浏阳市农村重性抑郁发作患者自杀意念与自杀未遂及影响因素分析

Prevalence and Related Factors of Suicidal Ideation and Attempts in Patients with Major Depressive Episode in Rural Community of Liuyang City

目的:探讨农村社区重性抑郁发作患者中自杀意念与自杀未遂的阳性率及其影响因素。方法:采用分层多级随机抽样方法调查浏阳市≥15岁农村常居居民7347人,以定式临床检查(Structured ClinicalInterview-I/P,SCID-I/P)为诊断工具进行了抑郁症的筛查及诊断,共发现并确诊重性抑郁发作患者234人,均符合美国精神障碍分类诊断标准(DSM-IV),调查其社会人口学资料及相关危险因素情况。结果:自杀意念与自杀未遂总阳性率达37.2%,女性高于男性(40.5%vs.31.4%,χ2=10.375,P=0.035)。再婚、离异和丧偶者阳性率高于未婚或初婚者(50.0%vs.34.0%,Z=2.577,P=0.010)。抑郁症的其他症状表现也与自杀意念和自杀未遂有关。多元logistic回归分析结果提示婚姻状况为再婚、离异或丧偶(OR=1.803,95%CI:1.220～2.532)和无价值感或自罪感症状阳性者(OR=2.056,95%CI:1.139～3.711)自杀意念和自杀未遂发生率较高,兴趣或愉快感缺失症状阳性与自杀意念和自杀未遂呈负相关(OR=0.397,95%CI:0.185～0.851)。结论:重性抑郁发作患者的自杀意念与自杀未遂阳性率较高,性别和婚姻状况对自杀意念与自杀未遂有影响,抑郁症的其他症状表现如无价值感或自罪感和自杀意念和兴趣或愉快感缺失也与自杀未遂有密切关系。

Objective： To evaluate the prevalence rate of suicidal ideation and attempts in patients with major depressive episode in rural community, and to explore its related factors. Methods： A stratified multistage random sampling was conducted and 7347 rural usual residents of Liuyang aged ≥ 15 years were investigated. The Structured Clinical Interview （ SCID-I/P） was used to assess major depressive episode （ MDE） according to Diagnostic and Statistical Manual of Mental Disorders （ DSM-IV ） criteria. Totally 234 patients with MDE were diagnosed and investigated for social and demographic characteristics and other related factors. Results： 37.2% patients had the symptoms of suicidal ideation and attempts, and females were significantly higher than males （ 40.5 % vs. 31.4%, X^2 = 10. 375, P = 0. 035 ） . The prevalence of suicidal ideation and attempts in patients in astable marriage status （ deuterogamy, divorce or loss of spouse） was, significantly higher than normal marriage status （ singlehood or primary marriage,） by Mann-Whitney Test （50.0% vs. 34.0%, Z =2.577, P =0.010） . Other symptoms of MDE were also related to suicidal ideation and attempts. The results of multiple logistic regression analysis showed that patients in marital status of deuterogamy, divorce or loss of spouse （ OR = 1. 803, 95% CI： 1. 220 -2. 532 ） and patients felt valueless or self guilty （ OR = 2. 056, 95% CI： 1. 139 - 3.711 ） had more suicidal ideation and attempts, and patients with symptoms of loss of interest or happiness had less suicidal ideation and attempts （ OR = 0. 397, 95% CI： 0. 185 -0. 851 ） . Conclusion： Patients with MDE have a higher prevalence rate of suicidal ideation and attempts. Sex and marital status have significant influences on suicidal ideation and attempts, and other symptoms of MDE such as valueless or self guilty and loss of interest or happiness are also significantly related to suicidal ideation and attempts.