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。     

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。     

住院精神分裂症与抑郁症患者自杀行为的临床特征比较

目的：比较精神分裂症与抑郁症住院病人自杀行为的发生比率，临床特征及自杀死亡率的差异。方法：采用病史询问、精神状态检查和定式评定的方法，确定精神分裂症有自杀行为者６４例，抑郁症３４例患者为研究对象，并在５年后追踪调查其自杀死亡的情况。结果：住院精神分裂症自杀行为的发生率为３３％，其中自杀未遂者为１２．９％；抑郁发作的自杀行为发生率为８９．５％，自杀未遂者为５７．９％。影响住院精神分裂症的自杀行为的主要因素为幻觉妄想；影响抑郁症自杀行为的影响因素除情绪障碍外，有８～１１％的病人伴有妄想症状。精神分裂症和抑郁症伴有自杀行为的追踪病例中病程在６年内自杀死亡的比率分别为２．９％和５．６％。结论：精神分裂症和抑郁症的自杀行为是精神科临床危机干预的重要内容，临床医师应当重视发病期精神症状对自杀行为的影响。     

精神病人自杀未遂临床资料分析

为探讨精神病人的自杀未遂发生率及其影响因素，作者对３５０例首次入院精神病人中的自杀未遂者和无自杀行为者进行对照分析。结果显示，自杀未遂发生率为１２．５７％。导致自杀未遂的主要因素为抑郁、幻觉和思维障碍。病人首发精神症状后能否及时治疗是预防精神病人发生自杀未遂的关键。     

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...     

部分自杀未遂者两年后与社区正常对照比较

目的：分析有自杀未遂史者与社区中无自杀行为者的差异，以便有针对性地制定预防自杀的措施。方法：用自制的调查问卷对363例曾经就诊于三所综合医院的自杀未遂者进行两年后的随访，并按性别、年龄、居住地匹配无自杀行为者进行比较。结果：尽管在性别、年龄、家庭收入、婚姻状况、职业、医疗来源方面两组无显著性差异，但与对照组比，有自杀未遂史组读书年限明显偏短，冲动性、攻击性的人格特征极为突出，近两年觉得活着没意思的频率高、遭遇的负性生活事件数目和相应的心理压力大，近一个月的生命质量、家庭亲密度和适应性差，近一周内的抑郁程度重。结论：有自杀未遂史者两年之后，仍然在许多方面与正常对照有显著的差别。提示有自杀未遂史者是较独特的人群，应该对该高危人群建立相应的干预措施。     

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     

河北省18岁及以上人群自杀未遂流行病学调查

目的:了解河北省自杀未遂的流行病学特点,分析自杀未遂的相关因素。方法:采用2004年10月至2005年3月河北省精神障碍流调样本,以该样本为多阶段分层整群抽样方法随机抽取≥18岁人群,共24000名,以回龙观医院北京心理危机与干预中心编制的自杀未遂调查表记录自杀未遂情况,用美国《精神障碍诊断和统计手册第四版(DSM-Ⅳ)》对各类精神障碍进行诊断。结果:(1)自杀未遂终生发生率为0.82%(95%CI:0.70～0.94);女性发生率为1.17%(95%CI:1.02～1.32),男性为0.47%(95%CI:0.38～0.56),女性明显高于男性(χ2=30.45,P0.001);城市发生率为0.45%(95%CI:0.36～0.54),农村为0.88%(95%CI:0.75～1.00),农村明显高于城市(χ2=5.26,P0.05)。(2)服毒药及治疗药为自杀的主要方式(78.2%),使用的药物或工具来源主要是放在家里(73.5%),最主要目的是解脱痛苦(73.5%),41.8%的自杀行为属冲动性,自杀未遂者中精神疾病患病率为52.9%。(3)Logistic回归分析显示:自杀未遂的危险因素为女性(OR=2.19,95%CI:1.55～3.09)、小学教育程度(OR=1.88,95%CI:1.34～2.65)、年龄30～39岁(OR=1.66,95%CI:1.19～2.34)、离婚(OR=3.28,95%CI:1.57～6.89)、再婚(OR=4.57,95%CI:2.00～10.46)、精神疾病(OR=8.72,95%CI:6.37～11.95)。结论:加强农药及治疗药的管理、及时发现、治疗精神疾病对自杀未遂的预防具有重要作用,应对自杀未遂人群进行有效干预,防止再次出现自杀行为。     

自杀未遂者的随访研究

目的：了解自杀未遂者一年之后自杀死亡、自杀未遂与自杀意念发生的情况，一年内生活事件发生的情况以及随访时的情绪状态，探讨自杀意念的相关危险因素。方法：对60例自杀未遂者在一年后进行随访调查，使用生活事件量表、抑郁焦虑自评量表评定一年内生活事件发生的情况以及随访当时焦虑、抑郁的情况。结果：60例随访自杀未遂者无一例发生自杀死亡的情况，有4例发生（6．67％）自杀未遂行为，在随访调查时仍有自杀意念者有11例（18．3％）。60例随访自杀未遂者的焦虑分、抑郁分和生活事件紧张总值分均明显下降，有自杀意念组的各量表分高于无自杀意念组。结论：自杀未遂者一年后的自杀未遂发生率和自杀意念发生率是较高的，与年龄、躯体疾病、生活事件和焦虑抑郁情绪等因素有关。     

北京心理援助热线来电者自杀未遂的相关因素

目的:探讨心理援助热线来电者自杀未遂行为的发生情况及其相关因素,为制定自杀热线干预措施提供依据。方法:北京市心理援助热线接线员在2002-2008年接听全部有效来电时,询问来电者在2周内是否实施过自杀行为,使用抑郁症诊断筛查量表评估其抑郁情绪,询问来电者是否有过酒精或其他物质滥用或依赖、有无常见精神症状、既往自杀未遂史、急性和慢性生活事件、希望程度等与自杀行为有关因素。结果:有22 415个来电者被纳入研究。362个(1.6%)来电者报告了2周内实施过自杀行为,女性233人,男性129人。在控制了人口学因素等变量后,既往自杀未遂史(OR=4.43,95%CI:3.37-5.83)、无望(OR=2.01,95%CI:1.52-2.67)、物质滥用(OR=1.97,95%CI:1.48-2.62)、急性生活事件(OR=1.94,95%CI:1.49-2.52)及严重抑郁情绪(OR=1.45,95%CI:1.08-1.95)与来电者实施自杀未遂行为有关联。结论:心理援助热线来电者自杀未遂行为发生率较高,对该群体的自杀干预要注重既往自杀未遂史、物质使用及生活事件的应对。     

Common Pesticides Used in Suicide Attempts Following the 2012 Paraquat Ban in Korea

To determine the change in pesticides used during suicide attempts after the 2012 paraquat (PQ) ban, we evaluated the annual number of suicide attempts by pesticide ingestion between 2011 and 2014. We extracted demographic, clinical outcome, and pesticide class data from the medical records of 1,331 patients that attempted suicide by pesticide ingestion. Pesticides were sorted into 5 groups: herbicides, insecticides, fungicides, other pesticides, and combined pesticides. Each group was subdivided into various classes based on publications by the respective Resistance Action Committees. The chi-square test for trends was used to compare the annual incidence of categorical variables. The total number of suicide attempts decreased each year, from 399 in 2011 to 245 in 2014. Simultaneously, PQ ingestion decreased from 253 patients in 2011 to 60 in 2014. The proportion of PQ to pesticides also decreased from 63.4% in 2011 to 24.5% in 2014. Furthermore, the rate of decrease in the proportion of PQ to all herbicide categories increased by calendar year. In conclusion, there is a significant trend in increased annual number of suicides and proportion of suicides using glyphosates and glufosinates versus total herbicides. However, the number of suicide attempts using glyphosate and glufosinate is lower than that using PQ. The ratio of persons completing suicide to those attempting suicide after pesticide ingestion has decreased every year after the PQ ban.

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Characteristics of attempted suicides seen in emergency-care settings of general hospitals in eight low- and middle-income countries

BACKGROUND: The objective was to describe patients presenting themselves at emergency-care settings following a suicide attempt in eight culturally different sites [Campinas (Brazil), Chennai (India), Colombo (Sri Lanka), Durban (South Africa), Hanoi (Viet Nam), Karaj (Iran), Tallinn (Estonia), and Yuncheng, (China)]. METHOD: Subjects seen for suicide attempts, as identified by the medical staff in the emergency units of 18 collaborating hospitals were asked to participate in a 45-minute structured interview administered by trained health personnel after the patient was medically stable. RESULTS: Self-poisoning was the main method of attempting suicide in all eight sites. Self-poisoning by pesticides played a particularly important role in Yuncheng (71.6% females, 61.5% males), in Colombo (43.2% males, 19.6% females), and in Chennai (33.8% males, 23.8% females). The suicide attempt resulted in danger to life in the majority of patients in Yuncheng and in Chennai (over 65%). In four of the eight sites less than one-third of subjects received any type of referral for follow-up evaluation or care. CONCLUSIONS: Action for the prevention of suicide attempts can be started immediately in the sites investigated by addressing the one most important method of attempted suicide, namely self-poisoning. Regulations for the access to drugs, medicaments, pesticides, and other toxic substances need to be improved and revised regulations must be implemented by integrating the efforts of different sectors, such as health, agriculture, education, and justice. The care of patients who attempt suicide needs to include routine psychiatric and psychosocial assessment and systematic referral to professional services after discharge.     

Suicide and attempted suicide in France: results of a general practice sentinel network, 1999-2001.

The continuous surveillance of suicide and attempted suicide cases was added to the tasks of the French Sentinel Network of General Practitioners (GPs) in 1999. In 2001, 9700 suicides were estimated to have occurred and an estimated 61 500 attempted suicide cases were diagnosed by GPs, representing approximately 40% of cases nationwide. The majority of suicide and attempted suicide cases involved women (67%) and 43% of all cases involved patients aged 25-44 years. The fatality rate increased with age. About 80% of GPs complied with the current recommendation to refer patients who had attempted suicide to hospital.     

Association of the COVID-19 Pandemic and Low-rescue Suicide Attempts in Patients Visiting the Emergency Department after Attempting Suicide

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic may increase the total number of suicide attempts and the proportion of low-rescue attempts. We investigated the factors affecting low-rescue suicide attempts using the risk-rescue rating scale (RRRS) among patients who visited the emergency department (ED) after attempting suicide before or during the COVID-19 pandemic.MethodsWe retrospectively investigated suicide attempts made by patients who visited our ED from March 2019 to September 2020. Patients were classified into two groups based on whether they attempted suicide before or during the COVID-19 pandemic. Data on demographic variables, psychiatric factors, suicide risk factors and rescue factors were collected and compared.ResultsA total of 518 patients were included in the study, 275 (53.1%) of whom attempted suicide during the COVID-19 pandemic. The proportion of patients who made low-rescue suicide attempts differed before and during the COVID-19 pandemic (37.1% vs. 28.8%) (P = 0.046). However, the proportions of patients who made high-risk suicide attempts and high-lethality suicide attempts did not significantly differ between the two periods. The independent risk factors for low-rescue suicide attempts were age and the COVID-19 pandemic (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.00–1.03; P = 0.006) (OR, 1.52; 95% CI, 1.03–2.25; P = 0.034).ConclusionThe COVID-19 pandemic was associated with low-rescue suicide attempts in patients visiting the ED after attempting suicide. Thus, we need to consider the implementation of measures to prevent low-rescue suicide attempts during similar infectious disease crises.     

Suicidal Ideation and Attempted Suicide Among Women Living With HIV/AIDS

The prevalence, timing, and predictors of suicidal ideation and attempted suicide were evaluated in a sample of 207 HIV-positive women in New York City. Twenty-six percent of the women reported attempting suicide since their HIV diagnosis. Of those who made an attempt, 42% acted within the first month after diagnosis and 27% acted within the first week. AIDS diagnosis, psychiatric symptoms, and physical or sexual abuse were significant positive predictors of both suicidal ideation and attempts. Contrary to expectations, having children and being employed were also significant positive predictors. Spirituality was significantly negatively associated with suicidal ideation only. These results suggest that suicide prevention measures should be implemented for HIV-positive women immediately after diagnosis. Specifically, interventions should target those with an AIDS diagnosis, psychiatric symptoms, an abuse history, children, or employment. The encouragement of spiritual connection seems to be a deterrent to suicidal thoughts and is a possible avenue for intervention.     

Reasons for suicide attempts in a clinical sample of active duty soldiers

BackgroundSelf-reported reasons for suicide attempts were examined in a sample of active duty soldiers who had attempted suicide using a functional approach that classifies suicidal behaviors into four primary functions of reinforcement: automatic negative (AN-R; to reduce aversive internal experiences), automatic positive (AP-R; to generate desired internal experiences), social negative (SN-R; to avoid aversive contextual demands), and social positive (SP-R; to generate desired environmental contexts). Based on previous theory and research, the authors hypothesized that soldiers would attempt suicide primarily to reduce aversive internal experiences (i.e., AN-R).Methods72 soldiers (66 male, 6 female; 65.3% Caucasian, 9.7% African-American, 2.8% Asian, 2.8% Pacific Islander, 4.2% Native American, and 9.7% “other”; age M=27.34, SD=6.50) were interviewed using the Suicide Attempt Self Injury Interview to assess suicidal intent, method, lethality, and reasons for attempting suicide.ResultsSoldiers endorsed attempting suicide for both automatic and social reasons, with multiple functions being endorsed in 95% of attempts. AN-R was endorsed in 100% of suicide attempts, and was primary to other functions. Suicidal intent was weakly correlated with AN-R, AP-R, and SN-R functions (rs<.22), and medical lethality was very weakly correlated with only the SP-R function (r=.18).LimitationsSmall sample size and retrospective self-report methodology.ConclusionsSoldiers attempt suicide primarily to alleviate emotional distress. Reasons for attempting suicide do not correlate strongly with suicidal intent or medical lethality.     

Attempted suicide in psychiatric outpatients with concurrent physical illness

Fifty outpatients with concurrent psychiatric and physical illness who were referred following a suicidal attempt to the Outpatient Psychiatric Department, University of Athens, during a period of 3 years (1979-1981) were compared with a random sample of 85 psychiatric outpatients without concurrent physical illness who had attempted suicide at the same time period. Attempters suffering from both mental and physical illness were more often of an older age, married, pensioners or housewifes, were living with their own family, were suffering from organic psychotic condition or major affective disorder (depressive type) and more frequently used violent methods for attempting suicide. Among attempters the commonest physical illnesses were neurological diseases (40%), cardiovascular diseases (26%) and cancer (10%).     

Risk Factors of Discharged Against Medical Advice among Adolescents Self-inflicted Injury and Attempted Suicide in the Korean Emergency Department

Suicide is a leading cause of death among Korean adolescents. Many suicide attempting adolescents often are discharged against medical advice in the emergency department. The aim of the present study was to determine the risk factors for discharge against medical advice (DAMA) after self-inflicted injury or attempted suicide in the emergency department. We extracted data on adolescents (10-19 yr old) from the national emergency department information system; we used data from 2007 and 2011. A total of 6,394 adolescents visited EDs after self-inflicted injury or attempted suicide. Among these patients, the median age was 17 yr (Interquatile range, 15-18 yr), 83.2% were between 15-19 yr of age, and 63.3% were female. Poisoning was the most common method of attempted suicide, while hanging and fall were the most common methods of fatality. The rate of DAMA from the ED was 22.8%. Independent risk factors for DAMA included female gender (odds ratio [OR], 1.49), older age adolescents (OR, 1.96), residence in a metropolitan/large city area (OR, 1.49), and discharge at night (OR, 1.38). These risk factors should be considered in establishing management and counseling plans for patients discharged against medical advice by community services and EDs.

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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.     

Suicide attempts: differences between unipolar and bipolar patients and among groups with different lethality risk

BACKGROUND: The present naturalistic study aimed to distinguish between suicide attempts (SAs) of bipolar and unipolar patients, and among SAs characterized by different lethality risk. METHODS: The records of 2395 consecutive admissions to our psychiatric intensive care unit (PICU) were assessed for presence of suicide attempt (SA). Cases of SA were rated for symptom severity with the brief psychiatric rating scale (BPRS), the scale for the assessment of positive symptoms (SAPS), the scale for the assessment of negative symptoms (SANS), the mini mental state examination (MMSE), the global assessment of functioning scale (GAF) and the clinical global impression (CGI). An original questionnaire was administered to explore clinical aspects related with suicidal behavior. RESULTS: Among 2395 admissions, 80 (3.3%) had attempted suicide. Fifty-three cases (66.2%) suffered from a mood episode, including 22 (27.5%) with unipolar depression and 31 (38.7%) with bipolar depression (types I and II combined) or mixed state, while 27 (33.8%) cases received other diagnoses. Forty-eight (60%) cases had attempted suicide prior to the index episode. Ten cases (12.5%) had a relative who attempted or committed suicide. Thirty-nine cases (48.7%) described their SA as impulsive. Twenty cases (25.0%) reported alcohol ingestion before SA. In comparison with women, men used more violent methods. Cases characterized by a non-lethal risk SA had higher BPRS psychotic cluster and SAPS scores than cases with either low or high lethal risk SA. Bipolar cases were over-represented in the high lethality risk group. BPRS anxiety-depressive cluster score was higher in unipolar than in bipolar cases. LIMITATIONS: The sample may not be representative of all patients with SA. The questionnaire has not been standardized for use in psychiatric populations. CONCLUSIONS: The higher proportion of high lethal risk SA in bipolar cases suggests that the risk of completed suicide is higher in bipolar disorder than in unipolar depression. The risk of lethality in SA was not associated with the intensity of symptoms of anxiety and depression.