抑郁症患者自杀态度与自杀意念的关系研究

目的探讨抑郁症患者自杀态度与自杀意念的关系。方法采用自杀态度问卷(Q SA)和B eck自杀意念量表中文版(BS I-CV)对334名抑郁症住院患者进行调查。结果抑郁症患者自杀态度的4个因子均分都在2.5~3.5之间;其与自杀意念强度、自杀危险程度呈一定负相关关系(P<0.05);结构方程模型拟合表明,自杀态度通过自杀意念强度影响自杀危险程度(近1周:χ2=2870.04,P<0.05,NNF I=0.88,CF I=0.89;最消沉抑郁时:χ2=1599.41,P<0.05,NNF I=0.94,CF I=0.95);在"近1周"和"最消沉"2个时间段,自杀态度对自杀危险程度的间接影响作用分别为0.308和0.410,P<0.05。结论自杀态度通过自杀意念强度对自杀危险产生影响。     

云南省大学生自杀意念、自杀行为与自尊及心理健康状况的调查研究

目的 了解云南省大学生的自杀意念及自杀行为状况、自尊及心理健康状况,分析影响大学生自杀行为的主要因素.方法 采用分层、随机、按比例抽样的方法,采用一般情况调查表、自编的外显行为量表、自尊量表(SES)及临床症状自评量表(SCL-90)对云南省13所高校的3400名大学生进行测试,共回收有效问卷3313份.结果 13.2%的大学生有自杀意念,4.6%的大学生有过自杀行为,女生略高于男生,经χ2检验差别无显著性;大学生自杀行为与自尊水平、心理健康水平之间呈显著相关.结论 应采取措施提高大学生的自尊水平及心理健康水平,以降低大学生的心理危机及自杀行为的发生率.     

Gender-Specific Factors Associated with Suicide Attempts among the Community-Dwelling General Population with Suicidal Ideation: the 2013 Korean Community Health Survey

We identified traditional risk factors and investigated poorly understood risk factors for suicide attempts according to gender in a large Korean population. We analyzed the data from 6,768 males and 12,475 females with suicidal ideation obtained from the nationwide 2013 Korean Community Health Survey. The dependent variable was suicide attempts within the past year. There was a significant trend towards an increase in suicide attempts with decreasing age in both genders. Compared with those who were married, suicide attempts were significantly higher among those who were widowed, divorced, or separated for males (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.34–3.20), but lower for females (OR, 0.66; 95% CI, 0.45–0.98). Current smoking and depression were significant risk factor for suicide attempts in males and females. However, monthly household income, myocardial infarction, and osteoporosis were significantly associated with suicide attempts only in males, whereas education level, recipient of National Basic Livelihood Security, family contact, leisure activity, and drinking frequency were significantly associated only in females. These findings indicate that gender difference should be considered in the assessment, prevention, and management of future suicide attempts by community policy-makers and clinicians.     

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.     

Self-Transcendence Mediates the Relationship between Early Trauma and Fatal Methods of Suicide Attempts

BackgroundEarly trauma is known to be a risk factor of suicide-related behavior. On the other hand, people who attempt suicide using a fatal method are reported to be more likely to complete suicide. In this study, we assumed that early trauma affects an individual''s temperament and character and thereby increases the risk of a fatal method of suicide attempts.MethodsWe analyzed 92 people with a history of previous suicide attempts. We compared the Temperament and Character Inventory-Revised scores between the groups with and without early trauma, and between the groups with and without a history of suicide attempt using fatal methods through an analysis of covariance with age, sex, and presence of a psychiatric history as covariates. A mediation analysis was conducted of the relationship between early trauma and fatal methods of suicide attempt with self-transcendence as a mediator.ResultsHigher self-transcendence was reported in the fatal group (27.71 ± 13.78 vs. 20.97 ± 12.27, P = 0.010) and the early trauma group (28.05 ± 14.30 vs. 19.43 ± 10.73, P = 0.001), respectively. The mediation model showed that self-transcendence mediates the relationship between early trauma and fatal methods of suicide attempt. The 95% confidence intervals for the direct and indirect effect were (−0.559, 1.390) and (0.026, 0.947), respectively.ConclusionSelf-transcendence may mediate the relationship between early trauma and fatal methods of suicide attempt. Self-transcendence may be associated with unhealthy defenses and suicidal behavior for self-punishment and may constitute a marker of higher suicide risk.     

Comparison of Families with and without a Suicide Prevention Plan Following a Suicidal Attempt by a Family Member

The frequency and extent of the existence of a familial suicide prevention plan may differ across cultures. The aim of this work was, therefore, to determine how common it was for families to develop a suicide prevention plan and to compare the main measures used by families with and without such a plan, after an attempt to commit suicide was made by a member of a family living in a rural area of Korea. On the basis of the presence or absence of a familial suicide prevention plan, we compared 50 recruited families that were divided into 2 groups, with Group A (31 families) employing a familial suicide prevention plan after a suicide attempt by a family member, and Group B (19 families) not doing so. The strategy that was employed most frequently to prevent a reoccurrence among both populations was promoting communication among family members, followed by seeking psychological counseling and/or psychiatric treatment. Contrary to our expectation, the economic burden from medical treatment after a suicide attempt did not influence the establishment of a familial suicide prevention plan. It is a pressing social issue that 38% (19 of 50) of families in this study did not employ a familial suicide prevention plan, even after a family member had attempted suicide. Regional suicide prevention centers and/or health authorities should pay particular attention to these patients and their families.     

精神分裂症患者自杀原因对照研究

目的：从社会支持、精神症状、个性特征等方面探讨精神分裂症患者的自杀原因，为预测和预防精神分裂症患者的自杀行为提供依据。方法：采用早年（１８岁以前）不良家庭环境问卷、社会支持量表（ＳＳＲＳ）、明尼苏达多相人格调查表（ＭＭＰＩ）等工具，对３１例自杀未遂的精神分裂症患者和３３名对照者进行研究。结果：精神分裂症患者自杀组的抑郁症状、偏执型、早年不良家庭环境、自杀前自杀意念的分布明显高于非自杀组，且ＭＭＰＩ的依赖性量表分高而疑病分低。结论：抑郁症状、精神分裂症偏执型、早年不良家庭环境和ＭＭＰＩ的依赖性量表分高可以预测精神分裂症患者的自杀行为     

有自杀和凶杀行为的精神分裂症患者人格特征比较研究

目前已有不少研究证实自杀行为和攻击行为关系密切[1- 2 ] ,但两者是否有共同的人格基础 ,此类研究甚少。本研究采用病例对照研究方法 ,使用ＭＭＰＩ,试图探索有自杀和凶杀行为的精神分裂症患者的人格特征。1　对象和方法1.1　研究对象1.1.1　自杀组　 ( 1)符合ＣＣＭＤ -ＩＩ精神分裂症的诊断标准 ;( 2 )无脑器质性疾病 ;( 3)入院前有明显的自杀行为 ,而无攻击行为史 ;( 4 )小学以上文化程度。共入组 2 7例。1.1.2　凶杀组　入组标准 :( 1)符合ＣＣＭＤ -Ⅱ精神分裂症的诊断标准 ;( 2 )无脑器质性疾病和躯体疾病 ;( 3)因杀人致死而送司法精…     

大学生自杀意念的流行病学特征

目的描述大学生自杀意念的流行病学特征,初步分析自杀意念的影响因素。方法整群随机抽取2所高校,采用问卷法调查大学生867名。结果①大学生自杀意念的流行率为12.9%;②女生（χ^2=16.267,P〈0.01）、新生和毕业生（χ^2=23.670,P〈0.001）、医科生（χ^2=25.050,P〈0.001）、独生子女（χ^2=4.988,P〈0.05）、单亲家庭（χ^2=205.883,P〈0.001）及农村学生（χ^2=21.609,P〈0.001）自杀意念流行率较高,并存在显著性差异;③经过Log istic回归分析,结果表明性别、年级、专业、生源地及家庭结构对自杀意念的产生有重要影响。结论加强新生入学教育和毕业生教育,重点关注女生、医科生、单亲家庭及农村学生,多渠道的心理疏导及良好的家庭和校园环境有利于减少大学生自杀意念。     

Comparison of Suicide Risk by Mental Illness: a Retrospective Review of 14-Year Electronic Medical Records

BackgroundKorea is one of the countries with the highest rate of suicide, while suicidality is known to be closely related to mental illnesses. The study aimed to evaluate the suicide rates in psychiatric patients, to compare it to that of the general population, and to investigate the differences among psychiatric diagnoses and comorbidities.MethodsMedical records and mortality statistics of psychiatric patients at Seoul National University Hospital from 2003 to 2017 were reviewed. The standardized mortality ratio (SMR) for suicide was calculated to compare the psychiatric patients with the general population. The diagnosis-specific standardized mortality rate and hazard ratio (HR) were adjusted by age, sex, and psychiatric comorbidity (i.e., personality disorder and/or pain disorder).ResultsA total of 40,692 survivors or non-suicidal deaths and 597 suicidal death were included. The suicide rate among psychiatric patients was 5.13-fold higher than that of the general population. Psychotic disorder had the highest SMR (13.03; 95% confidence interval [CI], 11.23–15.03), followed by bipolar disorder (10.26; 95% CI, 7.97–13.00) and substance-related disorder (6.78; 95% CI, 4.14–10.47). In survival analysis, psychotic disorder had the highest HR (4.16; 95% CI, 2.86–6.05), which was further increased with younger age, male sex, and comorbidity of personality disorder.ConclusionAll psychiatric patients are at a higher risk of suicide compared to the general population, and the risk is highest for those diagnosed with psychotic disorder.     

Mauling of the “Celtic Tiger”: Clinical characteristics and outcome of first-episode depression secondary to the economic recession in Ireland

Background

There is a dearth of studies describing clinical characteristics and outcome of patients who present with mood disorders related to economic recession.

Aims

To describe a cohort of patients admitted with first-episode depression related to the Irish economic recession and compare this cohort with all other first-episode depressives admitted during the same time period (2009–2010).

Methods

A cohort of 137 patients admitted with first-episode depression to an independent university teaching hospital was prospectively identified and followed up from admission over 2 years (mean follow-up 430 days, s.d. 176 days). The cohort was divided into “Celtic Tiger” (patients with first-episode depression secondary to the economic recession) and non-Celtic Tiger control patients (other first-episode depressed patients). Both groups were compared in terms of clinical characteristics at baseline and outcome over follow-up.

Results

The number of admissions due to first depressive episodes were higher in recession years 2009/10 than in pre-recession years 2008/9. Celtic Tiger patients were predominantly male and more severely depressed with more marked suicidal ideation (χ², p<0.001) than control patients. They were more likely to recover (χ², p=0.013), less likely to recur (χ², p<0.001) and had faster time to recovery (log rank, p<0.001) and slower time to full recurrence (log rank, p=0.001). The Celtic Tiger patients spent more time asymptomatic and less time at full and subthreshold depression levels over follow-up.

Limitations

Study setting of centre specializing in affective disorders treatment, retrospective nature of follow-up after initial prospective interview and lack of patient follow-up interview.

Conclusion

The study describes a subgroup of patients with severe depression associated with economic recession with likely high suicide risk but very favourable outcome.     

Feasibility and Safety of Laparoscopic Surgery for Obese Korean Women with Endometrial Cancer: Long-Term Results at a Single Institution

The purpose of this study was to evaluate the surgical feasibility of and survival outcome after laparoscopy in obese Korean women with endometrial cancer which has recently been increasing. We reviewed the medical records of the patients treated at our medical institution between 1999 and 2012. The patients were divided into three groups, non-obese (Body Mass Index [BMI]<25.0), overweight (BMI 25-27.99), and obese (BMI≥28.0). These patient groups were compared in terms of their clinical characteristics, treatment methods, as well as surgical and survival outcomes. In total, 55 of the 278 eligible patients were obese women. There were no differences in the three groups in terms of the proportion of patients who underwent lymphadenectomy, their cancer stage, histologic type, type of adjuvant treatment administered, intra-, post-operative, and long-term complications, operative time, number of removed lymph nodes, blood loss, and duration of hospitalization (P=0.067, 0.435, 0.757, 0.739, 0.458, 0.173, 0.076, 0.124, 0.770, 0.739, and 0.831, respectively). The Disease-Free Survival (DFS) times were 139.1 vs. 121.6 vs. 135.5 months (P=0.313), and the Overall Survival (OS) times were 145.2 vs. 124.8 vs. 139.5 months (P=0.436) for each group, respectively. Obese women with endometrial cancer can, therefore, be as safely managed using laparoscopy as women with normal BMIs.     

罪犯自杀意念及其相关因素研究

目的探讨罪犯自杀意念的发生率及其相关的心理因素,为监狱有效预防罪犯自杀,确保刑罚得到执行提供参考。方法采取随机抽样的方法,抽取某监狱180名罪犯,用症状自评量表(SCL-90)进行调查,对测试资料运用t检验和逐步回归分析。结果有31.1%的罪犯有不同程度的自杀意念;自杀意念与心理健康各因子的相关系数在0.46~0.66之间(P<0.01);有、无自杀意念两组罪犯在SCL-90各因子上的差异显著(t≥5.93,P<0.01);逐步回归分析表明,影响自杀意念的相关因素有抑郁、焦虑、恐怖和敌对等因素。结论罪犯群体中存在的自杀意念比例要高于普通人群,预防罪犯自杀是监狱机关需要重点研究的课题;罪犯的自杀与其心理健康状况存在极为密切的关系。     

Predictors of Treatment Response for Suicidal Youth Referred for Emergency Psychiatric Hospitalization

This study evaluated factors that predicted poor treatment response for 70 suicidal youth (ages 10 to 17 years; 67% African American) who received either multisystemic therapy (MST) or inpatient psychiatric hospitalization. Following treatment, suicidal youth were classified as either treatment responders or nonresponders based on caregiver or youth report of attempted suicide. Overall, female gender, depressive affect, parental control, caregiver psychiatric distress, and caregiver history of psychiatric hospitalization were associated with suicide attempts. However, controlling for other variables, only depressive affect and parental control predicted treatment nonresponse. These results suggest the need to adapt existing treatments for suicidal youth to better address problems relating to youth depression.     

躯体疾病患者自杀危险因素调查表的初步编制

目的:编制符合我同医疗背景下躯体疾病患者自杀危险因素调查表.方法:通过开放性访谈、查阅文献、专家咨询及小组讨论.确定量表条日85条.在长沙市某三甲医院的住院病人中施测,有效问卷438份.结果:经过探索性因素分析保留条目51条,躯体疾病病人自杀意念危险因素调查表总的Cronbach's仅系数为0.878,各因子的α系数在0.551-0.825之间,各条目的负荷为0.413-0.662.躯体疾病病人自杀危险因素调查表与抑郁自评量表(r=0.729)、焦虑自评量表得分(r=0.548)、自杀意念(r=0.345)呈正相关(P均<0.01).结论:躯体疾病患者自杀危险因素调查表条目区分度,初步的信、效度符合测量学要求.     

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。