life situations result in a process of suicidal thinking, planning, and acts.     

Sex differences in clinical predictors of suicidal acts after major depression: a prospective study

OBJECTIVE: Whether sex differences exist in clinical risk factors associated with suicidal behavior is unknown. The authors postulated that among men with a major depressive episode, aggression, hostility, and history of substance misuse increase risk for future suicidal behavior, while depressive symptoms, childhood history of abuse, fewer reasons for living, and borderline personality disorder do so in depressed women. METHOD: Patients with DSM-III-R major depression or bipolar disorder seeking treatment for a major depressive episode (N=314) were followed for 2 years. Putative predictors were tested with Cox proportional hazards regression analysis. RESULTS: During follow-up, 16.6% of the patients attempted or committed suicide. Family history of suicidal acts, past drug use, cigarette smoking, borderline personality disorder, and early parental separation each more than tripled the risk of future suicidal acts in men. For women, the risk for future suicidal acts was sixfold greater for prior suicide attempters; each past attempt increased future risk threefold. Suicidal ideation, lethality of past attempts, hostility, subjective depressive symptoms, fewer reasons for living, comorbid borderline personality disorder, and cigarette smoking also increased the risk of future suicidal acts for women. CONCLUSIONS: These findings suggest that the importance of risk factors for suicidal acts differs in depressed men and women. This knowledge may improve suicide risk evaluation and guide future research on suicide assessment and prevention.     

Elderly suicide in london: An analysis of coroners' inquests

The article describes the social, physical and psychological features of 104 consecutive elderly suicides, using information obtained from coroners' inquests. An age and sex matched cohort of 51 accidental deaths was used as a control. The suicide cohort was significantly more depressed and in pain, had experienced more previous depressive episodes and suicide attempts, and were less confused compared to the control group. The study confirms the importance of recognized risk factors: 61% were living alone, with 9% complaining of loneliness. Only one individual, on available data, attended a day hospital or day centre. Physical illness was common, with at least 56% having ill health prior to death and 63% showing postmortem abnormalities. Twenty-two per cent revealed abnormal cerebral pathology. Depressive illness was prominent, with 79% exhibiting depressive symptoms prior to death. Only 12 individuals were taking antidepressants and only one was on lithium. Despite contact with primary care services, only 20% had been seen by psychiatrists within three months of death. The roles of alcohol, drugs, abnormal cerebral changes and personality factors are discussed along with considerations for prevention.     

Characteristics of Chinese suicide attempters admitted to a geropsychiatric unit.

PURPOSE: To investigate the characteristics for elderly Chinese suicide attempters in Taiwan and make comparisons with Western reports. METHODS: During a six-year period, patients admitted to a geropsychiatric unit as a result of a suicide attempt were investigated for factors related to the suicide attempt. RESULTS: Of the 722 admissions during this period, 55 (7.6%) were patients who had been admitted due to suicide attempt. The sex and age distributions for the suicide attempters were similar to those for other patients. The most common diagnoses were depressive disorders (56.4%), followed by delusional disorders (20.0%). A total of 121 suicide motives were cited for the 55 attempters, an average of 2.2 per person, with depressive symptoms commonly found on admission. During the first week of hospitalization, 53 attempters (96.4%) still exhibited suicidal ideation and six patients made a further suicide attempt, however, only three patients retained suicidal ideation on discharge. CONCLUSIONS: Our study confirms previous Western reports that depressive disorders are commonly manifested in elderly suicide attempters. There were differences in the motives and methods employed for the suicides, possibly due to cultural difference and/or sample source. Most of the suicide attempters exhibited a favourable response with hospitalization.     

Suicide attempts in an adolescent female twin sample.

OBJECTIVE: To examine suicide attempts in an epidemiologically and genetically informative youth sample. METHOD: 3,416 Missouri female adolescent twins (85% participation rate) were interviewed from 1995 to 2000 with a telephone version of the Child Semi-Structured Assessment for the Genetics of Alcoholism, which includes a detailed suicidal behavior section. Mean age was 15.5 years at assessment. RESULTS: At least one suicide attempt was reported by 4.2% of the subjects. First suicide attempts were all made before age 18 (and at a mean age of 13.6). Major depressive disorder, alcohol dependence, childhood physical abuse, social phobia, conduct disorder, and African-American ethnicity were the factors most associated with a suicide attempt history. Suicide attempt liability was familial, with genetic and shared environmental influences together accounting for 35% to 75% of the variance in risk. The twin/cotwin suicide attempt odds ratio was 5.6 (95% confidence interval [CI] 1.75-17.8) for monozygotic twins and 4.0 (95% CI 1.1 -14.7) for dizygotic twins after controlling for other psychiatric risk factors. CONCLUSIONS: In women, the predisposition to attempt suicide seems usually to manifest itself first during adolescence. The data show that youth suicide attempts are familial and possibly influenced by genetic factors, even when controlling for other psychopathology.