综合医院自杀未遂者精神障碍和自杀意念强度特征

Characteristics of mental disorders and strength of suicidal ideation in suicide attempters in general hospitals.

目的探讨自杀未遂者精神障碍和自杀意念强度特征,为自杀未遂的心理危机干预策略提供参考。方法在沈阳市4所三级综合医院急诊室同一时段内收集到资料完整的239例自杀未遂者,以贝克自杀意念量表(BSS)评估自杀意念及其强度,以汉密尔顿抑郁量表(HAMD)评定自杀前1周的抑郁程度。精神障碍诊断标准按照美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)。结果①自杀未遂者总的精神障碍发生率为69.46%(166/239),前3位依次为:心境障碍47.70%(114/239),焦虑障碍38.91%(93/239),精神病性障碍8.37%(20/239);②有自杀意念的自杀未遂组总的精神障碍发生率为84.34%(140/166),其中心境障碍和焦虑障碍的发生率分别为61.45%(102/166)和48.19%(80/166),均明显高于从无自杀意念组(P<0.01);HAMD总分以及其中焦虑/躯体化、体重减轻、认知障碍、日夜变化、迟缓、睡眠障碍、绝望感等因子中的项目得分明显高于从无自杀意念组(P<0.01);③在有自杀意念的自杀未遂患者中,有精神障碍组BSS中13个条目的自杀意念强度较无精神障碍组高(经秩和检验,P<0.05)。结论自杀未遂者中以精神障碍患者居多,且有自杀意念并伴精神障碍的自杀未遂者其自杀意念严重程度更重。

Objective To explore characteristics of mental disorders and strength of suicidal ideation among suicide attempters as a first step in psychological crisis intervention strategies.Methods Two hundred thirty nine suicide attempters from emergency department of 4 tertiary general hospitals in Shenyang were interviewed.They were assessed using questionnaires on Beck,Scale for suicide ideation（BSS） and Hamilton depression rating scale for depression（HAMD-24 items）,and diagnosed based on DSM-Ⅳ criteria.Results The total prevalence of mental disorders of 239 suicide attempters was 69.46%.The top three were mood disorders（47.70%）,anxiety disorders（38.91%） and psychiatric disorders（8.37%）.The prevalence of mental disorders in suicide attempters with suicidal ideation group was 84.34%.Among them,the prevalence of mood and anxiety disorders were 61.45% and 48.19% respectively,which were significantly higher than those without suicidal ideation group（P0.01）.The HAMD total score and the scores of items on its factors in anxiety/somatization,weight loss,cognitive dysfunction,diurnal variation,blocking,sleep disturbance and hopelessness of suicide attempters with suicidal ideation group were significantly higher than those without suicidal ideation group,respectively（P0.01）.Moreover,among the suicide attempters with suicidal ideation,those who with mental disorders had higher strength of suicidal ideation than those without suicidal ideation（P0.05）.Conclusions The majority of suicide attempters have mental disorders.Among those who with suicidal ideation and current mental disorders,their strength of suicide intension is much stronger.