广州市精神病医院50年住院病人自杀危险因素的病例对照研究

A Case-Control Study of Suicide among Psychiatric Inpatients in the Guangzhou Psychiatric Hospital

目的:识别精神分裂症住院病人自杀的潜在危险因素,为探讨如何进一步预防住院精神病人的自杀提供依据。方法:对广州市精神病医院1956-2005年住院精神病人自杀进行回顾性分析,并对其中的精神分裂症病人按同性别、同诊断、相同或相近年龄、住院进行1:1匹配的病例对照研究。结果:共有77例住院精神病人发生自杀,自杀发生率为133.1/10万(95%CI103.4-162.85/10万)。多数自杀者为精神分裂症病人(64例,占83.1%),多数自杀者采取自缢的方式(59例,占76.6%),多数病人的自杀行为发生在病房内(52例,占67.5%);自杀组的住院次数明显高于对照组(2.13±1.89/1.23±0.75,P=0.001);自杀组本次住院前1月及住院期间的自杀未遂次数明显高于对照组(0.39±0.85/0.09±0.39,0.59±1.52/0.00±0.00,P=0.017,0.003)。自杀组有罪恶观念、心境抑郁者多于对照组(18.8%/3.1%,28.1%/6.3%,P=0.006,0.004);住院精神分裂症病人的罪恶观念、心境抑郁、本次住院前1月有自杀意念和自杀未遂是其自杀行为发生的危险因素(β=2.407、1.566、1.201、1.643)。结论:该院50年住院病人的自杀发生率与国外近似,精神分裂症病人自杀的危险因素是罪恶观念、心境抑郁、住院前1月自杀意念和自杀未遂。

Objective： To identify potential risk factors of suicide among schizophrenic inpatients, in order to provide basis of how to prevent suicide in psychiatric inpatients. Method： A retrospective analysis among inpatients with mental disorders in Guangzhou psychiatric hospital from 1956 to 2005, the first psychiatric hospital, in China. Using a case-control design, sixty four schizophrenic inpatients （ suicide group） who committed suicide in psychiatric hospital and the same number of randomly selected control subjects （ control group） who had no incident of suicide were selected and their psychiatric records were compared. Results： The rate of suicide was 133.1 （ 95% CI 103.4 - 62. 9） per 100 000 admissions. Sixty four cases （83.1%） were diagnosed as schizophrenia, fifty nine （76. 6% ） were hung by themselves, and fifty two （67. 5% ） happened in wards. The numbers of hospitalization and the suicide attempts before and duration of hospitalization were significantly higher in suicide group than that in control group （ P = 0. 001, 0. 017, 0. 003）, and guilty thoughts, depressive mood were significantly higher in suicide group than that in control group （ P = 0. 006, 0. 004） . Both suicidal ideation and suicide attempts one month before and during hospitalization were significantly higher in suicide group than that in control group （ P 〈 0. 01 ） . In conditional logistic regression analyses, guilty thoughts, depressive mood, suicidal ideation, and suicide attempts were identified as independent predictors of suicide with schizophrenic inpatients. Conclusion： The findings of risk factors for suicide should be taken into account when developing interventions to improve outcomes among in-patients in psychiatric hospital.