综合医院接诊的自杀未遂者有无自杀意念特征比较

Comparison of the characteristics of suicide attempters in general hospitals with and without suicidal ideation

目的获得城市综合医院急诊室自杀未遂者自杀意念特征,为预防其再次发生自杀行为提供参考。方法以在沈阳市4所三级综合医院急诊室同一时段内接诊的自杀未遂患者为调查对象,使用自伤情况问卷、贝克自杀意念量表和美国精神障碍与统计手册第4版病人版(DSM-Ⅳ)轴Ⅰ障碍临床定式检查为调查和诊断工具,并比较分析调查资料完整的239例自杀未遂者有无自杀意念特征。结果 (1)两组在年龄、受教育年限等方面差异无统计学意义(均P>0.05);(2)与从无自杀意念组相比,有过自杀意念组有宗教信仰者多(11.45%vs.1.37%,P<0.01),近一个月曾因心理问题而难以从事日常活动或工作者多(57.23%vs.19.18%,P<0.01),本次最早出现伤害自己的想法到自伤所间隔时间超过2h的多(71.69%vs.27.40%,P<0.01),这次自伤最主要的目的是解脱痛苦者多(65.06%vs.26.03%,P<0.01),自杀当时想死程度超过80%者多(61.45%vs.13.70%,P<0.01),对这次自杀认真者多(72.29%vs.23.29%,P<0.01),后悔这次自杀失败者多(17.47%vs.9.59%,P<0.05),近一周有绝望感者多(82.53%vs.34.25%,P<0.01),近一年想过自杀或故意伤害自己者多(82.53%vs.24.66%,P<0.01),近1个月生命质量得低分(<54分)者多(41.57%vs.12.33%,P<0.01);(3)与有过自杀意念组相比,从无自杀意念组这次自伤最主要的目的是对现实抗争等(73.97%vs.34.94%,P<0.01),自杀当时想死程度<50%者多(54.79%vs.14.46%,P<0.01),对这次自杀不认真者多(28.77%vs.0.60%,P<0.01);(4)有过自杀意念组的精神障碍总患病率显著高于从无自杀意念组(84.34%vs.35.62%,χ2=56.73,P<0.01)。结论城市综合医院急诊室有无自杀意念的自杀未遂者其自杀未遂特征有明显不同。有过自杀意念的自杀未遂者中精神障碍患病率较高,且其中抑郁障碍和焦虑障碍患病率占的比例较大;从无自杀意念的自杀未遂者有冲动性自伤的特点。因此对不同自杀未遂者应采取不同干预措施,防止其再次出现自杀行为。

Objective To investigate the characteristics of suicidal ideation among suicide attempters at critical emergency units of general hospitals in city as a first step in preventing suicidal behaviors among suicide attempters from occurring again. Methods Suicide attempters of emergency department of 4 tertiary general hospitals in Shenyang during the same period were interviewed,among them 239 cases with intact data were assessed with questionnaires on self -injury ,Beck. Scale for Suicide Ideation and diagnosed with a structured psychiatric examination based on DSM-Ⅳ criteria. Then the characteristics of them with or without suicidal ideation were compared and analyzed. Results There were no significant difference in age,years of education between the two groups ( all P > 0. 05). However,in comparison with the group without suicidal ideation,the one with suicidal ideation were more likely to have religion( 11. 45% vs. 1. 37% ,P < 0. 01) ,to difficult to engage in daily activities or jobs owing to psychological problems in the prior month( 57. 23% vs. 19. 18% ,P < 0. 01) ,to exceed two hours on the interval they had considered suicide before acting( 71. 69% vs. 27. 40% ,P < 0. 01) ,to releasing themselves from their suffering on the main aim of this time self-harm( 65. 06% vs. 26. 03% ,P < 0. 01) ,to have the degree of the thinking to die exceeding 80 percent( 61. 45% vs. 13. 70% ,P < 0. 01) ,to have serious attitude to this time suicide( 72. 29% vs. 23. 29% ,P < 0. 01) ,to regret the failure of this suicide( 17. 47% vs. 9. 59% ,P < 0. 05) ,to have hopelessness in the prior week( 82. 53% vs. 34. 25% ,P < 0. 01) ,to had suicidal thoughts or deliberate self-harm behaviors in the prior year( 82. 53% vs. 24. 66% ,P < 0. 01) and to have lower mean score( < 54) on quality of life in the prior month( 41. 57% vs. 12. 33% ,P < 0. 01). Conclusions The substantial differences between suicide attempters with and without suicidal ideation indicate the need to develop suicidal ideation-specific intervention strategies at critical emergency units of general hospitals in city to prevent the recurrence of suicidal behaviors. The suicide attempters with suicidal ideation had higher incidence of psychiatric disorders and a larger proportion of them were the depression and anxiety disorders. One of the characteristics of the suicide attempters without suicidal ideation was impulsive.