自杀意念危险因素研究进展

自杀意念是自杀的高危因素,自杀意念在人群中的危险因素错综复杂。本文按照社会人口学因素,生物学因素,躯体、心理疾病因素,社会环境因素以及自杀活动五个方面对自杀意念的危险因素进行了综述,并对自杀意念形成机制研究进展进行了介绍。     

精神分裂症自杀危险因素研究进展

本文复习国内外最新文献介绍精神分裂症自杀以及相关危险因素的研究进展。     

抑郁症患者自杀的危险因素研究

目的:探讨抑郁症患者自杀的危险因素及生物学指标.方法:以抑郁症患者入院时有无自杀行为分为自杀组和无自杀组.用汉密尔顿抑郁量表(HAMD,24项)、生活事件量表(LES)及自行编制的自杀行为调查表对入组患者进行调查;酶法测定两组患者的总胆固醇(CHO)、三酰甘油(TG)、高密度脂蛋白(HDL-C)和低密度脂蛋白(LDL-C)水平.结果:共107例.多因素Logistic回归分析发现,自杀与既往自杀行为、内向性格、生活事件、严重的抑郁(尤其是绝望感明显,存在严重的认识障碍)有关;两组的血脂水平差异无显著.结论:既往自杀行为、内向性格、生活事件、严重的抑郁是抑郁症患者自杀的主要危险因素;抑郁症患者的自杀可能与血脂水平无关.     

癫痫患者的自杀风险及其危险因素

癫痫是神经科常见的疾病,在过去的数十年中,新型抗癫痫药物的出现以及外科手术的进步使癫痫发作的控制水平得到了很大的提高.近年来,国外学者对癫痫与自杀之间的关系进行了较深入的探讨.本文将对癫痫患者的自杀风险及危险因素作一简要综述.     

深圳市中学生自杀倾向危险因素分析

目的探讨深圳市中学生自杀倾向发生率及其相关危险因素。方法采用分层整群抽样法,以中学生情绪及相关问题调查表、贝克抑郁量表和自杀行为问卷一修订版为工具对4177名中学生进行调查,结果进行多元逐步回归分析。结果自杀意念终生发生率、自杀计划发生率和自杀未遂终生发生率分别为42．40％、7．92％和1．46％。多元逐步回归分析显示：与自杀意念相关的因素为抑郁情绪、抑郁家族史、父母婚姻关系差、自杀家族史、独生子女、高年级学生和家庭经济状况差;与自杀计划相关的因素为抑郁情绪、母亲文化程度高、自杀家族史、家庭经济状况差和学习成绩差等因素;与自杀未遂相关的因素为抑郁情绪和父母婚姻关系差。结论深圳市中学生自杀倾向发生率高,抑郁情绪、父母婚姻关系差、有抑郁家族史、有自杀家族史和家庭经济状况差是发生自杀倾向的主要危险因素,应引起社会与家庭的高度重视,积极采取相应措施加以干预,尽量减少自杀发生。     

老年期情感性精神障碍患者自杀危险因素的随访研究

目的 探讨老年期情感性精神障碍患者自杀的危险因素。方法 采用队列内病例对照研究方法,对符合中国精神疾病分类方案与诊断标准第2版修订本中情感性精神障碍诊断标准出院的72例老年患者,进行为期6－7年的随访、自杀危险因素的单因素分析和非条件Logistic回归分析。结果 18例（25％）患者发生过自杀,其中自杀未遂15例（21％）,自杀死亡3例（4％）。自杀危险因素为双相昆合或快速循环型、频繁发作和自杀未遂史,保护因素为多次住院。结论 有潜在自杀危险因素的老年情感性精神障碍患者应加强自杀的预防,住院为有效的预防措施之一。     

成年癫痫患者的自杀风险及相关危险因素研究

目的：研究成人癫痫患者自杀风险及相关危险因素。方法采用简明国际神经精神访谈（MINI）自杀风险模块和抑郁障碍模块对211例我院门诊的成年癫痫患者进行心理评估,并详细记录患者的年龄、性别、就业状况、婚姻、教育年限、发病年龄、病程、发作类型、发作频率、头颅M RI结果以及使用抗癫痫药种数,比较上述因素与自杀风险的关系。结果本组病例中有自杀风险的患者占21.3％（45/211）,伴抑郁障碍的患者占17.1％（36/211）;而伴抑郁障碍患者的自杀风险高达75.0％（27/36）,非抑郁障碍患者的自杀风险达10.3％（18/175）,差异有统计学意义（χ2＝74.525,P＜0.01）。结论伴抑郁障碍的癫痫患者自杀风险更高。     

山东农村居民自杀意念的发生率及其危险因素研究

目的 了解农村居民自杀意念的发生率及其危险因素,为自杀干预提供依据.方法 采用包括一般健康状况问卷、冲动性和攻击性量表、社会支持量表、家庭亲密度与适应性量表等对山东滕州市东郭镇19个村≥15岁的5039例农村居民进行自杀意念及其相关因素的调查,以多因素logistic模型分析自杀意念的危险因素.结果 在农村居民中,9.33%(470/5039)在过去任何时候有过自杀意念(95%CI:8.52%～10.13%),5.39%(299/5039,95%CI:5.28%～6.59%)近1年有过自杀意念.近1年自杀意念的危险因素排列为:近1年慢性压力大(OR=5.61,95%CI:4.04～7.78),攻击性高(OR=2.54,95%CI:1.93～3.35),非现婚状态(OR=2.04,95%CI:1.52～2.76),生命质量低(OR=1.86,95%CI:1.40～2.48),女性(OR=1.76,95%CI:1.34～2.32),自我感觉经济状况差(OR=1.70,95%CI:1.29～2.25),认识的人中有自杀(OR=1.53,95%CI:1.17～1.99),家庭亲密度低(OR=1.38,95%CI:1.06～1.80).结论 农村居民自杀意念发生率处于较高水平.慢性压力大、攻击性高、非现婚状态是近1年自杀意念最主要的危险因素.应根据其危险因素制订有针对性的干预计划.     

农村未遂自杀者的再自杀意念及相关因素研究

目的探讨农村未遂自杀者再自杀意念的发生率及其相关因素。方法以乡镇卫生院近2年的抢救记录为调查线索,共完成74例自杀未遂者的调查,对其再自杀意念进行评定,并用SDS和FES对其抑郁症状和家庭环境进行评估,收集其一般资料。结果74例自杀未遂者中有48例(64.86%)有不同程度的再自杀意念,48例有再自杀意念者的SDS得分(42.42±7.64)明显高于26例无再自杀意念者(33.58±9.52)(t=4.35,P<0.001),有再自杀意念组的家庭亲密度、成功性、文化性、娱乐性和组织性均较无再自杀意念组差,家庭矛盾性较对照组突出。多元逐步回归分析显示,影响自杀未遂者再自杀意念的主要危险因素为:家庭成功性、SDS总分和家庭矛盾性。结论64.86%的自杀未遂者在其后的一段时期内仍存在不同程度的再自杀意念,而且再自杀意念主要与患者的家庭环境和患者的抑郁症状有关。     

抑郁症的自杀未遂及其危险因素分析

为了获得抑郁症病人的自杀未遂发生率及其危险因素，采用自制的抑郁症与自杀的关系登记表和Ｈａｍｉｌｔｏｎ抑郁量表，分别对符合中国精神疾病分类方案与诊断标准第２版修订本的２１２例住院的抑郁症病人进行调查评分，然后用ＳＰＳＳ和ＰＥＭＳ软件包进行统计分析。结果：在２１２例抑郁症病人中发生自杀观念１５８例（７４．５％），自杀未遂６７例（３１．６％）。在自杀未遂组中的自杀方式以过量服药为主（４７．８％），自杀地点多在室内（７７．６％）。自杀未遂组的抑郁症状评分高于无自杀行为组（ｔ＝７．２７，Ｐ＜０．０１）。自杀与绝望感、抑郁情绪、自卑感、自知力等呈正相关。逐步回归分析发现，绝望感对自杀的影响最大，其次是抑郁情绪，再次是自卑感和自知力。提示抑郁症与自杀的关系密切，频繁出现≥３次自杀观念的抑郁症病人发生自杀行为的可能性较大。     

上海部分医院自杀未遂相关因素分析

目的 调查上海部分综合医院和精神卫生中心自杀未遂者的自杀行为特征和相关因素,为制定自杀预防及干预措施提供依据.方法 使用自编的自杀未遂者调查登记表对就诊于急诊和门诊的自杀未遂者进行调查,数据输入SPSS统一分析.结果 363例自杀未遂者中女性245(67%)与男性118(33%)的比例为2:1.平均年龄33±16.8岁...     

Increased suicide risk and clinical correlates of suicide among patients with Parkinson's disease

IntroductionParkinson's disease (PD) is a debilitating, neurodegenerative condition frequently complicated by psychiatric symptoms. Patients with PD may be at higher risk for suicide than the general population, but previous estimates are limited and conflicting. The aim of this study is to estimate the suicide rate based on the clinical case registry and to identify risk factors for suicide among patients diagnosed with PD.MethodsThe target sample consisted of 4362 patients diagnosed with PD who were evaluated at a general hospital in Seoul, South Korea, from 1996 to 2012. The standardized mortality ratio for suicide among PD patients was estimated. In order to identify the clinical correlates of suicide, case-control study was conducted based on retrospective chart review. The 29 suicide cases (age: 62.3 ± 13.7 years; females: 34.5%) were matched with 116 non-suicide controls (age: 63.5 ± 9.2 years; females 56.9%) by the year of initial PD evaluation.ResultsThe SMR for suicide in PD patients was 1.99 (95% CI 1.33–2.85). Mean duration from time of initial diagnosis to suicide among cases was 6.1 ± 3.5 years. Case-control analysis revealed that male, initial extremity of motor symptom onset, history of depressive disorder, delusion, any psychiatric disorder, and higher L-dopa dosage were significantly associated with suicide among PD patients. Other PD-related variables such as UPDRS motor score were not significantly associated with death by suicide.ConclusionSuicide risk in PD patients is approximately 2 times higher than that in the general population. Psychiatric disorders, and also L-dopa medication need further attention with respect to suicide.     

Suicide attempts and clinical risk factors in patients with bipolar and unipolar affective disorders

Background

Suicide is an important clinical problem in psychiatric patients. The highest risk of suicide attempts is noted in affective disorders.

Objective

The aim of the study was to look for suicide risk factors among sociodemographic and clinical factors, family history and stressful life events in patients with diagnosis of unipolar and bipolar affective disorder (597 patients, 563 controls).

Method

In the study, the Structured Clinical Interview for DSM-IV Axis I Disorders and the Operational Criteria Diagnostic Checklist questionnaires, a questionnaire of family history, and a questionnaire of personality disorders and life events were used.

Results

In the bipolar and unipolar affective disorders sample, we observed an association between suicidal attempts and the following: family history of psychiatric disorders, affective disorders and psychoactive substance abuse/dependence; inappropriate guilt in depression; chronic insomnia and early onset of unipolar disorder. The risk of suicide attempt differs in separate age brackets (it is greater in patients under 45 years old). No difference in family history of suicide and suicide attempts; marital status; offspring; living with family; psychotic symptoms and irritability; and coexistence of personality disorder, anxiety disorder or substance abuse/dependence with affective disorder was observed in the groups of patients with and without suicide attempt in lifetime history.     

Psychosocial and psychiatric factors associated with adolescent suicide: A case–control psychological autopsy study

This study aimed at the investigation of psychosocial and psychiatric risk factors of adolescent suicide by means of a case–control psychological autopsy study.Relatives and other informants of 19 suicide victims and 19 matched psychiatric controls were interviewed by means of a semi-structured interview schedule. Psychiatric controls included adolescents, individually matched according to gender, age and time between interview and suicide/admission, who had been admitted to a Psychiatric Department with suicidal ideation or attempted suicide at admission.Results showed that suicide victims had been exposed more frequently to suicidal behaviour by friends and through media and experienced more relational problems in the past year. Suicidal communication was less frequently reported in suicide victims than in controls and when communication did occur, it was less often directed towards parents. Treatment of psychiatric disorders was significantly less found in suicide victims. Psychiatric control patients were more likely to have comorbidity of psychiatric disorder, conduct disorder, delinquency or academic difficulties.This study showed significant differences between young suicide victims and psychiatric controls for life events, exposure, communication and treatment. These results also suggest that more symptoms and more externalizing behaviour can be observed in psychiatric control patients which could indicate more warning signals of possible psychiatric problems for the environment, which could result in more help-seeking behaviour and treatment.     

Risk factors of suicide in inpatients and recently discharged patients with affective disorders. A case-control study

ObjectivePatients with affective disorders are at high risk of suicide, especially during inpatient treatment and during the first year after discharge.MethodsA blinded case-control design was used. The study included a total national sample of patients with affective disorder admitted during the period from January 1, 1994 to December 31, 1995, who died because of suicide, either during admission or shortly after discharge.ResultsA history of suicide attempt was a significant risk factor (IRR 4.9; 95% CI 2.1–11.6). Loss of job during the year prior to the index admission was associated with an increase in suicide risk (IRR: 2.9; 95% CI 1.2–7.5). Clinical improvement during the index admission (IRR: 0.3; 95% CI 0.1–0.7), and treatment with antidepressant drugs at the censoring date (IRR: 0.3; 95% CI 0.1–0.7) were associated with a decrease in suicide risk.ConclusionImproved treatment may be a key factor in suicide prevention in patients during, and shortly after hospitalisation with affective disorders. Also, there is a need to be especially aware of suicide risk in patients with little or no improvement at discharge.     

广东省怀集县中学生自杀未遂状况调查及相关因素分析

目的了解广东省怀集县中学生自杀未遂的报告率,探讨其危险因素,为实施心理危机干预提供依据。方法采用分层整群随机抽样方法,在广东省怀集县两所中学每个年级各抽取2个班级共12个班级的593名学生为调查对象。采用自编人口学问卷、自杀未遂调查表进行匿名调查。通过Logistic回归模型探讨自杀未遂相关因素。结果共567份(95.6%)问卷纳入最终分析。被访者平均年龄(15.1±11.6)岁,女生293名(51.7%)。自杀未遂率为4.8%,女男自杀未遂率比为2.2:1。女性(OR=3.4,95%CI:1.2~9.3)、认识的本校同学有自杀行为(OR=15.4,95%CI:5.9~40.2)、近一个月因心理问题影响学习(OR=9.2,95%CI:2.8~30.4)是既往自杀未遂的独立危险因素,班主任为女性(OR=0.2,95%CI:0.1~0.5)可能是独立保护性因素。结论怀集县中学生,尤其是女生自杀未遂发生率高,应根据研究发现的自杀未遂相关因素在怀集县建立有针对性的自杀预防体系。