15～24岁人群自杀特征及危险因素的病例对照研究

The characteristics and risk factors for suicides with 15-24 years of age: a case-control study

目的了解全国15～24岁自杀死亡者的特征,并通过与其他伤害死亡案例的比较了解青年自杀的危险因素。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15～24岁的88例自杀案例(自杀组)和76例其他伤害死亡案例(对照组)的家属和周围知情人进行深入调查。结果(1)自杀组的平均受教育年限为(6.2±3.2)年,59%为女性,88%居住在乡村,82%服毒或服药自杀,26%为现婚,76%自杀前一直在工作或学习,26%有自杀未遂既往史,14%有血缘关系的人曾有自杀行为,31%朋友或熟人有过自杀行为,50%自杀当时有精神疾病,18%曾因心理问题寻求过帮助。(2)有既往自杀未遂史(经单因素分析)、自杀前2周有抑郁症状、自杀当时急性应激强度大和自杀前1个月生命质量低(后3项经多因素logistic回归分析)是自杀的危险因素。结论15～24岁自杀死亡者中50%有精神疾病,仅极少数自杀死亡者曾因心理问题寻求帮助。自杀未遂既往史、近2周有抑郁症状、经历急性负性生活事件和近1个月生命质量低为青年自杀死亡的主要危险因素。

Objective To describe the characteristics of suicides with 15-24 years of age in a national sample and identify risk factors for suicide in comparison with a control group died of injuries. Methods According to the death reports from 23 geographically representative disease surveillance points around the country, the psychiatrists used the psychological autopsy method to interviewed the family members and associates of 88 suicides （cases） and 76 injury deaths （controls） with 15-24 years of age. Results The 88 suicides had a mean of 6 years of education; 59% were women, 88% lived in rural villages, 26% were currently married, 76% had been actively employed or a student prior to the death, 26% had a previous suicide attempt, 14% had a family member with suicidal behavior, 31% had other associates with suicidal behavior, 82% ingested poisons, 50% had a mental illness at the time of death, and 18% had previously sought help for psychological problems. Multivariate logistic regression analysis showed that the previous suicide attempt, depressive mood in the prior two weeks, acute stress at the time of suicide, and low quality of life in the prior month were risk factors for suicide. Conclusion We urgently need to develop, implement and test preventive steps targeted at the risk factors for youth suicide, such as large-scale screening programs for the early recognition and treatment of depressive symptoms in youth, increasing their coping strategies and tolerance for acute stressors, and improving their quality of life.