社区环境与自杀行为的关联性研究

目的探索社区环境对社区居民自杀的影响程度，为提出自杀预防措施提供理论依据。方法从山东、辽宁、湖南三省采用完全随机方法抽取16个县（市），收集了392例15～34岁自杀死亡者和416例对照进行研究。采用心理解剖方法收集自杀死亡者信息；采用同样结构式访谈工具获取同社区对照2名信息人信息。利用WHOSUPRE—MISS社区压力和问题调查量表测量居民的社区环境。结果研究结果表明社区环境因子得分与自杀呈正相关关系，社区环境不良为个体自杀的主要危险因素（Waldx2=10．036，P〈0．05，OR=1．323）。社区存在的问题如家庭不和、交通不便、缺乏医疗保健、就业保障、酗酒、迷信现象可以明显提高中国农村自杀率。同时显示相对贫穷、患有精神疾病（OR=32．346）是自杀的主要危险因素；受较好教育、已婚、健康身体状况是自杀的主要保护因素。结论政府需要进一步完善社会救助系统，解决社区现存的一些问题，营造和创建良好的社区环境，减轻其生活压力；同时应加强心理障碍筛检，对高危人群积极实施社区心理健康干预，提高人的应激能力，以此有效降低中国农村社区居民自杀率。

Relationship between community environments and suicide behaviors

Objective To explore the relationship between the neighborhood environment and the resi- dents suicidal risk and provide evidence for suicide prevention. Methods The study sample consisted of 392 young suicides （ aged 15-34 years） and 416 community living controls from the same areas of China （ randomly se- lected from 16 rural counties in three provinces）. Social factors in the village neighborhoods were measured by the WHO SUPRE-MISS scale of Community Stress and Problems. Psychological autopsy methods and multivariable Lo- gistic regression were employed. Two informants were interviewed to collect the information of each subject. Results It was found that there was positive correlation between the community surrounding score and suicide. The commu- nity stress and problems was the main risk factor for suicide（ Wald X2 = 10.036, P〈O.05, OR= 1.323 ）. Family dis- putes,inconvenience transportation, lack of health care and job security, alcohol abuse, and superstition can in- crease the suicidal risks among rural young Chinese. It was still indicated that relative poverty, suffering from a mental illness（ OR= 32.346） were the risk factors; but good education, married and good health were the protec- tive factors for suicide. Conclusion Further improving the social assistance system, solving the existing communi- ty stress and problems, building better community environment are needed to reduce the stress of community resi- dents. Psychological screening and the community mental health intervention for high-risk groups should be strengthened to improve residents＇ response capacity to stress. Those measures can reduce the suicide rate of China rural community residents effectively.