新近出院精神分裂症患者自杀行为相关因素分析

Risk of suicide behavior in schizophrenic patients recently discharged from first time hospitalization:the influence of demographic,clinical,social and psychological factors

目的探讨新近出院精神分裂症自杀行为的相关社会心理因素。方法首次住院后出院一年半的95例精神分裂症患者,自我报告有自杀观念和自杀未遂者26例为研究组,其余作为对照组,比较社会人口学、住院病史、Beck抑郁量表(BD I)、家庭环境量表(FES)亲密度和矛盾性分因子、大体评定量表(GAS)和社会功能缺陷筛选量表(SDSS)调查。结果总体样本年龄为(34.15±11.99)岁,其中约1/4者出现过自杀观念和自杀未遂等自杀行为,研究组和对照组在社会人口学特征、主要精神症状、住院日程、目前药物治疗情况、GAS和SDSS没有显著性差异;与对照组相比,研究组因病停职和出院疗效“显著进步”的比例高、家庭环境亲密度低、矛盾性高、抑郁程度高,有统计学显著性差异;抑郁和亲密度呈负相关、和矛盾性及SDSS的第10项呈正相关;抑郁程度高,自杀行为发生的风险增加4.417倍。结论对于病情恢复良好、处于病程早期阶段的年轻精神分裂症出院患者的自杀预防,需要密切关注患者的社会功能状态。

Objective： To investigate the demographic, clinical, social and psychological risk factors associated with suicidal behavior in recently discharged schizophrenic patients. Methods： 95 schizophrenic patients within 18 months of discharge from first - time hospitalization divided into study group as self - report having suicide ideation and attempted suicide and control group were assessed for a range of demographic, clinical（ including BDI and GAS） ,social and psychological measures. Results：The age in the sample of which approximately 1/4 self reported suicide ideation and attempted suicide was （34. 15 ± 11.9）9 years old. No significant differences were found with regard to most of demographic characteristics, main psychotic symptoms, duration of hospitalization stay, doses of main antipsychotic drugs, GAS and SDSS. Compared with the control group, the study group showed higher proportion of unemployment due to illness and ＂significantly improved＂ rates at the time of discharge from in- hospitalization ,less cohesion and more conflicts in the family members, and suffered more severer depression which of statistical significance. The score of Beck Depression Inventory （BDI） is significantly related to the score of cohesion and conflicts in the Family Environment Scale （FES） and the 10th item of SDSS. Severer depression （ OR = 4. 417 ） increased risk. Conclusion： Suicide behavior in young schizophrenia patients recently discharged from first time in-hospitalization with better clinical improvement is significantly associated with depression, adverse family environment and some social dysfunction. To reduce risk of suicide, these factors need to be assessed and measures are taken to reduce their influence.