无严重躯体疾病的55岁以上自杀者中有无精神障碍者的特征比较

目的:了解无严重躯体疾病的55岁以上自杀死亡者的特征并比较其中有、无精神障碍者的特征.方法:由精神科医师运用心理解剖方法对全国有地理代表性的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深入调查.结果:①自杀前一年有严重的急性或慢性躯体疾病者126例(其中女性占42.1%),平均年龄68±9岁;居住在乡村者101例(80.2%),接受正规教育年限的中位数为0年(25%-75%位数:0-3),65.9%从未上过学;33.3%丧偶;23.0%有自杀未遂既往史,16.1%一级血缘亲属有自杀行为;64.3%服农药或鼠药自杀,6.3%自杀当时有人在场并知道自杀的发生.②126例中有、无精神障碍者分别为76例(60.3%)和50例(39.7%).两组相比,有精神障碍者年纪轻,现婚比例高,自杀前一个月与人谈论死亡问题的比例高,经历的负性生活事件数目多,慢性心理压力大,自杀前一个月的生命质量低,自杀前2周的抑郁程度重,曾因心理问题寻求帮助的比例高(均P<0.05).结论:无严重躯体疾病的老年自杀者的特征与其是否患有精神障碍有关.     

有自杀未遂史与无自杀未遂史自杀者有关问题的比较

据报道 ,3 0 % -60 %的自杀死亡者有自杀未遂史 ;10 % -14 %的自杀未遂者最终自杀身亡[1 ] 。本文就有、无自杀未遂史自杀死亡者在患精神疾病、经历生活事件、自杀原因等方面进行了比较。资料取自北京回龙观医院与中国疾病预防控制中心“意外死亡研究”合作课题。该课题从在全国不同区域内选择2 3个监测点 ,对 3个监测点 1995年 8月至 2 0 0 0年 8月和 2 0个监测点 1997年 1月至 2 0 0 0年 8月期间上报的意外死亡案例或死因为精神病的案例进行调查。各监测点在 3个月期间上报的自杀、其它意外死亡案例分别超过 5例时则随机各选择 5例 ,如果…     

人格在大学生负性生活事件和自杀意念间的中介作用

目的:探讨大学生人格在负性生活事件与自杀意念之间的中介效应.方法:采用青少年负性生活事件量表、自杀意念量表、艾森克人格问卷对8379名大学一年级学生进行调查,采用SPSS 23.0进行数据分析,并进行中介效应检验.结果:大学生自杀意念、自杀倾向(最近一周、最忧郁时)得分与负性生活事件应激量总分及各因子得分均正相关(r=...     

大学生生活事件、人格特征与自杀意念的关系研究

目的了解大学生负性生活事件及人格特征对自杀意念的影响,为大学生自杀预防提供依据。方法采用统一的调查量表,以目的抽样对湖南多所高校在校大学生进行问卷调查。结果1大学生自杀意念的报告率和程度在不同年级(P0.01)、不同学校及专业(P0.05)的比较上,存在显著性差异;2大学生负性生活事件对自杀意念存在显著性影响(P=0.000);3大学生人格特征的内外倾、精神质与自杀意念存在显著性相关(P=0.000)。结论1生活事件、人格特征对自杀意念存在联合预测作用;2各高校应加强毕业生危机干预工作,对大二学生应有针对性释压;3办学层次越高的高校在对大学生自杀危机干预方面的工作应开展得更加深入细致。     

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     

中国北方城乡居民样本在设定条件下自杀的可能性调查

目的:了解中国北方城乡居民样本在设定条件下自杀的可能性。方法:本现况调查以18岁及以上人群为研究对象,通过分层随机抽样抽取北京市区10个居委会和河北武安10个村庄作为调查现场,共1007人完成了调查,其中城市503人,农村504人。评定工具为公众对自杀的态度量表,列出24种特殊境遇,评估设定遭遇时可能和肯定考虑自杀的可能性。结果:本样本中,在设定遭遇列举的特殊境遇时会考虑自杀的累计百分比之和位居前7位的依次为患不治之症(65.2%)、是别人的累赘且未来没有希望(62.0%)、吸毒成瘾(61.2%)、因赌博而大量欠债(57.3%)、被强奸或被强暴(54.2%)、严重抑郁或忧郁(51.6%)、年老无人赡养(50.7%);任何情况下不会考虑自杀的仅占14.6%,可能考虑自杀的占50.7%,肯定考虑自杀的占34.8%。进一步分析发现男性和女性、不同年龄段城乡居民对24种负性生活事件的感受不同,在经历某种相同的负性生活事件的时候考虑自杀的可能性存在差别。结论:当城乡居民经历负性生活事件的时候给予及时的心理帮助是必要的,且应建立个体化的干预措施,以期有效降低自杀率。     

大学生自杀可能性与生活事件的相关性

目的:研究大学生自杀可能性与生活事件的关系,为大学生心理健康教育提供理论依据。方法:采用青少年生活事件量表(ASLEC)、自杀可能性量表(SPS),对351名大学生进行调查。结果:大学生自杀风险较高,自杀可能性总分在60分以上的占76.4%,80分以上的占15.38%。负性自我评价与自杀意念因子在性别差异上具有统计学意义(t=4.261,P0.01;t=3.886,P0.01)。负性生活事件、人际关系、受惩罚、学习压力与健康适应因子在生源地差异上具有统计学意义(t=-3.127,P0.01;t=-2.296,P0.05;t=-3.204,P0.01;t=-4.537,P0,001;t=-2.034,P0.05),负性自我评价与学习压力因子在独生子女差异上具有统计学意义(t=2.586,P0.01;t=-2.338,P0.05),大学生负性生活事件总分及其各个因子在年级差异上具有统计学意义(总分:F=5.921,P0.01;受惩罚:F=2.932,P0.05;人际关系:F=9.584,P0,001;学习压力:F=4.577,P0.01;健康适应:F=3.833,P0.05;丧失:F=3.140,P0.05;其他:F=3.429,P0.05)。自杀可能性与生活事件呈显著正相关(r=0.478,P0.001)。大学生自杀可能性与生活事件中的受惩罚因子存在显著正相关(r=0.467,P0.001),能够解释21.6%(R2=21.6%)因变量的变异,有良好的预测作用。结论:大学生自杀可能性与生活事件相关,高校在开展心理健康教育工作时,应积极关注在学校中体验到生活事件应激的学生。     

抑郁症自杀行为的相关危险因素临床分析

目的　研究抑郁症自杀行为的危险因素 ,为预防自杀提供依据。方法　按 CCMD— 3诊断标准收集 2 1 1例住院的抑郁症患者 ,采用多因素 Logistic回归分析与抑郁症自杀行为有关的危险因素。结果　抑郁症自杀未遂 68例 (3 2 .2 % ) ,自杀与绝望 (相对危险度 RR=9.3 1 0 )、负性生活事件 (RR=3 .844)、自杀家族史 (RR=3 .62 7)、妄想 (RR=3 .783 )及自责 (RR= 2 .985 )呈正相关 (P均 <0 .0 1 )。结论　绝望、负性生活事件、自杀家族史、妄想及自责是抑郁症患者自杀的危险因素。     

长沙市青少年自杀意念与若干心理因素的相关分析

目的了解青少年自杀意念现况及其影响因素,为有针对性地采取防治措施,提高中学生心理健康水平提供依据。方法采取分层整群随机抽样的方法,在长沙市抽取2216名中学生,采用自制一般情况问卷、自杀意念问卷、青少年生活事件量表和自尊量表进行调查。结果①长沙青少年自杀意念的检出率为24.2%,自杀计划的检出率为6%,自杀未遂的检出率为2.5%;②女生自杀意念发生率高于男生(χ2=34.814,P<0.01)、非独生子女的自杀意念发生率高于独生子女(χ2=5.760,P<0.05)、单亲家庭的自杀意念发生率高于非单亲家庭(χ2=17.385,P<0.01),家庭经济条件越差、家庭关系越不和睦和父母经常打骂,自杀意念发生率越高(χ2=23.215,44.442,66.915;P<0.01);③多因素Logistic回归分析显示,影响自杀意念的相关因素有性别、家庭关系情况、家庭暴力情况、生活事件总刺激量、学习压力因子、受惩罚因子、丧失因子和自尊水平。结论青少年自杀意念发生率仍较高,其危险因素有女性、非独生子女、单亲家庭、家庭经济差、家庭关系不和睦、父母经常打骂、负性生活事件以及低自尊水平。     

有无精神障碍自杀未遂者自杀强度和生活满意度的比较

目的：对有、无精神障碍自杀未遂者自杀强度及生活满意度进行比较。方法：对急诊室救治的自杀未遂者，由精神科医生使用调查表进行询问并做出精神障碍诊断，按有、无精神障碍分组，比较自杀强度和生活满意度。结果：调查自杀未遂者120例，有精神障碍39例，占32．5％。与无精神障碍自杀未遂组比较，有精神障碍组自杀强度高、生活满意度低；两组自杀未遂者均认为自杀当时的生活满意度最低，而离自杀行为的时间越远生活满意度越高。结论：有精神障碍的自杀未遂者自杀强度高、生活满意度低，这或许是精神病人出现较多自杀行为或有较高自杀死亡率原因之一。     

Risk factors for suicide in China's youth: a case-control study

BACKGROUND: Suicide is the most common cause of death among youth in China. METHOD: A case-control psychological autopsy study in 23 geographically representative disease surveillance points around China collected information from family members and close associates of 114 persons aged 15-24 years who died by suicide (cases) and 91 who died of other injuries (controls). RESULTS: Among the 114 suicides 61% were female, 88% lived in rural villages, 70% died by ingesting pesticides (most commonly stored in the home), 24% previously attempted suicide, and 45% met criteria of a mental illness at the time of death. Multivariate logistic regression identified several independent risk factors: severe life events within 2 days before death (OR 31.8, 95% CI 2.6-390.6), presence of any depressive symptoms within 2 weeks of death (OR 21.1, 95% CI 4.6-97.2), low quality of life in the month before death (OR 9.7, 95% CI 2.8-34.1), and acute stress at time of death (moderate: OR 3.1, 95% CI 0.8-11.9; high: OR 9.1, 95% CI 1.2-66.8). A significant interaction between mental illness at time of death and gender indicated that diagnosis was an important predictor of suicide in males (OR 14.0, 95% CI 2.6-76.5) but not in females (OR 0.3, 95% CI 0.0-3.6). Prior suicide attempt was related to suicide in the univariate analysis (OR 57.5) but could not be included in the multivariate model because no controls had made prior attempts. CONCLUSIONS: Suicide prevention efforts for youth in China must focus on restricting access to pesticides, early recognition and management of depressive symptoms and mental illnesses, improving resiliency, and enhancing quality of life.     

社区中75例精神分裂症自杀死亡者的特征

目的：为社区中精神分裂症病人的自杀预防，提高依据。方法：用意外死亡问卷对全国社区居民中901例自杀死亡者的家属和知情者进行详细调查，并用SCID－P定式检查的结果按DSM－IV标准做出精神科诊断。结果：75例自杀者确诊为精神分裂症，其中女性明显多于男性（52／23例），年龄中位数为45岁，病程中位数为7年，68％（51例）来自乡村，39％（29例）有自杀未遂史，27％（20例）自杀当时伴有抑郁发作，31％（23例）自杀当时精神分裂症处于缓解期。55％（41例）在自杀前一个月内用过抗精神病药物，32％（24例）从未接受赤精神科治疗，仅有53％（40例）住过精神病院，结论：在社区自杀的精神分裂症患者与住过院自杀精神分裂症患者的特征有所不同，预防住过院和未住过院精神分裂症患者的自杀是迫切需要解决的公共卫生问题。     

Suicide at 50 years of age and older: perceived physical illness, family discord and financial strain

BACKGROUND: Mental disorders amplify suicide risk across the lifecourse, but most people with mental disorder do not take their own lives. Few controlled studies have examined the contribution of stressors to suicide risk. METHOD: A case-control design was used to compare 86 suicides and 86 controls aged 50 years and older, matched on age, gender, race and county of residence. Structured interviews were conducted with proxy respondents for suicides and controls. RESULTS: Perceived physical illness, family discord and employment change amplified suicide risk after controlling for sociodemographic covariates and mental disorders that developed > or = 1 year prior to death/interview. Only the effect of physical illness (OR 6.24, 95% CI 1.28-51.284) persisted after controlling for all active mental disorders. CONCLUSIONS: Interventions to decrease the likelihood of financial stress and to help families manage discord and severe physical illness may effectively reduce suicides among middle-aged and older adults.     

A case-control study of tattoos in young suicide victims as a possible marker of risk

BACKGROUND: The goal was to examine tattooing in suicides, as tattoos have been associated with several risk factors for suicide. METHOD: A chart review of a three-year sample of 134 consecutive suicides in Mobile County, Alabama, was conducted. The prevalence of tattoos was compared between young (<30) white suicides and accidental deaths matched for age, gender and race, in a case-control study. RESULTS: Tattoos were found in 21% of suicides. Fifty-seven percent of young white suicides were tattooed compared to 29% of matched accidental deaths. LIMITATIONS: Findings are preliminary due to the small sample size. The study methodology precluded obtaining information of psychiatric diagnoses prior to death. CONCLUSIONS: Tattoos may be possible markers for lethality from both suicide and accidental death in young people, presumably because of shared risk factors such as substance abuse and personality disorder. Affective disorders should receive further, more specific studies. The clinical value of inquiring about tattoos in young people at risk of suicide needs further study.     

Potential for suicide prevention in primary care? An analysis of factors associated with suicide.

BACKGROUND: General practitioners (GPs) need to be aware of the risk factors for suicide. GP records may provide clues to identifying the relative importance of such risk factors. AIMS: To identify, in suicide cases and matched controls, the patterns of consultation, diagnosis, and treatment of mental illness, and recording of risk factors for suicide. To examine the usefulness of data routinely collected by GPs in computerized databases to investigate treatment of patients in general practice prior to suicide. METHOD: Case control study using GP records from the General Practice Research Database (GPRD). Three controls selected for each case, matched for age, sex, and duration of registration with practice. Information extracted of the prevalence of major disease; diagnosis of, and treatment, or referral for, mental illness; frequency of recording of recent life events; and consultations with the GP in the 12 months prior to death. RESULT: Of the 339 suicide cases recorded, 80% were male, which is similar to the national percentage for this age group. Females were more likely than males to have a history of mental illness and to have been diagnosed and treated for mental illness in the 12 months before death (59% versus 35%), and women were more likely to have previously attempted suicide (47% versus 27%). There was no significant difference between males and females in period of time since last contact with GP practice, but females consulted more frequently. Twenty-nine per cent of cases had not consulted their GP in the six months prior to death. In multivariate analysis, the following were identified as independent risk factors: history of attempted suicide; untreated serious mental illness (odds ratio > 20); recent (past 12 months) marital life event; alcohol abuse; frequent consultations with GP; and previous mental illness. Recording of life events by GPs was poor. CONCLUSIONS: Females at risk of suicide are more likely than males to have been diagnosed and treated for mental illness. It is likely that GPs are under-diagnosed and under-treating males at risk. Data from the GPRD give comparable results to those from other studies. The GPRD is a potentially useful tool for research into relatively uncommon events in general practice.     

The role of primary care in the prevention of suicide and accidental deaths among young men: an epidemiological study.

BACKGROUND: Despite generally falling mortality and suicide rates, among young men the rates of violent death from accidents and suicide continue to rise. Most research has focused upon suicide, and the potential for effective interventions, particularly in primary care, remains controversial. AIMS: To compare health service contacts prior to suicidal and accidental deaths among young men. DESIGN OF STUDY: Examination of inquest data, postmortem and toxicology reports, and general practitioner (GP) and hospital records. SETTING: All sudden, unexpected, violent or unnatural deaths involving young men aged between 15 and 39 years and reported to the four coroner's offices of Merseyside and Cheshire during 1995. METHOD: We compared data on the timing and nature of final GP contacts before death among young men with a verdict of accident or misadventure and suicide or undetermined death. RESULTS: Out of a total of 268 violent deaths, 130 received verdicts of accident/misadventure and 97 received verdicts of suicide/undetermined death. Information on the final contact with a GP was available for 172 deaths. Although there was a significant difference between the proportion of suicide cases (56%) and that of cases of accidental death (41%) who had seen their GP during the 3 months before death, this was not significant at 1 month (38% versus 30%, respectively). Suicide cases were more likely to have seen a mental health professional at some time (27% for suicides versus 13% for accidental deaths). CONCLUSION: These findings confirm that relatively few young men consult their GP during the period before death from suicide or accidents. Prevention strategies must extend beyond suicide risk assessment, and consider ways to encourage young men to consult GPs when they are experiencing emotional distress or problems related to mental health or substance misuse.     

Suicide in current psychiatric in-patients: a case-control study The National Confidential Inquiry into Suicide and Homicide

BACKGROUND: Few controlled studies have investigated factors associated with suicide in current in-patients. We aimed to identify psychosocial, behavioural and clinical risk factors, including variations in care, for in-patient suicide. METHOD: We conducted a national population-based case-control study of people who died by suicide between 1 April 1999 and 31 December 2000 while in psychiatric in-patient care in England. Cases were 222 adult mental health in-patients who died by suicide matched on date of death with 222 living controls. RESULTS: Nearly a quarter of suicides took place within the first week of admission; most of these died on the ward or after absconding. After the first week, however, most suicides occurred away from the ward, the majority of patients having left the ward with staff agreement. Previous deliberate self-harm, recent adverse life events, symptoms of mental illness at last contact with staff and a co-morbid psychiatric disorder were associated with increased risk for suicide. Being off the ward without staff agreement was a particularly strong predictor. Those patients who were detained for compulsory treatment were less likely to die by suicide. Independent predictors of in-patient suicide were male sex, a primary diagnosis of affective disorder and a history of self-harm. Being unemployed or on long-term sick leave appeared to be independently protective. CONCLUSION: Prevention of in-patient suicide should emphasize adequate treatment of affective disorder, vigilance in the first week of admission and regular risk assessments during recovery and prior to granting leave. Use of compulsory treatment may reduce risk.     

The prevalence of human thymic lymphoid follicles is lower in suicides

In an autopsy study we determined the prevalence of thymic lymphoid follicles in 311 accident victims in whom the time interval between accident and death was known. We found that the prevalence decreased abruptly in those surviving 48 h or more (P=0.000008). We then compared the prevalence in 271 accident and 168 suicide victims, all of whom had died less than 48 h after the incident and found that the prevalence was significantly lower in the suicide group (P=0.03). We conclude that this difference may be related to the effect on the thymus of high levels of psychological stress likely to have been experienced by the suicides in the days prior to the act. The use of the term hyperplasia to indicate the presence of lymphoid follicles in the thymus and the methodology appropriate for determining the prevalence of thymic lymphoid follicles are discussed. Received: 9 February 1999 / Accepted: 26 August 1999     

Suicides and serious suicide attempts: two populations or one?

BACKGROUND: Few studies have examined the extent to which populations of suicides and attempted suicides are similar, or different. This paper compares suicides and serious suicide attempts in terms of known risk factors for suicidal behaviour. METHODS: Using case-control methodology, risk factors for suicidal behaviour were examined in 202 individuals who died by suicide, 275 individuals who made medically serious suicide attempts and 984 randomly selected control subjects. Based on data from significant others, measures used spanned sociodemographic factors, childhood experiences, psychiatric morbidity and psychiatric history, exposure to recent stressful life events and social interaction. RESULTS: Multiple logistic regression identified the following risk factors that were common to suicide and serious suicide attempts: current mood disorder; previous suicide attempts; prior outpatient psychiatric treatment; admission to psychiatric hospital within the previous year; low income; a lack of formal educational qualifications; exposure to recent stressful interpersonal, legal and work-related life events. Suicides and suicide attempts were distinguished in the following ways: suicides were more likely to be male (OR = 1.9, 95% CI 1.1, 3.2); older (OR = 1.03, 95% CI 1.02, 1.04); and to have a current diagnosis of non-affective psychosis (OR = 8.5, 95% CI 2.0, 35.9). Suicide attempts were more likely than suicides to have a current diagnosis of anxiety disorder (OR = 3.5, 95% CI 1.6, 7.8) and to be socially isolated (OR = 2.0, 95% CI 1.2, 3.5). These findings were confirmed by discriminant function analysis, which identified two functions that described the three subject groups: the first function discriminated the two suicide groups from control subjects on a dimension corresponding to risk factors for suicide; the second function discriminated suicide from suicide attempt subjects on a series of factors including gender, non-affective psychosis and anxiety disorder. CONCLUSIONS: Suicides and medically serious suicide attempts are two overlapping populations that share common psychiatric diagnostic and history features, but are distinguished by gender and patterning of psychiatric disorder.