有严重躯体疾病老年自杀死亡者的特征及其有无精神障碍者间的比较

Characteristics of elderly suicide completers with serious physical illnesses and comparison of those with and without mental disorders

目的了解有严重躯体疾病的老年自杀死亡者的特征并比较有无精神障碍者特征的异同。方法由精神科医师运用心理解剖方法对全国23个疾病监测点上报的≥55岁的304例自杀案例的家属和周围知情人进行调查,分析其中178例(58.6%)报告自杀死亡前1年内有严重躯体疾病者的自杀特征。结果178例自杀死亡者中,女性占41.6%;79.2%居住在乡村;58.4%从未上过学;38.8%丧偶;25.8%有自杀未遂既往史;10.7%一级血缘亲属有自杀行为;43.3%服农药或鼠药自杀,32.6%上吊;68.0%自杀当时有精神障碍,主要是重性抑郁障碍;仅5.1%自杀当时有人在场。有、无精神障碍者在社会人口经济学特征、有无自杀未遂史和自杀行为家族史、负性生活事件导致的慢性心理压力和急性应激强度以及自杀前一个月的生命质量等方面的差异无统计学意义(P均大于0.05)。结论有严重躯体疾病老年人自杀死亡最常见的两种方式是服毒和上吊,2/3有精神障碍,但有无精神障碍者的自杀相关特征无明显不同。

Objective Describe the characteristics of elderly suicides who had serious medical illnesses at the time of death and compare those with and without a concurrent mental illness. Methods Psychiatrists conducted independent, psychological autopsy interviews with family members and associates of 304 suicides 〉 55 years of age from 23 geographically representative disease surveillance points from around China. Among them, 178 （58.6%） had a serious medical illness in the year prior to suicide. Results Among these 178 suicides the mean （sd） age was 70 （9） years; 41.6% were women; 79.2% were from rural villages; 58.4% had never attended school; 38.8% were widowed; 25.8% had made a prior suicide attempt; 10. 7% had a family history of suicidal behavior in first-degree relatives; 43.3% ingested pesticides or rodenticides, 32.6% hung themselves; 68.0% had a diagnosable mental illness at the time of the suicide, primarily major depressive disorder; and in 5. 1% the suicidal behavior occurred in the presence of someone else. There were no statistically significant differences between those with and without a mental illness in terms of social, demographic and economic status, prior suicide attempt, family history of suicidal behavior, acute and chronic stress due to negative life events, and quality of life in the month prior to suicide （all Ps 〉 0. 05）. Conclusions The most frequent methods of suicide among elderly suicide with a serious physical illness are ingesting poisons and hanging; two-thirds of them had a mental disorder. Socioeconomic characteristics and negative life experiences of elder suicides in China with a physical illness, do not distinguish those with and without a mental illness.